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The Kerslake Collection | Social purposes

NHS-university collaboration to support a place 


In November 2021, the NHS Confederation jointly published a report with the Civic University Network on reimagining the NHS-university relationship. The word ‘reimagining’ was important, signalling the need to go further than simply resuming the relationship post-pandemic, instead ensuring that place occupied a much more intentional and explicit role. Lord Kerslake’s outstanding public service across health and higher education played a leading role in stimulating this shift in mindset, and continues to be felt. In a general-election year, and with a long-term national workforce plan to deliver, leaders across both sectors are now facing challenges as to how they work together in increasingly difficult political and financial circumstances. The cultural change Lord Kerslake fostered is about to be tested like never before. In this essay, we use the totemic issue of the NHS workforce to revisit the framework of 2021, reflect on what has changed since and explore future priorities and policy. 

The NHS Long Term Workforce Plan (LTWP) is a fascinating lens through which to assess the role of place in the NHS and university relationship. It will demand attention, time and resource from operational managers and strategic leaders. Over the next 15 years, the plan commits, among many other things, to expanding domestic education and training by up to 65 per cent, increasing adult nursing training places by more than 90 per cent, trebling to 22 per cent the proportion of all training through apprenticeships, and doubling the number of medical-school training places.

Any approach to demand and supply modelling for Europe’s largest workforce will understandably be complex in design, development and delivery. The plan contains more than 200 actions, delivered through more than 60 programmes of activity across three themes (‘train’, ‘retain’ and ‘reform’) and seven key priority areas agreed with government – all supported by newly established governance structures. Irrespective of geography, scale, focus or specialism, there is a good chance this plan will touch on your local university. 

It will also point to a wider challenge for the NHS, which can be inward-looking in nature. Improvement strategies tend to focus on doing things better, rather than doing better things, with a constant struggle to think more broadly, collaboratively and over a longer horizon. Place is vital for the LTWP to be successful, but also for our health service to be sustainable and for our collective principles and ambition to be strengthened. 

A window into local practice and national policy

Workforce has been a critical challenge for the NHS for many years, so the plan received widespread support. As Amanda Pritchard, chief executive of NHS England, said on publication: ‘This is the first time that the NHS has produced a comprehensive long-term workforce plan, and it represents a once-in-a-generation opportunity to put staffing on a sustainable footing for the future.’ 

Despite this, confusion remains about how this will be funded, and the early consensus that secured the publication of the plan is in danger of splintering – with, for example, growing opposition to expanding apprenticeship routes and roles such as physician associates. There are certainly no grounds for complacency, and local discussions run the risk of becoming bogged down in operational challenges, such as placements, rather than focusing on how we can use our agency and leadership to underpin places. 

The NHS and university report: why it mattered

The timing of the 2021 joint report was significant, pointing to what many vice-chancellors and NHS chief executives felt was a critical moment in how they work together. The pandemic revealed fragilities and exclusion in local communities, and exposed the interconnected nature of the challenges institutions faced. Those areas with an element of ‘place maturity’, where leaders supported each other across sectors and worked together on a shared vision, tended to find it easier to adapt and respond.

The original report highlighted five principles for rebuilding this relationship. The opportunity now is to test and refine these principles as the sectors collectively seek to deliver on the promise of the LTWP. 

Testing out the five principles

1. Collaborate and co-develop consistently – focusing on the shared common values that bind universities and NHS organisations

A key question for any form of collaboration is: what are we committed to doing together? In this sense, as well as being a priority in itself, the LTWP provides an immediate raison d’être for local partnerships across the country to coalesce around. 

For the LTWP to succeed and generate a positive wider impact, it needs to be people-centred and place-sensitive. The former will demand multiple national strands of work, but it is the latter that will tie them together in a complementary manner, bring purpose and context, and determine whether they survive contact with reality. 

National planning is unlikely, for example, to prioritise the leadership qualities and competencies most aligned to place-based working. The current context requires people who think beyond their institution, about the communities they serve, and with the transferrable skills to engage with many sectors within a place. In a world of increasing specialisms, how are universities developing future generalist place-leader roles?

New health and care structures can help. The sector now has a much stronger spatial element in design and decision-making. Forty-two Integrated Care Systems (ICSs) became statutory organisations across England in July 2022, responsible for health and care planning across populations ranging from around 500,000 in Shropshire, Telford and Wrekin to more than three million in North East and North Cumbria, with an average annual budget of £2.7 billion. The voice of higher education needs to be heard around the ICS table in relation to workforce, of course, but vice-chancellors need to join, stretch and magnify this. While there are a range of sub-national university groupings in England, it still not clear as a partner whether collaboration or competition is the main driver of behaviour in the higher-education sector. This will be a direct challenge to making engagement consistently place-based, not just project-based.

Working together locally can also influence national implementation. How can a national workforce plan possibly account for England’s urban, rural and coastal split? The chief medical officer’s 2023 annual report made a feature of the skewing of the geography of older age in England away from large urban areas towards rural, coastal and other peripheral regions. When mapped together, these areas show very little overlap with the sites of the most well-resourced universities and medical schools. The gap between health demand and labour supply will be starkest not just in deprived coastal areas but in relatively well-heeled retirement destinations, such as North Yorkshire and the South West. What if place, and thus social and economic development, could be brought explicitly into conversations about where new medical and nursing schools should be based? The NHS-university relationship, particularly when targeted through emerging Civic University Agreements, will be critical in ensuring that national policy grapples with wider civic impact. 

2. Recognise our role as part of an anchor network – and the vital place of universities and NHS organisations in local economy and society

The idea of institutions as local anchors beyond their core function has become mainstream. Since the 2021 report, there has been a deepening and a broadening of networks of local anchors. In Leeds, Birmingham and London, for example, NHS organisations and universities are working closely with local authorities, colleges, voluntary, community and social enterprise organisations, sports clubs and businesses to make local populations both better and better off. With more intentionality and focus, these emerging anchor networks can, and indeed should, be the foundation on which the longer-term vision for a health and place strategy builds. 

There are four core purposes of an ICS: improving population health, enhancing efficiency, tackling health inequalities and helping the NHS to support broader social and economic development. This fourth purpose is by far the least understood in traditional health-management, clinical and strategy terms, yet is particularly relevant to anchor networks. Institutions may have direct levers at their disposal, but they often lack the broader understanding of the economic and social context in which they operate. A wider partnership, looking at the LTWP through the lens of this fourth ICS purpose, can redirect approaches to health, and the strategy and investment needed to improve it. 

One example could be the development of new and preventative models of training and care that are predominantly high-street or town-centre based. Education and health services are increasingly being courted by developers and regeneration leads to become focal points in the remodelled, post-retail experience of a place. Were universities and NHS organisations jointly to run educational facilities or to broker new approaches to integrating public services into empty units, shopping centres or department stores (new anchors in place of old), they could actively support the social and economic viability of their places. And they could also adapt new approaches that remodel how teams work, creating changes in working patterns, supporting new role development, enabling better use of AI and digital advancements and bringing a broader focus on health creation. Clinical placements often become the insurmountable hurdle to local strategic partnerships, but this form of place-based engagement in non-acute settings could again broaden thinking.

3. Commit to building the future – the actions of universities and NHS organisations today have a significant impact on the health and wealth of communities tomorrow

It is hard to think of anything that speaks more strongly to this principle than the LTWP. Parts of the NHS have repeatedly sought to develop deep and embedded links into communities, through which to inspire people into the sector. However, the internal cultural shift necessary to realise this often falls short. Approaching this principle through local discussions around the LTWP can bring workforce-specific benefits, and also a much broader understanding.

Firstly, universities and NHS organisations, through anchor networks, should connect a more nuanced, data-rich understanding of trends in health and care demand, with the many and varied local routes for labour supply. Depending on the context, this might mean prioritising retaining students, particularly in those places consistently seeing the largest graduate outflow, and retraining those over the age of 50, so that population ageing is an asset. Providing health and care support to enable people to train and find work in the sector can also generate a benign feedback loop for local planners to draw on, using the extensive research and digital expertise of most universities. 

How much further can this principle be pushed? As successive governments experiment with varying forms and degrees of decentralisation, it is the NHS-university relationship that can grasp the nettle. 

There is a live debate in national health policy around the autonomy of ICSs, with this issue central to a government-commissioned review in April 2023, undertaken by Patricia Hewitt, a former health secretary of state, and currently Norfolk and Waveney ICS chair. ICSs are a form of decentralisation, with leaders needing to understand the local context in a far richer and more nuanced way than traditional NHS executives did. Universities have a role in supporting ICSs with the intellectual heft needed to develop a shared perspective of population need – and thus better, more responsive public services. Given the gaps between the Department of Health and Social Care and both the Department for Levelling Up, Housing and Communities and the Department for Education, health is not automatically a part of Whitehall’s devolution discussions. A more collective approach to developing the long-term evidence base for local delivery can push Westminster for greater autonomy. This point highlights the difference between leading a hospital and a system. Universities benefit from supporting system leaders to grow into their roles, and have the confidence, capabilities and alliances to take longer-term perspectives on a range of complex and challenging priorities.

4. Prioritise inclusivity – social justice should sit at the heart of the NHS-university relationship 

The ICS focus on health inequalities can bring inclusion centre stage for the LTWP. Providing equitable access, ensuring that organisations reflect communities, tackling discrimination and supporting evidence-based decisions lead to thriving workforces. Such micro-level work can also play a key role in framing and evidencing new approaches to some of the more saliant political issues, such as migration, showing the broad value of and need for immigration in real terms, through the lens of place. Collectively, this will lead to stronger community relationships, increased trust and take up of services, and better levels of care. Inclusivity directly affects the bottom line, and leaders should be aiming to better engage communities, to be smarter with spatial understanding and to think about the student and staff experience. 

As two of the most significant employers in almost every locality, NHS organisations and universities need to prioritise diversity and equality, offer opportunities to learn and develop, and advocate for social justice and, vitally, mental wellbeing. This direct role extends to staff and students, for whom their experiences should be a central rallying call. Attrition is particularly high for students transitioning into the NHS workplace, with up to a third of nurses leaving courses before completion. 

The more organisations engage with and through communities, the more leaders understand their priorities. The South London Listens community partnership project has seen extensive community interaction over several years, pushing housing, migration, employment, mental health and young people to the top of the to-do list for local partners. Rather than focus on these issues in isolation, many of which do not have an obvious lead, these are the cross-cutting themes on which to develop and deliver a workforce plan. On the issue of young people in particular, the recent Institute for Fiscal Studies review of the educational outcomes of Sure Start raises the question of how universities and NHS organisations can coalesce around policy in this vital area, which outlives political cycles. 

Similarly, the joint work by NHS London and the capital’s universities in developing an industrial-placement scheme for non-clinical roles is important. Focused on students who stand to benefit the most from social mobility, this will open NHS roles – and potentially careers – to those studying the breadth of higher-education courses. It is also stretching the parameters of traditional widening-participation approaches taken by universities. Actions rather than words will develop the trust necessary to cement the local partnerships needed to deliver the LTWP in ways appropriate for a given place.

5. Measure impact – evaluating our collective work within a region, sharing learning across sectors, and in turn amplifying real-life impact

The final principle was measurement. Addressing the LTWP nationally will likely focus outcomes on the hard currency of numbers in training and, subsequently, employment. A civic approach would be much clearer on the economic and social impact. Locally, there is a need to build into the approach to the LTWP some of the potential outcomes discussed throughout this essay, and to evidence them over a longer period, understanding what can be done best at what geographic footprint. 

This long-term impact is important. There are clear overlaps with the broader devolution agenda, and skills forms a critical part of every deal struck with government. There is a desire from health leaders for ICSs to become the default level for future workforce decision-making. This would enable increased autonomy over the development of local system architecture, responsibility for managing strategic external relationships and, critically, control of dedicated funding streams. It would also truly help us to reimagine the relationship with universities.


The principles in the November 2021 report were co-developed through deep engagement with leaders. The tumult of the intervening period reinforces, rather than weakens, their meaning. The NHS Long Term Workforce Plan is perhaps the most important opportunity yet to show what local university and NHS relationships can and should achieve, and how leaders should go about fulfilling the opportunity. 

This essay has tried balancing new ideas for local practice with learnings for national policy. It is important to understand that place doesn’t simply interpret policy – it contributes to it, too. How loud this contribution will be in the future health and care workforce will be a key determining factor in place-based success and national policy development. The benefits of this are multiple: a better understanding of ‘place’ (in terms of scale, assets and priorities); more thriving, productive communities; a more united, inviting proposition 

for investors looking for returns; and ultimately more preventative towns and cities, which keep us healthy and prosperous.

It has on occasion seemed like university leaders saw civic impact as largely a one-way process of benevolence: another corporate social responsibility programme. The implications in terms of everything from mission and values to governance and patterns of investment was underestimated. Given the intensifying fiscal pressures and the often unrealistic expectations set by national politicians, we need as many friends as we can get. It would be ironic – and indeed sad – if universities turned to face inwards just as partnerships are being seen as the true test of civic and place success. 

Michael Wood and Matthew Taylor CBE

Estimated Read time: 14 Mins

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