The government’s ambition of a truly “seven-day” NHS is threatened by the loss of thousands of senior and advanced nurse posts in recent years, the Royal College of Nursing has warned.
Workforce data shows the NHS now has 2,295 fewer registrants working in band 7 and band 8 jobs – the level of the workforce which comprises expert and leadership nursing roles – than in 2010.
“Nursing staff, and above all senior expert nurses, are a huge part of the solution to delivering seven-day care”
In April 2010 there were 66,750 band 7 and 8 nurses in England compared to just over 64,450 in January 2015, according to data from the Health and Social Care Information Centre.
The roles in question – which include ward sisters, specialist nurses, those working in advanced posts, nurse and midwife consultants, and matrons – are a “crucial” part of the workforce for the proposed seven-day services, warned the RCN.
The government is already preparing to drive through its key election pledge to create a truly “seven-day” NHS, with improved access to primary care services at weekends and in the evenings and better hospital care for patients admitted during these times.
“Nursing staff, and above all senior expert nurses, are a huge part of the solution to delivering seven-day care,” said RCN chief executive and general secretary Peter Carter.
“Not only do we have too few of these staff to supervise and support care at the moment, those we do have can be stretched so thinly that they cannot do their vital work in developing the next generation of staff,” he said.
Analysis of the workforce data was unveiled at the RCN’s annual conference in Bournemouth this week, as part of a briefing on what seven-day services could mean for nurses. The report warned that seven-day services could not be achieved by stretching the resources currently in place.
It said nurses in higher bands would be crucial to achieving the service expansion, because they were experienced in making decisions, delivering complex care, helping patients to live with long-term conditions and avoid hospital admissions, and were often able to prescribe medication.
Such nurses were also at a point in their careers where they could supervise, mentor and train less experienced staff, added the RCN.
“The NHS will find itself in a double bind if it has a lack of senior experts now, and nobody to plug the gaps in the future,” added Mr Carter.
The report also raised the issue of anti-social hours pay. Nurses “rightly expect fair compensation” for working unsocial hours at the weekends and at night, and funding the seven-day service through cutting this payment would only increase low morale, it said.
During recent months there has been widespread concern among nurses that such remuneration will be cut, after ministers submitted evidence to a review by the NHS Pay Review Body on how much money could be saved if current arrangements were changed. The review’s recommendations are yet to be published.
“Those we do have can be stretched so thinly that they cannot do their vital work in developing the next generation of staff”
Detailed consideration of the impact of seven-day services on nurses’ work-life balance was required, added the RCN report, noting that flexible hours and levels of pay were important considerations for nurses when choosing hours of work.
The union re-iterated that cutting payment for unsocial hours would lead to many nurses deciding not to work at those times and “severe damage” of recruitment and retention in the NHS.
“Any short-term gains for the NHS budget from lower non-basic pay bills would quickly be eclipsed by increased agency and bank usage, higher staffing costs and poorer quality of care,” it said.
On Friday, health secretary Jeremy Hunt restated a commitment to increase the size of the practice nurse workforce, as part of plans to pave the way for seven-day GP access.
“Most urgently we need to deal with concerns about the primary care workforce…So at the election we committed to the challenging objective of increasing the primary and community care workforce by at least 10,000, including an estimated 5,000 more doctors working in general practice, as well as more practice nurses, district nurses, physicians’ associates and pharmacists,” he said in a speech.
Mr Hunt noted that the shape of the workforce increases would be “informed” by work being done on skill mix by the Primary Care Workforce Commission, which is scheduled to report this summer.
He particularly highlighted the expansion of the new physician associate role, which is often viewed as being a potential career option for nurses.
“Innovation in the workforce skill mix will be vital,” said Mr Hunt. “I have already announced pilots for new physicians’ associates, but I can announce those pilots are planned to ensure 1,000 physicians’ associates will be available to work in general practice by September 2020.”