Although training routes are expanding, the NHS will have to make sure that it doesn’t just happen in richer areas.
Over the past decade, the NHS has expanded the routes available for its clinical support staff, such as healthcare assistants and nursing auxiliaries, to train for and progress into registered roles, such as nursing or physiotherapy.
New research from the Institute for Fiscal Studies looking at the NHS in England finds that 16% of the new nursing cohort in 2024 were recruited from a clinical support role in the NHS, compared with just 4% in 2014.
The expansion in new routes for support staff to progress reflects efforts to fill workforce gaps, improve retention and position the NHS as a force for social mobility. The recent 10 Year Health Plan committed to using training pathways to improve local prosperity, with a focus on individuals from the most deprived communities.
“New pathways into registered roles are a valuable way for NHS trusts to attract and retain staff, and often result in training opportunities that would not have otherwise been available,” said Olly Harvey-Rich, a research economist at IFS and an author of the report.
Speed is needed
Yet so far, occupational transitions have been much more common in regions with higher wages elsewhere in the local labour market, as well as in mental health trusts. For example, in 2023, clinical support staff working in the South East were twice as likely to move into registered roles in the NHS as those working in the North East. One likely explanation is that some of these trusts find it more difficult to recruit, and so have a stronger incentive to train staff in-house.
The research argues that if this government wishes to use apprenticeships and other training for support staff as a tool for social mobility, it will need to ensure all trusts have both the resources and the incentives to provide these opportunities.
This is needed sooner rather than later. Increasing rates of transition are set to continue for at least the next few years, as many staff are still in training. More than 1,000 existing NHS staff members started a nursing degree apprenticeship in 2024, up from just over 300 in 2019.
“As the NHS drafts its new ten-year workforce plan, it should therefore be clear about what it wants these pathways to achieve. There will likely be a trade-off between designing incentives that target areas with workforce shortages and achieving broader social objectives such as reducing regional inequalities,” said Harvey-Rich.
