Bold action needed to fix NHS clinical placement crisis

University of East London

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A fundamental rethink of how the NHS trains its future workforce is urgently needed, according to a new paper from the Higher Education Policy Institute (www.hepi.ac.uk), Rethinking Placement: Increasing Clinical Placement Efficacy for a Sustainable NHS Future (HEPI Report 194).

The paper, written by senior leaders from the University of East London (UEL), argues that the National Health Service (NHS) cannot achieve its ambitious workforce goals without bold system-wide reform of how students gain real-world experience – the essential bridge between classroom learning and frontline care.

The HEPI Report, which has been published with the support of the Council for Deans of Health, sets out a blueprint for transforming placement provision across the health and care sectors. Drawing on best practice across London through UEL partner organisations, it urges policymakers, universities and NHS providers to move beyond the narrow goal of simply increasing numbers and to focus instead on removing systemic barriers to create placements that are equitable, flexible, digitally enabled and aligned with the future of healthcare delivery.

Authored by Professor Amanda Broderick, Vice-Chancellor and President of the University of East London, and Robert Waterson, Executive Dean of UEL’s School of Health, Sport and Bioscience, the report highlights the growing strain on the system, with more than 106,000 vacancies across secondary care and a shortfall of placement opportunities for health students.

It also challenges ‘legacy assumptions’ and outlines a series of practical interventions to make placements more effective and sustainable. These include greater use of simulation and digital learning, new supervision frameworks that ease pressure on clinical staff and community-based models that widen access to diverse learning environments. It points to pioneering examples across the UK – including UEL’s own simulation-based and telehealth placements – as proof that innovation can expand capacity without compromising quality or safety.

Working hand-in-hand with NHS providers, universities can help reimagine supervision models, expand simulation-based training and pilot technology-led learning that mirrors the realities of modern healthcare. The authors warn that without urgent reform, student learning, workforce readiness and patient safety will all be at risk.

Professor Amanda Broderick said: ‘Incremental adjustments will not be enough. We need bold, innovative approaches that harness the full potential of simulation, technology and new models of supervision, while deepening partnerships between universities, NHS providers and community organisations. Our goal is to shift the conversation from “more placements” to “better placements”: placements that are equitable, flexible, future-facing, and designed around both workforce needs and student success.

‘By challenging old assumptions and reimagining what placements can be, we can help build the confident, agile and compassionate workforce the NHS requires to meet the challenges of the next decade and beyond.’

Nick Hillman OBE, HEPI Director, said: 'We all rely on the NHS, but the NHS can only cope with the ageing population if it has a workforce to match.

‘This report reveals how to resolve the difficult blockages in the training pipeline to unlock capacity and improve quality.

‘I hope Ministers respond constructively.’

In a Foreword to the report, Ed Hughes, Chief Executive of the Council of Deans of Health, writes:

‘Clinical placements are the foundation of health and care education. They are where knowledge, skills and professional values come together to shape the workforce our communities need. Yet as this paper makes clear, the placement model that has underpinned education for decades is under significant strain. Capacity is stretched, supervision is challenged, and quality cannot be taken for granted. …

‘We cannot simply expand the existing model indefinitely. Changing this will require adaptation from both placement and education providers, including the willingness to take decisions which work in the interests of the system as a whole over addressing issues for particular courses, and which place the student interest at their heart. Placements must be designed to reflect new ways of working, embed simulation and digital learning at scale and develop supervision models that are flexible, safe and resilient. …

‘Placements are not a peripheral issue; they are central to the supply, confidence and competence of the future workforce. … As the NHS and the wider health and care sector enter a decisive period of reform, it is imperative that placement transformation is aligned with national strategy and resourced accordingly.’

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Method of Research

Commentary/editorial

High-precision measurement of potential dynamics inside plasma

Achieved with a high-efficiency accelerator and non-contact diagnostics

National Institutes of Natural Sciences

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image: 

The Large Helical Device (LHD) and the heavy ion beam probe (HIBP) system. The inset on the left shows an enlarged view of the section from the negative ion source to the injection side of the tandem accelerator.

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Credit: National Institute for Fusion Science

Nuclear fusion, which operates on the same principle that powers the Sun, is expected to become a sustainable energy source for the future. To achieve fusion power generation, it is essential to confine plasma at temperatures exceeding one hundred million degrees using a magnetic field and to maintain this high-energy state stably.  A key factor in accomplishing this is the electric potential inside the plasma. This potential governs the transport of particles and energy within the plasma and plays a crucial role in establishing a state in which energy is effectively confined and prevented from escaping. Therefore, accurately measuring the internal plasma potential is essential for improving the performance of future fusion reactors.

 

A non-contact diagnostic technique called the heavy ion beam probe (HIBP) is used to measure plasma potential directly. In this method, negatively charged gold ions (Au⁻) are accelerated and injected into the plasma. By detecting how their charge state changes through interactions with the plasma, the electric potential inside the plasma can be inferred with high sensitivity. However, obtaining high-precision signals requires a strong and stable ion beam. Although advances in negative ion sources have increased the available beam current, efficiently transporting and injecting high-current beams into the accelerator has remained difficult, limiting the achievable diagnostic precision.

 

In the Large Helical Device (LHD), the HIBP system has been developed to measure electric potential in plasmas. In this system, a gold negative ion (Au⁻) beam is injected into a tandem accelerator, converted into a gold positive ion (Au⁺) beam, and further accelerated up to 6 mega–electron volts (MeV) at the accelerator’s exit before being injected into the plasma. The beam that becomes Au²⁺ through collisions with the plasma passes through the magnetized plasma, and by measuring the energy difference between the incident Au⁺ beam and the Au²⁺ beam after it traverses the plasma, the electric potential at the position where Au²⁺ was produced can be determined. To obtain a clear and precise potential signal, a higher injection current into the plasma is required. Although the output current of the Au⁻ ion source had been successfully increased, the injection beam current into the tandem accelerator could not be increased in direct proportion, which remained a significant challenge.

 

To identify the cause of this limitation, the research team analyzed the heavy-ion beam transport efficiency on the low-energy side — from the negative ion source to the entrance of the tandem accelerator — using the ion-beam transport simulation code IGUN. The simulations revealed that when the Au⁻ beam current is below 10 microamperes (µA), the beam can pass through the entrance slit during the acceleration, as shown in Fig. 2(a). However, at higher beam currents, the beam expands due to the space-charge effect, resulting in significant beam loss before entering the tandem accelerator, as shown in Fig. 2(b). For heavy-ion beams such as gold, this space-charge-induced limitation becomes particularly pronounced even if the output current from the negative ion source is increased. To improve beam transport efficiency, the team proposed using the multistage accelerator located between the ion source and the tandem accelerator, not only for acceleration but also as an electrostatic lens by optimizing its voltage distribution, as illustrated in Fig. 2(c). Numerical simulations demonstrated that by optimizing the voltage allocation of the multistage electrodes, a high-transmission region exceeding 95 % could be achieved, as shown in Fig. 3, significantly enhancing the beam transport efficiency compared with the conventional voltage configuration (blue circle). Subsequent plasma experiments confirmed the validity of this approach, showing that the Au⁻ beam current injected into the accelerator increased by a factor of two to three.

 

As the Au⁻ beam current increased, the corresponding Au⁺ beam injected into the plasma also increased, thereby expanding the measurable range of plasma potential in the LHD up to a line-averaged electron density of 1.75×10¹⁹ m⁻³. The enhanced signal clarity enabled the detection of temporal transitions in the internal plasma potential distribution associated with changes in the plasma confinement state (Fig. 4). At t = 4.0 s, the plasma was sustained by electron cyclotron heating; at t = 6.1 s, 0.1 s after the heating was turned off; and at t = 7.0 s, by 180 keV neutral beam injection. The results revealed a rapid overall decrease in plasma potential immediately after the termination of electron heating, followed by a gradual flattening of the potential profile. Because variations in plasma potential strongly influence plasma confinement performance, these experimental data are indispensable for improving predictive models of plasma behavior and for establishing new confinement frameworks in fusion research.

 

The method developed in this study provides a practical and compact solution for optimizing heavy ion beam transport and can be extended to other diagnostic systems and accelerator applications that require high-intensity beams. Furthermore, achieving high-precision and reproducible measurements of the internal potential structure in plasmas is extremely important as a fundamental database for future research on plasma control and reactor design.

Variation of beam shape inside the multistage accelerator. (a) Beam trajectory at low beam current and (b) beam expansion at high beam current. (c) In the present study, optimization of the electrode voltages enabled both acceleration and focusing of the beam, resulting in a higher beam current.

Credit

National Institute for Fusion Science

Beam transmission map as a function of electrode voltages V₂ and V₃ in the multistage accelerator shown in Fig. 1. The blue circle indicates the voltage setting before optimization.

By optimizing V₂ and V₃, an increase in the transmitted negative ion beam current can be expected.

Credit

National Institute for Fusion Science

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Journal

Nuclear Fusion

DOI

10.1088/1741-4326/ae0da1 

Method of Research

Experimental study

Article Title

Enhanced beam transport via space charge mitigation in a multistage accelerator for fusion plasma diagnostic

 

100 years of menus show how food can be used as a diplomatic tool to make and break political alliances

Researchers examined menus from Portuguese diplomatic dinners dating from 1910 to 2023 and showed that meals can play a significant role in a country’s foreign policy.

Peer-Reviewed Publication

Frontiers

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image: 

Menu of the “Luncheon in honour of her Majesty Queen Elizabeth II and his Royal Highness the Duke of Edinburgh” held in Alcobaça (Portugal) on February 20th, 1957.

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Credit: Cabral et al., 2025.

Food brings people together. It serves as a tool to communicate political stances, to cultivate cross-cultural comprehension or, if necessary, create tensions. Menus can reflect these intentions by using food to create specific psychological effects and convey symbolic messages. But how exactly is it done?

Now, researchers in Portugal have examined menus from diplomatic dinners, state banquets, and receptions hosted over the 20th and 21st centuries to find out how meals reflected and shaped Portuguese foreign policy and geopolitics.

“Those meals play a significant role as diplomatic institutions in the execution and continuity of Portuguese foreign policy,” said Óscar Cabral, the first author of the Frontiers in Political Sciences article, who is a gastronomic sciences researcher at the Basque Culinary Center. “They demonstrate how culinary and gastronomic practices have facilitated diplomatic negotiations and provided opportunities for cultural exchange, political messaging, and the conveyance of Portuguese culture.”

Food from Portugal

“Menus can be intentionally designed to convey political messages and communicate non-gastronomic aspects,” Cabral explained. “For example, the COP25 meal in Madrid used dish names like ‘Warm seas. Eating imbalance’ and ‘Urgent. Minimize animal protein’ to draw attention to climate issues.”

But using food in this way is not a new idea. For the present study, the researchers analyzed menus from 457 diplomatic meals dating between 1910 and 2023. While a clearly structured culinary diplomatic strategy or public policy could not be identified, certain historical periods showed distinct characteristics.

During the first half of the 20th century, lavish nine or 10-course meals featuring French cuisine were the norm. The introduction of Portuguese products happened gradually over the second half of the 20th century. A turning point occurred during the dictatorial Estado Novo period, which lasted from 1950 to 1961/62.

“We see a fundamental shift towards the inclusion and promotion of Portuguese products, territory, and culinary regionalism,” said Cabral. During this time, meals were designed to reflect an emerging gastronationalism, that is the use of food to promote national identity.  “This crystallized in the 1957 ‘regional lunch’ for Queen Elizabeth II, which was designed to convey a sense of territory and ‘Portugality.’” Dishes included lobster and fruit tarts from the Portuguese cities of Peniche and Alcobaça.

During the 1960s and 70s, diplomatic meals increasingly featured rare ingredients, like the turtle soup served to Prince Philip, the Duke of Edinburgh in 1973, or trout from the Azores served to the American and French presidents in 1971. Yet, around the same time, typically Portuguese products may have been included because sourcing more exclusive alternatives was difficult during times of economic and energy crises, which in Portugal lasted beyond the 1970s.

Another shift on menus occurred when Portugal’s former colonies gained their independence. The understanding of what Portuguese cuisine was shifted – for example, coffee was simply referred to as such, without an indication of its country of origin – and colonial language was removed.

To make, foster, and break alliances

The team identified five functions of diplomatic meals. Tactical meals often relate to territory transfers; geopolitical meals aim at renewing and confirming alliances. Economic diplomacy meals intend to foster commercial and financial relations. Scientific, cultural, and developmental cooperation meals may be hosted to show common interests. Cultural proximity meals can be a tool to strengthen cultural ties to specific countries, for example, Portuguese-speaking countries across the world. “When strengthening these ties, menus intentionally feature products closely tied to a shared national gastronomy, like Cozido à Portuguesa (Portuguese stew) or codfish recipes,” Cabral said.

Integrating gastronomy – alongside Portuguese language, values, and traditions – into national institution’s strategic work is necessary to shape the world’s understanding of Portuguese culture, the team said. “Our study illustrates how national cuisines can be strategically used to strengthen a country’s global standing,” said Cabral. It is limited, however, by the availability of archival materials from specific historical periods. Further study should also aim to understand seemingly contradictory menu choices, such as roast beef being served to the Indian president in 1990, the team said.

“Another dish that stands out is the Consommé de presunto de Barrancos, a thin soup made of cured ham from Barrancos, served to King Felipe VI of Spain in 2016. It presents a cultural and gastronomic identity challenge,” Cabral pointed out. It’s a hybrid dish – a French-style soup using a classic French cut but featuring a key Portuguese product (Barrancos ham) – one that was served to the monarch of a nation famously known as the country of cured ham. “One can read it as a gastronomic funny challenge,” concluded Cabral.

Official dinner menu served to Felipe VI of Spain by the President of the Republic, Marcelo Rebelo de Sousa, in November 2016 at Paço dos Duques de Bragança (Guimarães).

Credit

Cabral et al., 2025.

Journal

Frontiers in Political Science

DOI

10.3389/fpos.2025.1669350 

Method of Research

Experimental study

Subject of Research

Not applicable

Article Title

Power for dinner. Culinary diplomacy and geopolitical aspects in Portuguese diplomatic tables (1910-2023)

Article Publication Date

14-Nov-2025