6 July 2023
On Friday 30 June, NHS England published the NHS Long Term Workforce Plan. The plan aims to model NHS workforce demand and supply over a 15-year period and estimate the resulting shortfall. It sets out steps to close this shortfall and address the changing needs of people over the next 15 years.
Following the results of our recruitment survey earlier this year, which identified a vacancy rate of 25% in speech and language therapy services in England, we have been lobbying to ensure the needs of the profession are recognised, so we are glad to see the NHS Long Term Workforce Plan includes speech and language therapy as one of the professions that will face an increasing shortfall over the next 15 years if action isn’t taken.
The plan includes the following ambitions which are relevant to the speech and language therapy profession:
- Student numbers: Increase AHP training places by 25% by 2031/32, with associated reforms to training and placements and student expenses on placement.
- Apprenticeships: NHS England to better support employers with the cost of employing an apprentice and an ambition that 5% of entrants to the speech and language therapy workforce to join via an apprenticeship route by 2031/32.
- Prevention and proactive care: Grow the number and proportion of NHS staff working in mental health (including increased approved clinicians), primary and community care to enable the service ambition to deliver more preventative and proactive care across the NHS.
- Expand consultant, enhanced, advanced and associate roles: This includes increasing the number of advanced practitioners and independent prescribers, and AHPs acting as senior decision-makers in appropriate settings. It also offers opportunities for the profession to shape new roles to support demand and capacity.
- CPD: Ongoing national funding for continuing professional development for AHPs. Focus on skills in digital, mental health, public health, personalised care, health for older people, compassionate leadership and need for additional specialist training in gender dysphoria all very relevant. Recognition of the link between CPD and retention. Consideration of career planning and development opportunities at key stages.
- ICS role: A role for ICSs in integrated career pathways between health and social care, and also longer term planning for education and training.
- Support workers: Developing skills and specialist knowledge of healthcare support workers and to help address specific workforce shortfalls.
More detail needed
We welcome many of these ambitions, including those which aim to address the shortage of speech and language therapists. However, more detail and clarity is needed on some of the plans and assumptions:
- The plan makes the assumption that a significant part of the shortfall can be addressed by improving retention within the NHS, and developing skills mix. Without action in these areas, it will be impossible to reduce the staffing shortfalls in the way the plan has projected.
- Clarity around how the proposed funding for education and training places will be distributed, including how will it reach allied health professions and speech and language therapy specifically.
- We think that apprenticeships can play a much a much larger role than 5% of the student intake, current intake levels will reach about 5% by the end of this year.
- Care taken in assumptions about how many speech and language therapists will be available to the NHS; as the plan recognises, many clinicians work outside the NHS.
- Role of ICSs in addressing future local training needs: this is welcome, but as funding for AHP faculties is being removed, how will this be achieved in practice?
More still to do
- SLT shortfall: while the recognition of a 2-5% shortfall in the NHS SLT workforce is welcome we do not believe the actions planned are sufficient to address it, combined with the current 25% vacancy rate across the whole profession. An extra 2100FTE SLTs in the NHS by 2036/37 will not be sufficient to meet expected demand in our view.
- SLT availability in the NHS: we want to see the Government make a full commitment to the continuing provision of speech and language therapy in the NHS to those who need it and end the current postcode lottery of provision. That is everyone from children who need help with language development to the elderly who need help with swallowing. From the current position of 25% vacancies in the profession everything in this plan and more is required.
- Demand and unmet need: the assumption made that current demand is represented by the number of substantive staff and existing delivery plans fails to address the current unmet need we know exists in SLT, both pre-pandemic and resulting from it. Neither does it address future growth from new roles in mental health and justice, or future unmet need, despite the commitments the plan contains to address health inequalities and prevention. Any future modelling must take this into account if we are to improve access to speech and language therapy for people who need it.
- Equality, diversity and inclusion: we welcome the ongoing commitment to address the negative experiences and lived experience of protected and under-represented groups in the NHS workforce, but are concerned about the piecemeal nature of activity across England.
- Support for today’s workforce: while recognising that this is a long term plan urgent action is needed to support speech and language therapy services as they struggle with 25% vacancy levels now.
The RCSLT has this week launched our second vacancies survey to ensure we continue to monitor the pressures facing the SLT workforce.
We are encouraged that the plan represents a new iterative approach to NHS workforce planning, and that NHS England commits to working with partners including NHS staff and royal colleges, to implement and build on the actions and ambitions set out. We stand ready to work with NHS England, our members and other stakeholders to support the refinement of the plans and ensure the ambitions become reality.