Apprenticeships: grow your own

The NHS has a workforce problem. Despite overall staff rising in recent years, problems persist in some areas – both geographically and in particular staff roles. There are still 34,000 nursing vacancies, according to NHS Digital, and spending on temporary staff remains high, although there has been some success in attempts to curb it.

With unemployment low, the government’s commitment to increasing pay has been welcomed by staff and employers. However, exiting the European Union could have an impact on a valuable source of workers.

One way of counteracting these problems could be for the NHS to recruit and train its own staff using apprenticeship schemes.

The NHS is a well-established training body, particularly in clinical roles. It has used apprenticeships in the past, but the introduction of the apprenticeship levy last year has given an additional financial incentive to get the workers it badly needs.

NHS apprenticeships range from support roles, such as catering, accountancy and general management, through to front-line clinical positions, including a nursing degree apprenticeship.

While there is opportunity, there is also a challenge to scale up the support for taking in more apprentices. NHS employers who wish to become training bodies, rather than outsourcing the off-the-job training to established providers, will have to recruit trainers and assessors and provide accommodation for classes.

Apprenticeships cannot be seen as a silver bullet for all NHS recruitment difficulties – it is understood that when the levy was introduced, around 500,000 of the health service’s employees (about 42%) were in roles for which no apprenticeship was available.

The levy amounts to 0.5% of the pay bill of all employers that spend more than £3m a year on salaries. That means many NHS organisations are affected, with some facing paying millions of pounds every year towards the levy. Estimates put the total NHS levy at £200m a year.

The levy is paid each month, based on the pay bill, and is sent to HM Revenue and Customs through the PAYE process. The funds – plus a 10% government top-up – can then be accessed by levy-paying employers via an online account. The online account allows employers to pay training providers, though funding expires two years after it is deposited.

The levy cannot be used to pay salaries – the funds can only be spent on training and assessing apprentices.

NHS organisations will wish to get maximum value and impact from their levy spending. An HFMA survey earlier this year found that more than half of its sample of 70 NHS organisations expected to spend 25% or less of the funds they had deposited in 2017/18. Only one in eight believed they would use more than half the available funds.

Current provision

At present, there are 19 health-related apprenticeships available in the NHS, with almost 30 in development. Each apprenticeship role has been placed in one of 15 bands and spending per apprenticeship is limited to the maximum for that band.

In the past, apprenticeship funding was related to the age of the apprentice, but this has been abolished in the new system. Spending maxima currently range from £1,500 to £27,000. A level 3 assistant accountant apprenticeship is in funding band 9, with a maximum payment of £9,000, while a level 6 healthcare science practitioner degree apprenticeship attracts the maximum payment of £27,000 as it is in band 15.

It does not always follow that two apprenticeships at the same learning level will be placed in the same funding band. For example, while the assistant accountant and senior healthcare support worker apprenticeships are both at level 3, the former is in funding band 9 (£9,000 maximum spend) and the latter is in band 4 (£3,000 maximum).

Danny Mortimer (pictured), chief executive of NHS Employers, says the health service is trying to make the most of the levy. ‘The introduction of the apprenticeship levy in April 2017 has enabled the NHS to scale up its approach to embedding apprenticeships into the way that we recruit and develop talent – and significantly so,’ he says.

‘In the past 12 months, we have seen a marked increase in the range of apprenticeship standards available for healthcare-specific courses. There are now 19 health and science industry-specific apprenticeships available and 29 more in development. That’s more than double what it was when the levy was first introduced.’

He agrees that the new push on apprenticeships could play a role in securing the NHS workforce for the future. ‘The NHS has harnessed apprenticeships to enhance and develop the skills of the workforce for many years. The health service continues to be a strong supporter of apprenticeships – not just for entry-level positions, but also across the broader professional workforce. The expansion of apprenticeships is a key part of our long-term supply strategy.’

Liz Faulkner  is head of workforce transformation at Worcestershire Health and Care NHS Trust, which was recently named in the top 100 employers for apprentices by the government-backed National Apprenticeship Awards. The trust has around 70 staff on apprenticeship programmes in a range of clinical and support roles.

‘We have been trying to change the message about apprenticeships. People have preconceived views about what apprenticeships are and the age of the people who undertake them. Apprenticeships offer an on-the-job training route at a range of levels and roles across the organisation. We offer apprenticeships at levels 2 to 5 to both new and existing staff.’

The number of apprenticeship starts at the Worcestershire trust for 2017/18 is lower than previous years and there are two reasons for this, she says. First, the trust is in the process of setting up as an apprenticeship employer provider – this means it will be able to deliver apprenticeship training to its staff. ‘The real driver [for this] is quality – we will be in control of the apprenticeships, with more input into the off-the-job learning that’s relevant to the organisation and its values.

‘The development of the nursing associate role, which sits between the roles of healthcare support worker and registered nurse, is the second reason for apprenticeship starts being down as we have not been able to include our current cohort of trainee nursing associates in our apprenticeship numbers,’ she says.

In October 2017, the government announced expansion plans for the number of nursing associates, which will lead to 5,000 being trained through the apprentice route in 2018 and 7,500 in 2019 across England.

Ms Faulkner says the trust is embracing the role and is in the process of recruiting a second cohort of trainees because it offers a great opportunity for staff to progress their careers.

‘The nursing associate role will be an important part of our workforce plans. As with other parts of the NHS, we experience recruitment and retention difficulties regarding our registered nursing workforce. The trust utilises its workforce planning processes to identify gaps in our workforce and try to identify how we can use apprenticeships to develop existing or new staff to meet our workforce requirements.’

Leeds input

In the first eight months after the apprenticeship levy was introduced, Leeds Teaching Hospitals NHS Trust contributed almost £1.8m – the government top-up has brought the total available to spend to £1.96m. Over the same period, the trust paid training providers just £245,000.

However, it has plans to ramp up its apprenticeships, including those on the higher end of the apprenticeship funding bands. Between April 2017 and January 2018, 464 apprentices started at the Leeds trust – they have been employed in a range of apprentice roles, including intermediate business administration, advanced plumbing and health and fitness assistant. The biggest group was on the intermediate clinical healthcare support worker apprenticeship (229 of the 464).

Before the end of the financial year, it plans to have a further 219 new apprentices, including 71 intermediate clinical healthcare support workers.

The trust will employ its first apprentice nurses (level 6), which is in the highest funding band at £27,000. It plans to recruit 33 nurse degree apprentices to begin work in June, with a further 33 in each of the next two years.

The trust believes the levy will have a significant impact over time. It anticipates that, once qualified, the number of clinical apprentices will offset the need for future spending on bank and agency staff.

Building on its base of healthcare support worker and business administration apprenticeships, Worcestershire Health and Care NHS Trust is also looking to widen the scope of the apprenticeships it offers. A cohort of housekeeping staff are undertaking a level 2 hospitality apprenticeship, while it is also looking at delivering leadership and management apprenticeships (at levels 3-5).

During 2018/19, the trust is committed to achieving the public sector apprenticeship target of 2.3% of its workforce – equal to approximately 90 apprenticeship starters.

The trust’s apprenticeship levy amounts to around £450,000 a year. ‘We haven’t committed much apprenticeship spending at the moment, but we have built into our apprenticeship plans how we will be using more in the future,’ says Ms Faulkner. ‘The price cap on the nursing associate apprenticeship, for example, is £15,000 over two years per apprentice and the nursing degree apprenticeship is £27,000 over three to four years. You can see how we will quickly allocate more of the apprenticeship funds to support the training and development of our staff.

‘We will need to carefully manage our apprenticeship spending to maximise the benefits. I think we will get value from the levy. It’s still relatively early days, but hopefully we are moving in the right direction.’ 

Mr Mortimer acknowledges that employers face barriers in making the most of the levy they pay. ‘While employers across the NHS are expanding their apprenticeship programmes, they are facing some specific, significant challenges unique to the health sector,’ he says.

‘Unfortunately, these challenges are preventing the most effective use of the levy and hampering the ability of employers to scale up their apprenticeship offers.’

Mr Mortimer continues: ‘To help ease the impact of these challenges, and to make best use of the £200m contribution the sector makes to the levy, we at NHS Employers have three suggestions.

‘The first is for the government to allow the use of the levy to support backfill for apprenticeships that require significant supernumerary time as part of their training. The second is to extend the time within
which employers must have used their levy. Finally, employers should be enabled to access levy funds to create infrastructure to boost the scale-up of placement capacity and supervisory support.’

Although the Worcestershire trust is in the process of becoming an apprenticeship employer training provider, some apprenticeships, particularly when specialist knowledge is not available or numbers are small, would not be delivered in-house, Ms Faulkner says. Accountancy falls into this category. The trust has trained level 2 accountancy apprentices for the last two years.

Accountancy issues

However, Ms Faulkner highlights potential issues with accountancy apprenticeships where there is no mandatory qualification. Apprenticeships have been governed by frameworks, but these are being phased out and are expected to be replaced by new standards by 2020.

While the existing accountancy apprenticeship frameworks (at level 2 and 3) included links to AAT qualifications, the new level 3 standard does not include a mandatory qualification.

This creates two issues, says Ms Faulkner. First, an apprentice might reasonably expect to receive a recognised qualification at the end of the programme, but it remains to be seen whether employers will give equal weight to candidates who have completed a level 3 apprenticeship compared with, say, those with an AAT level 3 diploma. Second, since the standard does not include qualifications such as AAT and City & Guilds diplomas, the apprenticeship levy cannot be used to fund these qualifications.

Apprenticeships do not offer a complete solution to workforce issues. NHS organisations will be mindful of the challenges of ensuring they get best value from the levy – and meeting the requirements of their workforce strategy. But apprenticeships and the levy not only offer the opportunity but also the financial incentive for the NHS to address some of its workforce issues.