In an exclusive interview for Hospital Times, Dr Navina Evans, Chief Executive of Health Education England, explains how the pandemic has sparked new joint working across the health sector. However, she warns that we must address systemic disparities across our health and care workforce.

The question of how health and care staff are recruited, educated and trained has taken on new meaning. In turn, the role of Health Education England (HEE) has become profoundly important. The disruptive nature of Covid-19 has meant HEE has had to, in the words of its new Chief Executive Dr Navina Evans, “solve problems on the hoof”. Students were streamlined, retired clinicians called back and resource was diverted from all corners of the sector to stem the tide of the virus. However, temporary measures such as these, while successful at battling a crisis, are clearly not viable for sustainable health service delivery.

There is also the small matter of recruiting 50,000 nurses and 6000 additional primary care staff. A Government manifesto pledge that has defined much of its talking points on healthcare policy. With national targets born out of political promises, there has historically been a danger of a Government promising the world to the public and leaving an impossible task to the organisations actually responsible for delivering it. However, in this case, Navina stresses that HEE are “well on track” to deliver from an educational point of view and, in fact, are actually overachieving in the case of GPs.

Of course, education is only one part of the jigsaw, but early signs suggest that HEE are holding up its end of the bargain more than well. Not only is it well on track to meet these targets, recent data from its Education and Training survey suggests that students are experiencing healthcare education and training positively. Out of the 37,000 respondents surveyed, more than 90 per cent said that their overall clinical supervision was positive and 89 per cent of students and trainees positively rated the overall educational experience gained in placement.

This will have been music to the ears of Navina, whos background is very much one of clinical leadership and is eager to see the NHS retain its workforce. For 25 years Navina worked at East London NHS Foundation Trust (ELFT), starting as a psychiatrist, progressing to consultant, before working her way to becoming a clinical director and then becoming ELFT’s Chief Executive in August 2016. Navina moved to HEE as its full time Chief Executive in October 2020 and, despite her short tenure thus far, is overseeing major shifts in NHS workforce strategy.

The changing needs of our workforce

The process of health education, understandably, takes time. When HEE is making such arrangements on the workforce and developing new training programmes, it will be up to seven years until they see the fruits of their labour. As such, the task of predicting what workforce the NHS will need by the end of an educational cycle is a tricky one. But the pandemic has perhaps highlighted acute areas of need that were previously not as obvious.

Generalist roles, it seems, will take a more central position in workforce strategy. As Navina outlines, HEE has already been doing considerable work to advance the roles and numbers of advanced practitioners – health professionals educated to Master’s level who can take on a versatile portfolio of work – across the health sector. HEE’s Centre for Advancing Practice has been crucial in facilitating this drive towards generalist roles.

“You are always going to need highly specialised individuals,” says Navina. “But the pandemic has highlighted the need for greater versatility and adaptability within healthcare, and we must place a greater emphasis on generalist roles will help us plan for the long term.”

With so much of health policy discourse focused on use of innovation, workforce planning cannot take place without digital skillets being placed front and centre of short and long term considerations. “HEE is working closely with NHSX and the Department of Health to ensure that the principles of innovation in healthcare apply to the future health and care workforce,” says Navina, who points to a number of e-learning courses that are proving successful in enhancing the digital capacity of the NHS workforce. “Providers have to think short term, they are thinking about the next crisis, that is their job, but securing the longer-term workforce is our remit. And we need more and we need different.”

Navina is certainly not saying HEE is there to dictate what ‘different’ means. Its strategy must bear sensitivity to locality. “What is required in Northumberland will be different to Devon, to London to Kent, etc,” she says. “HEE will work closely with providers to understand differing service designs and models. We are in a unique position, we act as a convener between a host of organisations and educational institutions, and we can use our extensive connections to bring people together to bring together people under a common purpose of driving improvements in health education and training.”

Addressing the frank questions

Covid-19 has ruthlessly exposed shortfalls in how the NHS protects its staff, both from a physical and mental health point of view. Arm’s-length bodies, regulators as well as providers have come under increasing pressure to ensure better protection. After relentless waves of coronavirus, burnout is an increasing concern across the health sector.

This is just as relevant to HEE’s own staff, and Navina’s initial focus has been in ensuring that the principles of staff wellbeing are prioritised. “You’ve got to have your own house in order first,” she stresses.

With students and trainees called in from all corners of the sector to help fight repeated waves of coronavirus, HEE has the responsibility to help ensure they take positive lessons from their expereince and that disruption to their educational calendar has a minimal effect on their future careers. The organisation must find ways to resume their training so that they will fulfil their aspirations. This is crucial for NHS recovery from the pandemic and for the objectives of the Long Term Plan to be fulfilled.

“We may have to run double programmes for people to catch up on what they have missed,” says Navina, who will increasingly look to foster closer ties to the various Royal colleges and to develop new ways to maintain and even enhance learning.

Facing “uncomfortable” truths

We cannot expect interest in applying for healthcare work to continue to increase while we do not care for frontline staff. Navina wants us to “face up to the uncomfortable truths” that Covid-19 has ruthlessly exposed.

The latest NHS staff survey found that more than two in five health workers are feeling unwell because of work-related stress. More than a third are considering leaving. The survey has also compounded issues of racial inequality and bias from health and care leadership, with black, Asian and minority ethnic (BAME) respondents “more likely” to have worked on Covid-19 wards than white colleagues. This is concerning, following findings from the British Medical Journal last year that showed that the vast majority of frontline staff who have died from Covid have been from an ethnic minority background.

“It does not make for good reading,” says Navina. “In some areas we have gone backwards.” Although disappointed, Navina is not surprised by the findings: “This is nothing new. Covid-19 has merely lifted the lid and forced us to face uncomfortable truths about racial discrimination in the health service and, indeed, in wider society. These are findings that some experts have been telling us for years.

“We have to face the fact that we have not made as much progress as we thought.”

Navina, the first Asian woman to lead HEE, sees the task as correcting racial inequality as a far greater task than merely the box-ticking exercise some leaders have been guilty of relegating it to. “It’s great that HEE have appointed an Asian woman, but just because I am here, doesn’t change anything,” she adds.

Diversifying leadership would be start; repeated studies have shown diverse leaderships to perform better. “Even if you cast aside the ethical and moral duty to ensure fair representation, there is a strong business case in favour of diversity,” says Navina.

Gender imbalances must also be corrected, Navina stresses. Increased flexible working, she says, could provide part of the solution. “Many women in HEE, for instance, who have had children may previously not have been able to come back to work, with the shift towards flexible working, there are now new opportunities to maintain a career as well as raising a family.”

In response to these challenges, HEE is working closely with other bodies, such as the GMC, to widen participation across race, gender, and disability, as well as developing workstreams to improve changes of career progression and differential attainment. Navina is seeking to plug HEE closer into the early careers of trainees and students to provide another outlet, should they experience discrimination in the workplace. She also wants to be closer aligned with UK universities to ensure that that the quality of training and education that students are getting from those institutions is promoting these aims.

From challenge comes unique opportunity

Needs are changing, requirements shifting, and health challenges are developing. But in spite of this, applications to healthcare roles are increasing. People, it seems, are not being deterred from joining the heath and care workforce, despite the considerable strain under which it has found itself under in recent years.

“HEE has made considerable efforts in recruitment drives, which have of course helped boost numbers in a host of professions,” says Navina. “But the economy is such that healthcare is the one sector which is only set to expand and jobs are constantly being created, a trend unlikely to change anytime soon.

“Right now, we have a wonderful opportunity to get people with the right skillset and values to join the NHS family.”

That the health service is something close to a national “religion” has become something of a cliché, but its status within public discourse undeniably increased as the severity of the pandemic became clear – perhaps leading to tangible benefits for NHS recruitment drives. “It’s more work for us, but it’s a problem we want to have.”