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News analysis: Building a quality workforce fit for the future of nursing

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A high-quality workforce will be key to taking the NHS Next Stage Review forward. Louise Tweddell examines in detail the main points of the staff strategy plan

Quality is the word that is emphasised throughout junior health minister Lord Ara Darzi’s plans for creating a workforce to meet the challenges of the NHS.

These plans are outlined in A High Quality Workforce, a report accompanying the main NHS Next Stage Review document, published last week.

Workforce planning and education must be reshaped to provide the care necessary to cope with trends in long-term illness, the report states. This will be achieved by forging stronger links between primary and acute care providers and the higher education sector.

This will also allow the NHS workforce to focus on providing quality care, which is patient centred, clinically driven, yet also more flexible, says the report. Staff will be highly valued and life-long learning will be promoted to ensure everyone continually updates their skills.

Lord Darzi has devised a four-pronged strategy to reshape the workforce to deliver these goals.

This includes reaffirming the role of the nurse, improving the way in which quality of nursing care is measured, modernising career and education pathways, and improving recruitment and retention (see box).

Lord Darzi is confident he can build a nursing profession fit for the challenges the NHS will face in the next 10 years. But just how realistic is this?

Janice Sigsworth, deputy chief nursing officer for England, says nurses should take heart as the changes were a response to nurse opinion voiced in direct consultations with the profession.

‘They are the things that nurses have told us they wanted to see change. We met with hundreds of nurses in drawing this up and they are based on what we were told,’ she said.

‘A lot of these ideas have been around in nursing for a long time but this is the first time they have been brought together in a plan of action to take forward to make change,’ she added.

Indeed, the profession has many reason to be optimistic. Education has been given special attention, with all nurses guaranteed personal development and access to appropriate training.

The strategy acknowledges that improving training is the only way to continue to deliver high-quality care if nurses are to be able to respond more effectively and flexibly to changes in health needs and technology.

For the first time, nurses have been given the directive by government to hold their employer to account if they do not deliver or invest sufficiently in their education.

Nurses will be able to formally raise concerns through the new Care Quality Commission watchdog. Its predecessor, the Healthcare Commission, has agreed that staff satisfaction will become an indicator in its annual health check of NHS trusts.

But Sue Bernhauser, chairperson of the Council of Deans of Health, is sceptical:

‘I do not really think so. An employee-employer situation has a power dynamic and I cannot see any nurse, or other healthcare professional for that matter, challenging their employers on it.’

But even if nurses cannot find the courage to confront their employer, organisations will have to be more accountable.

From now on, all organisations that receive central funding for education and training will need to formally publish annual expenditure on CPD.

This will allow present and future employees to make informed choices about where they want to work.

There is no clear plan on how training should be funded in the report, although it does state that the government is ‘reforming the funding of education and training to make it fairer, more transparent and ensure that it is used for the purpose it is intended’.

As highlighted by NT’s Time Out For Training campaign, strategic health authorities have been raiding training budgets in an attempt to balance their books, with the result that nurses have been missing out on opportunities to improve their knowledge and skills.

The Multi-Professional Education Training budget, which SHAs receive from the Department of Health to fund workforce training, including that of nurses, looks likely to be scrapped to stop further abuses.
Ms Sigsworth told NT the government was planning to have reviewed education funding in the next six to nine months.

Lord Darzi has also somewhat pre-empted the outcome of the NMC’s, as yet unpublished review of pre-registration education, by backing a ‘shift’ to a graduate-only nursing profession. However, while the report notes that it favours this direction of travel, it says it will await the outcome of the consultation before acting.

The workforce document states: ‘Nursing must attract the best quality recruits in an increasingly competitive labour market. Evidence suggests that a graduate registered workforce may help achieve these objectives.’

There is also good news for nurses about to qualify. They will now be entitled to a preceptorship period of six months when they start their
first job.

At the beginning of this financial year, the SHAs received £10m to fund a preceptorship scheme. That money will now be tripled to £30m, though it appears the funding will not be ringfenced for that purpose and government advisers disagree over whether it will be enough to cover all newly qualified nurses.

‘We did not want to be prescriptive about it in terms of what they should and should not use it for,’ Ms Sigsworth told NT.

‘They [trusts] will be in the process of spending it, using it in a variety of ways to support education and training, or buying time for staff to have mentoring or backfill. We went to talk to all the nurse directors at the start of the year and they said it was more helpful for them to do what is best for their position locally,’ she said.

‘Preceptorship is something we have been trying to achieve for years,’ she added.

Indeed, the UKCC, the forerunner of the NMC, said as long ago as 1995 that there should be a preceptorship scheme but the idea was never enforced with the result that some trusts have such schemes and others do not – largely dependent on resources.

The new emphasis on preceptorships in the workforce strategy is welcome news, according to RCN education adviser Dame Betty Kirshaw.

‘The RCN has been calling for this. But I would want to make sure that it applied to all new nurses,’ she said.

Ms Bernhauser added: ‘Of course we would support this but I would be much more concerned that they based it on a number of principles rather than a length of time.

‘You can train some people and they might get it on the first week or stay in the same place for 52 weeks.’

Meanwhile, a national training advisory body for nurses is being established, which will report to NHS workforce planners on key issues in the education and training of future nurses.

Ms Sigsworth said: ‘What we want to do across the profession is make sure that we have an over-arching view.’

The workforce strategy document may well create a feeling of optimism among those in the profession who have been disheartened by the training cuts and workforce cutbacks of the last few years.

Now the biggest challenge is for the government to ensure that Lord Darzi’s vision of a high-quality, highly trained and highly motivated workforce becomes reality.

‘This may just seem like words to nurses,’ said Ms Sigsworth, ‘but it is now up to us to take this forward and make it happen.’

A high-quality workforce: the key points

Reaffirm the role of the nurse:

  • refresh definitions of care to meet modern requirements.

Improve the measurement of nursing quality:

  • Develop an over-arching set of metrics to define and measure the quality of nursing care;

  • encourage clinical teams to develop their own metrics at local level in a ‘clinical dashboard’;

  • put in place enablers to improve managerial and leadership skills for nurses through training and role modelling.

Modernise career and education pathways for nurse:

  • threefold increase in investment in preceptorships;

  • shift to a graduate registered nursing workforce;

  • stronger clinical academic careers;

  • taking a pathway approach to nursing careers;

  • support for careers in health promotion;

  • new standards for advanced nursing roles;

Recruit and retain the best nurses:

  • ensure careers are attractive.

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