Grow your own – an idea whose time has come (again)

Richard Griffin MBE is Visiting Senior Research Fellow, King’s Business School. (869 words)

Back in 2010 I produced a paper for the Department of Health with the snappy title of Widening Participation Into Pre-registration Nursing Degree Programmes. Nursing was becoming an all degree profession and there was a concern at the time that this might narrow the pool of future recruits as vocational routes were closed. The document mapped pathways up to and into pre-registration degrees for existing support staff, including via the then current version of apprenticeships. It also set out the wider benefits of a “Grow Your Own” (GYO) approach to workforce development and recruitment. These included, not only securing future labour supply, but also helping ensure that the NHS workforce better reflected its local population, supporting diversity and reducing turnover.

Fast forward a decade and I’m having a conversation with an NHS Trust who had hoped to recruit from their existing support staff on to a degree apprenticeship. There is no shortage of candidates, but it appears the step up from support role to a pre-registration degree is too large for staff and the Trust is unable to recruit. The 2010 paper, which I repeated for Camilla Cavendish’s review three years later, made the point that GYO needs to be “end-to-end”, starting even before employment begins and delivering investment in the formal education of support staff at every level, creating clear pathways to mobilise what we called back then, the NHS “skills escalator”. GYO seeks to create progression steps creating horizontal and verticals career routes, avoiding the “gap” problem experienced by the Trust I was talking to.

Not least due to the rising levels of unemployment being caused by the wider impact of COVID-19 on the economy, GYO workforce strategies are, I would argue, more important now than ever.

GYO has two aspects.

The first, which could be called “outside/in”, engages with schools, colleges, hospital volunteers and local labour markets (including the unemployed and those who experience barriers to employment, such as people with disabilities) to attract local people into employment. The second element is “inside/up” providing staff with clear pathways and development opportunities from entry level up and into pre-registration. Together these allow the NHS to act as an “anchor institute” in local communities.

Whilst the two are distinct they need to be linked. Too often in the NHS workforce strategies are not. This means worthy initiatives, whilst valuable in themselves (such as new roles like the Nursing Associates), are implemented in siloes creating unintended consequences for other roles (like Assistant Practitioners) and training (such as the distribution of the apprenticeship levy), as well as shining a light on wider barriers, such as functional skills attainment, that in a GYO approach would have resolved. National policy further highlights the lack of an end-to-end approach that characterises healthcare policy. As we pointed out in our Fair Care Work report it makes no sense, for example, that 40% of the NHS workforce has no access to CPD funding. GYO requires development opportunities and funding at every level.

Whilst there are welcome signs in areas such as maternity, that a more comprehensive approach to workforce development is emerging, these remain, in the words of someone I interviewed a couple of years ago, “islands of excellence”. The NHS could learn much from Australia where healthcare GYO workforce strategies are mainstream and engagement with colleges, for example, is second nature to employers (something that is not the case in England as the recent NHS Confederation/Future College Commission report highlights).

There is a history in the NHS of the same interventions being used again and again to address its long-standing workforce challenges: international recruitment, return to practice, reducing attrition on pre-registration degrees, supporting the newly qualified and so on. The results of these have been mixed. What has not been comprehensively introduced and supported are GYO strategies; strategies that would see the NHS looking outwards into local employment system for recruitment and inwards to its existing support staff to build capacity and capability, working with local partners like councils and colleges. This is an approach being adopted by one Integrated Care System (ICS) I work with (The North West London Health and Care Partnership) which we call “partnerships and pathways”. GYO is particularly suited to systems working [1]. GYO should also be prioritised because the NHS and social care are currently one of the few employment growth sectors in England. GYO will be vital to rebuild community wealth and inclusive growth.

The first iteration of the NHS People Plan published last year pointed to the importance of widening recruitment routes. The version published this year said (p.43):

Employers must increase their recruitment to roles such as clinical support workers and, in doing so, highlight the importance of these roles for patients and other healthcare workers as well as potential career pathways to other registered roles.

The final part of the Plan due next year will hopefully more explicitly articulate the need for a comprehensive GYO strategy. Victor Hugo said, “Nothing else in the world…is so powerful as an idea whose time has come.” Let’s hope he was right. I think the time has come for GYO once more.

Richard Griffin MBE is Visiting Senior Research Fellow, King’s Business School.


[1] Examples of this approach are summarised in: