An urgent need to reverse disinvestment

Source: NHE March/April 2018

Danny Mortimer, chief executive of NHS Employers, asks for national action on the dwindling investment levels going into continuing professional development in the name of workforce transformation.

As anyone who’s seen the news or been near a hospital, GP practice or community or mental health teams can verify the NHS is facing huge pressures right now. Some of the most-cited reasons for the strains on the NHS – reduced investment, the perilous state of social care, an ageing population, the impact of Brexit on the workforce – are very real, and very pressing.

Staffing issues are a central challenge. A report from NHS Improvement last month showed that there are now around 100,000 vacancies in England, with one in every 11 NHS posts unfilled.

There are many reasons why NHS trusts across the country struggle to fill jobs or to retain people. There is much that employers need to take responsibility for themselves in recruiting and retaining people. But there are also national actions that are required.  

Support for investment in pay is welcome, as is the work to develop affordable housing for NHS staff. But one of the main national actions results from the drastic changes in funding for continuing professional development programmes for staff – more commonly and perhaps erroneously known as CPD. There is an urgent need for the government and ALBs to turn back this tide of disinvestment.

Health Education England (HEE), which receives funding through the Department of Health and Social Care, has provided support to trusts for the development of the existing workforce for some years, inheriting budgets from SHAs and, before them, WDCs.   

Recently, however, this funding has been reduced substantially as a consequence of the last CSR settlement. The budgets allocated to CPD have shrunk dramatically – from £190.9m in 2013-14 to just £83.5m in 2017-18. This has affected individual trusts, with some seeing their CPD budgets slashed by more than half.

Three little letters

So why are these three little letters proving such a challenge? CPD is one of the most important issues for clinical staff and one of the top reasons they give for staying with their employer or quitting. It is the mechanism by which we help our staff maintain knowledge and skills to deliver services for patients.

This investment in our people and patients is also seemingly misunderstood. It is not misspent on mandatory training, and neither is it a luxury item or one that nurses need to undertake to maintain their registration.

It is a fundamental part of how we support the day-to-day business of delivering safe care to our patients. In fact, with the pace of change, increasing these programmes ensures capability keeps up with constantly changing practices and technology. It’s not that they are just nice to have – they are essential.


Clinical staff who had embarked on degree- and masters-level programmes now face uncertainty whilst alternative sources of local funding are explored. The effect on career plans, motivation and engagement has been significant. 

This funding isn’t just about development for the next role, it’s about ensuring staff continue to have the skills to do the day job – in ITUs, neonatal units and on wards, in the community and across the system, this funding provided essential training to support patient care.

And at NHS Employers, we know full well the effects of the cuts down to the ground level. Understanding the data and key issues for staff in different groups and areas of work gives a focus to addressing causes of high turnover. 

Lack of CPD and progression was highlighted by many staff, and data indicates that 6% of turnover is caused by dissatisfaction with these issues – and as the UK’s largest employer, that’s no small figure.

Less confidence

The national staff survey doesn’t ask staff directly for their views on development funding. However, it’s clear from feedback in last year’s survey that there’s less confidence in the appraisal process being able to identify key development opportunities. 

Given that more than half of the current workforce will still be working in 2032, development opportunities are crucial to ensure safe, effective care for patients. Once again, employers are feeling the pressure to meet cost reductions imposed by external forces. 

Some employers are looking at the apprenticeship levy to see if this fund can be used to support the CPD shortfall. In some cases this has proved possible, but it’s not what the levy – currently costing the NHS upwards of £2m – was designed for. Apprenticeships support training into new roles and career progression, not development for an existing member of staff in their current role. 

NHS Employers gave evidence to the recent Health Select Committee inquiry on the nursing workforce, which called on the government to increase opportunities for nurses to access high-quality CPD. Evidence to the committee consistently highlighted that reductions in the availability of funding for CPD is a major issue contributing to nurses leaving the profession. 


The Royal College of Nursing’s evidence also raised funding for CPD as a major issue. Janet Davies, its chief executive and general secretary (who writes on p49), told the committee: “I am talking to directors of nursing all the time who are trying to get their nurses on an intensive care programme, or accident and emergency, or community providers who need someone to do the district nurse programme. There is no money for those programmes at the moment. It has been pretty much decimated.”

So what do employers want to see happening? 

No one is naïve enough to believe that additional funding can be easily identified. The pressures on HEE’s budget are well recognised, and employers are pragmatic about the need for priorities to be identified.

But in the battle to reconcile priorities, have we gone too far in funding workforce transformation at the expense of keeping the show on the road? We see this as a fundamental issue for national action – and our response to the draft Workforce Strategy will highlight this. 

HEE’s response to the select committee indicated that it now intends to increase funding for nurses’ CPD – the committee would like to see evidence of a clear plan for this, and so would employers across the health system.




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