Over the last 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. 16% of the new
nursing cohort in 2024 were recruited from a clinical support
role in the NHS, compared with around 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 Plan for the NHS committed to using training pathways to
improve ‘local prosperity', with a focus on ‘individuals from the
most deprived communities'.
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.
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.
These are among the key findings from new research, published
today by the Institute for Fiscal Studies as part of the NIHR
Policy Research Unit in Health and Social Care Workforce. Other
findings include:
- The share of clinical support workers who move into a
registered profession has doubled since 2010, with particularly
sharp rises in transitions to nursing.
- There is evidence that earlier cohorts of occupational movers
have higher retention in their new roles than
comparable staff recruited directly. However, early evidence on
more recent cohorts suggests that this pattern may not
replicate when these roles are expanded at scale.
- Increasing rates of transition are set to continue for at
least the next few years, as many staff are still in training.
Over 1,000 existing NHS staff members started a nursing
degree apprenticeship in 2024, up from just over 300 in
2019.
Olly Harvey-Rich, a Research Economist at IFS and an
author of the report, said:
‘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. But
the trusts that are keenest to offer internal staff training are
often in areas of the country that already have higher wages and
better training opportunities; trusts in more deprived areas may
find it cheaper to hire through other routes. As the NHS drafts
its new 10-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.'
ENDS
Notes to Editor
Career pathways between occupations in the English
NHS is an IFS report by Olly Harvey-Rich, Elaine Kelly
and Isabel Stockton.
