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How can we improve access to healthcare careers?
Last updated on Friday 16 Feb 2024 at 9:42am
Many young people are motivated by a career in healthcare but are being put off. Emma Dodsworth from the Nuffield Trust explains why young people aren’t going into healthcare degrees and how the NHS, education leaders and the government can work together to deliver the NHS workforce of the future.
Expanding the supply of homegrown healthcare workers is central to the ambitions of the NHS long-term workforce plan in England – including doubling medical school places and, overall, around a two-thirds increases across nursing and other clinical training places by 2031–32.
Recent trends are concerning however, as the numbers of nursing applicants to English universities fell by around a third in the last three years, and acceptances by almost a fifth in the last two years to 2023.
A new survey commissioned by Universities UK of over 5,000 people aged 16 to 26 sheds important light on the motivations to, and barriers against, pursuing healthcare careers. The results are striking: there is significant, although not universal, interest in these careers. But there are still considerable problems around the perceptions of both the training pathway and roles themselves.
Interest in a healthcare career
It is positive to see that almost three in four young people are considering or have considered a career in healthcare (73%). However, one in eight respondents were unfamiliar with the variety of career options within the NHS beyond becoming a nurse or doctor.
Many young people spoke of altruistic motivations for pursuing a healthcare career, with respondents saying improving the lives of others (46%) and having a rewarding career (40%) are the most important factors.
Many young people spoke of altruistic motivations for pursuing a healthcare career, with respondents saying improving the lives of others (46%) and having a rewarding career (40%) are the most important factors.
Interest in healthcare careers varied across the UK, with the highest proportion of young people considering healthcare careers in Scotland (79%) and Greater London (77%) while the lowest figure was in Wales (66%) (Figure 1).
There is significant and complex variation in interest based on a young person’s background. Those eligible for free school meals were more likely than other young people to consider a career in healthcare (by 8 percentage points).
But respondents where neither parent was university educated were less likely (by 9 percentage points).
Interest in studying midwifery is particularly associated with these socio-economic factors, as those eligible for free school meals or whose parents were not university educated are more likely to be interested. However, of those respondents who are young parents, substantially fewer expressed an interest in studying medicine (Figure 2).
The Nuffield Trust has previously highlighted the clear moral and legal cases for the NHS to increase the diversity and inclusivity of its workforce. There is evidence of other benefits too, including better quality of care for patients. Certainly, given the vast planned expansion of the domestic clinical training pipeline, the NHS needs to promote positive perceptions of careers to young people from all backgrounds.
Perceptions of healthcare careers
Low pay was the most frequently raised issue that would put students off embarking on a healthcare career, cited by nine in ten (90%) respondents (Figure 3). Other common reasons were lack of flexibility or work-life balance (82%), and pressure or stress (79%).
Low pay was the most frequently raised issue that would put students off embarking on a healthcare career, cited by nine in ten (90%) respondents (Figure 3). Other common reasons were lack of flexibility or work-life balance (82%), and pressure or stress (79%).
While undoubtedly the NHS has the potential to deliver fulfilling careers, these concerns are also echoed by those leaving their roles. For example, a survey of UK nurses departing the profession found that their physical or mental health and burnout or exhaustion were the top two reasons for leaving, behind retirement. Similarly, the number of people leaving their NHS role because of ‘work-life balance’ has tripled in the last 11 years.
Given evidence around generational changes in expectations of work, such as young people’s desire for greater flexibility and work/life balance, and the influence of media reporting on the impact of the Covid pandemic on staff wellbeing, these findings on perceptions of NHS jobs come at a crucial time. Now with sustained periods of industrial unrest over poor pay and working conditions, it is imperative that efforts are made to positively influence young people’s attitudes to healthcare careers.
Concerns around getting a degree
While respondents pointed to a range of factors that might put students off from studying a healthcare course at university, workload and financial featured strongest.
The most common factors – chosen by around one in four – were concerns over hours spent working and/or studying (28%) followed by cost of repaying a student loan after graduating (25%) and the ability to manage costs while studying (23%). Other research by the Nuffield Trust has highlighted that while the vast majority of those taking clinical courses complete their intended degree, those struggling point to a range of factors including financial and academic difficulties, as well as issues with workload and placements.
What’s the solution?
As with any complex problem, there’s rarely a simple, single solution. But given the scale of the task and the importance of delivering a sustainable clinical workforce, it’s time for bold policymaking.
For example:
- Greater flexible working rights (something the survey highlighted that was important to many young people) was agreed in 2022, but the NHS could certainly do more to embed and promote this and other positives of healthcare careers.
- The survey highlighted substantial differences in interest in, and awareness of, careers between different demographics. NHS campaigns could deliver a more universal, positive view on healthcare roles.
- Universities UK have previously set out recommendations for making healthcare education and careers more appealing, including additional wellbeing support for students and greater financial help for those studying from low-income families, among other recommendations.
- The Nuffield Trust have already called on government to seriously consider a student loan forgiveness scheme. Three in four (73%) young people said that having some or all of tuition fees written off when starting work in the NHS would make them more likely to choose to study a healthcare course at university.
