Sir David Behan, Chair of Health Education England (HEE), reflects on the way the healthcare workforce has responded to Covid-19 and what this means for the future.

Sir David Behan commands a uniquely influential voice within the health sector, having led some of its most important organisations. The one he chairs currently, Health Education England (HEE), has the mountainous task of allocating staff to overstretched health and care services across England.

HEE exists for one reason: to support the delivery of excellent healthcare by ensuring the workforce of today and tomorrow has the right numbers, skills, values and behaviours, at the right time and right place. If there were ever a right time to ensure these skills and values are secure, it is now.

HEE has had to adapt and refocus rapidly to concentrate fully on getting health and care staff to where the country needs them most. Effectively, the entire organisation has been refocused into meeting the surge in demand that Covid-19 has caused. To this end, HEE has demonstrated its leadership by examining which part of its own workforce can be released back to the frontline.

Fast tracking students

There is a vast pool of medical talent available at universities throughout the country. Part of the job for Sir David has been to ascertain the level of this talent pool that can be used and the capacity in which it can be deployed. “We have constantly examined the courses of medical students up and down the country to see where contributions can be made to the current crisis,” he said. HEE is examining the status of medical students in years one to four to find out who might be able to be released to join the workforce. “We want them to take some of their learning and apply it in practical ways.”

Third year university students have already been offered paid placements to assist in the fight against Covid-19, with over 30,000 answering the call so far. Thousands of fifth year medical students have also volunteered to come to the frontline. Sir David highlighted that provisional registration for an interim foundation year one has also been developed. Much of the questioning will be the equivalent to the interview process for a care assistant.

“These young people will largely be asked to care for people outside of the Covid-19 ward, however, there will certainly be flexibility in that,” Sir David said. “It is immensely positive to see people with varying levels of expertise volunteer their services to make a contribution to fight this crisis.”

The contribution to this effort from nursing students has been immense, over 22,000 nursing and midwife students have asked to take paid placements on the NHS frontline. Sir David pays tribute to Mark Radford, HEE’s Chief Nurse,nus tfor “tireless” work on this. Years one and two nursing students are operating as health assistants wherever possible and third year nursing students are being asked to contribute to frontline services as part of their placements. They won’t be fully registered nurses, but Sir David stresses they will be remunerated for the vital contribution they will be making.

The same goes for any other types of staff, allied health professionals (of which over 2,400 have already joined the frontline), paramedics and physician associates. The situation of any student who might have something to offer is being assessed. “It’s about identifying the level they are at and outlining the contribution they can make,” he said. Supporting and encouraging former staff has also been a key feature of HEE’s Covid-19 strategy.

In providing the resources necessary to reskill or upskill this expected influx of staff, Sir David hails the organisation’s e-learning for health as a crucial tool. This resourse, partly administered by the Academy of Medical Royal Colleges, “is allowing us to provide materials to upskill our workforce wherever they work, whether that’s in the community, end-of-life care or supporting the use of PPE equipment,” Sir David said.

The e-learning programme has been launched 420,000 different times since it was made freely available by HEE. Interestingly, Sir David notes, much of the uptake has come from countries across the world, including some African nations, demonstrating the global value and reach of HEE.

Protecting frontline heroes, old and new

We have a duty of care towards these staff, to protect them and not expose them

Sir David Behan, Chair, Health Education England

It goes without saying that for staff joining the frontline, whether they are a young student looking ahead to a long and successful career in medicine, or a retired, seasoned clinician asked to don scrubs once again, they will need support. They are not being asked to provide normal clinical support and Sir David is not one to mollify the challenges they will meet. “This is a global emergency and is quite frankly unprecedented,” Sir David said. “For all of these staff who are choosing to make a vital contribution, it is unlikely they will have ever seen anything like this in their lives.”

In partnership with NHS trusts and community health providers, HEE has a massive task at hand in balancing the desire to get numbers into the frontline workforce while simultaneously nurturing them for long-term careers in the health service. “This is not about throwing people into the deep end,” said Sir David, “this is about enabling each of them to contribute based on their valuable knowledge.

“We have a duty of care towards these staff, to protect them and not expose them.”

What does the future hold?

While HEE is mobilising resources to ensure the NHS and the wider health system has enough staff to deal with the immediate crisis, the longer term ramifications of Covid-19 cannot be ignored. Disruption to academic calendars could pose huge logistical challenges for students.

There are so many unanswered questions in the wider training pipeline surrounding when universities will reopen for students and what will happen for A-level students planning on joining medical and nursing courses from September 2020. Sir David doesn’t pretend to have all of the answers to these questions. As with elsewhere in the sector, the work of HEE is largely dictated by the trajectory and severity of the global pandemic and the uptake of intensive care provision required at that moment in time. This is something the HEE board is reviewing constantly.

“Clearly students will want to know what is going to happen with their education, that’s completely understandable. We need to think these decisions through in the context of the mobility and movement restrictions that are currently in place while paying consideration to the requirements of the health service at any particular point in time,” Sir David reflected.

A revaluation of what our workforce can offer

“The post-Covid world will be very different from the one that we previously knew,” Sir David explained. “The terms of our use of technology will change and I strongly suspect that we will not return to business as normal. Entire practices are now almost completely transferring their work to digital platforms.”

HEE is having to upskill and reskill the health and care workforce in an unprecedented way to deal with an equally unprecedented situation. As learnings are extrapolated from the experience of Covid-19, sector leaders and experts such as Sir David are being forced to re-examine exactly what we need our health and care workforce to do.

“We must establish the skills that people require and how long it takes to achieve them, not to mention the best way they can be developed. What’s the balance between learning that needs to be delivered in a classroom and learning that can be delivered online, and do we take this balanced approach forward?”

It is clear is that a re-examination of the generalist versus specialist care approach will also need to occur. “What do people need to know in order to operate effectively? What general skills can be applied?” Sir David asked. An example is where clinicians have become accustomed to working in areas such as airways management and have therefore developed new skills, as facilitated by HEE.

Of course, these questions are about systemic changes, far beyond the type of care that is delivered in acute settings, vital though they are. Sir David has a well-known background in leading social care inspector teams and currently heads the single largest care provider in the country. It is therefore unsurprising that he identifies social care as a key part of the systemic shift that the Covid-19 pandemic could ignite.

“Both the negative and positive experiences driving major changes in this space have been debated for years”. “There will be a distillation of the learning from this crisis,” Sir David said. “I believe this can help us strengthen the way that services are working together. Not just for now, but for future generations.

“Ultimately, there should be a renewed emphasis on how professionals within a system can, and should, work together.”