Laura Walsh wanted to work in an ambulance when she left school, but “life and subsequently children happened”, she says. But last year, the 36-year-old saw an advert for an NHS ambulance care assistant apprenticeship. “What better example could I set my children?” she asked herself, and decided to apply. It was the start of 2020, and the experience would be very different to what she had expected.
During the Covid-19 pandemic, apprentices – like other NHS staff – have found themselves in the middle of the greatest health crisis in generations. They have been working on the front line and in the back office, supplementing their practical experience with distance learning. For some, real-world experience has become virtual.
Around 18,000 people started an apprenticeship in the NHS in the 2019 to 2020 academic year, and more than 51,000 have done so since 2017, when the Apprenticeship Levy was introduced on employers, including those in the public sector, with a wage bill of £3m or over in order to boost vocational training. The NHS has provided such schemes since the mid-1990s, when Modern Apprenticeships were created by the Major government.
Apprenticeships mix formal study at a further education institution and learning in the workplace. Depending on the level of study, from GCSE equivalent to a degree, they can last from 12 to 18 months through to four years. Being able to earn a salary while learning makes them an attractive option.
The NHS, along with the civil service, is more likely to recruit apprentices over the age of 25 across a range of vocations. In 2017 to 2018, 30 accountant, 130 assistant accountant, and 50 engineer apprentices started in the health service, alongside thousands of clinical roles such as healthcare support workers and nursing associates.
Matthew Fairclough, a mental health nursing degree apprentice, is a peer supporter within a community treatment team in north-east England. Social distancing has impacted how he works. “Facial expression means so much, especially for my patients,” he says, “but many of them have actually really embraced the idea of wearing PPE.”
During the first lockdown, contact with the people Fairclough supported was limited to phone calls, but he is now back to doing some face-to-face appointments, which can be really important to the more vulnerable. “My visits may be the only time they feel safe and comfortable in leaving the house.”
Some apprentices have had to take on new roles as part of the pandemic response. Amber James started a healthcare assistant apprenticeship in May 2019, with the plan to complete a year as a band 2 worker and go up to band 3, enrolling on further training. She worked shifts at Great Ormond Street Hospital while having specific study days where practice educators, who are allocated to particular wards and clinical specialities, teach apprentices about their areas of expertise. This was on top of the core skills needed to work in a hospital ward. “You really got a feel for what the patient’s day looks like,” she explains.
Early into the pandemic, however, James volunteered to be redeployed to one of the Nightingale Hospitals established as part of the pandemic response. She joined as a clinical support worker and her apprenticeship was put on hold for three months, but it gave her an opportunity to build skills and experience across different departments.
James originally qualified in early years child development and was working in a children’s centre, but was frustrated by the lack of clear career progression. Like Laura Walsh, the idea of working in the NHS had been in the back of her mind for years. James recalled doing a week-long placement at Great Ormond Street Hospital in her final year of university. At the time she thought it was where she wanted to be. “I love the whole ethos of the hospital, I love the atmosphere, the work that they do,” she says.
James worked with adults for the first time at the Nightingale, learning the skills needed to help those fighting Covid-19: ventilation observations, suctioning the tubes, and “proning” patients – turning them safely from their back onto their abdomen – to help them breathe. With the help of her colleagues she also dealt with deteriorating and dying patients for the first time, supporting people at the end of their life and their families.
She says that when starting out in the NHS there is an emphasis on being “one team… and that was something that I instantly recognised when helping out with other teams in the pandemic”.
Walsh is another front-line worker and apprentice, whose role involves transporting patients to and from hospital appointments. Keeping the vehicle clean and well-stocked with PPE is a critical task for ensuring the health of staff and patients, but she also provides emotional support. “Sometimes the day involves you being a counsellor, or a friendly ear, and sometimes you are the only person a patient may have seen for a few days, or even weeks,” she says.
The patients Walsh works with don’t have serious or life-threatening conditions but can still be very vulnerable. She is there to make sure that the clinicians she hands the patients over to get vital information. “Covid-19 has been a real struggle for everyone, more so for some of the patients we transport,” reflects Walsh. “I’ve done as I’ve always done and come to work realising I have a job to do that other people rely on.”
Read more: How Covid-19 exacerbated NHS staff burnout
It is not just apprentices working in front-line roles who have had to adapt to supporting the NHS as it copes with the crisis. Michael Bottomley is in a finance team, working and studying virtually. “At times it can get a bit lonely working from home, especially as I previously worked in the bustling hospitality industry,” he says.
Like many of those who cannot meet colleagues and fellow students in person, Bottomley has had to find the joy in the everyday, taking early-morning walks with his dog, listening to the radio, and having lunch with his girlfriend. He is also positive about the support of colleagues and the distance-working systems they use to keep working. It is a stark contrast to his former colleagues from his time in hospitality, many of whom have been furloughed or made redundant. “I feel very lucky to be in this position,” he says.
Back at Great Ormond Street, Amber James has returned from her deployment at the Nightingale and is now working across several different wards. She has moved into a four-year nursing degree apprenticeship. When she finishes she will be a registered nurse, and the scheme means she can continue to work while her tuition fees will be covered.
Thinking back over 2020, she says the experience underlines the importance of staff being really flexible and versatile. “This past year has really taught us that we have very little understanding of which way things can turn,” she says.
This article originally appeared in the Spotlight report on Skills and Apprenticeships. You can download the full edition here.