Around a third of government-funded course places for nurses wanting to return to practice have failed to deliver additional nursing staff for the health and care service in the first 18 months since a national campaign launched, a Nursing Times investigation has indicated.
The Come Back campaign was set up in autumn 2014 by Health Education England to tempt former nurses back into the profession and help fill staffing shortages by paying their course fees.
NHS leaders have consistently cited it as part of the solution to the current nursing recruitment crisis, though when the campaign was launched HEE admitted it had no clear idea of the likely scale of demand.
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Nursing Times can reveal that, in the first academic year of the scheme more than 1,000 course places funded by HEE could have been made available at universities across England, but a year and a half later only around 700 nurses had completed the course.
In addition, during the second academic year that the campaign ran, only around 270 people out of more than 890 possible course places had completed the programme after six months.
Course leaders said there were a range of reasons behind the findings, which are based on data supplied to Nursing Times by three quarters of universities offering return to practice courses.
“I firmly believe the return to practice programme has shown some great results”
Some of the 28 universities said they decided not to take on the maximum number of HEE-funded places as they had never offered the course before and wanted to begin with lower numbers, while others said some participants took longer to complete than others because they studied part-time or continued in employment at the same time.
Others said the overall number of applicants was less than anticipated in their region. Another university said adjustments made to the length of their course and level of training meant applicants had reconsidered and decided not to take up their place.
In addition, one institution – the University of West London – was due to run a return to practice course in 2015-16 with HEE-funded places but cancelled due to the low numbers recruited.
Meanwhile, the University of Gloucestershire has not offered its course over the past two years and is in the process of phasing it out.
Previous efforts to fill nursing shortages saw 18,500 former nurses and midwives returning to work in the NHS between 1999 and 2004 following a centrally funded return to practice initiative.
HEE’s own data from its current campaign, collected from all participating universities in England, shows that around 800 people were employed as a nurse at the end of June – 21 months after the scheme launched.
The workforce planning body stressed it could take between three and 12 months for nurses to complete return to practice courses, that there were multiple start dates throughout the year and that it could take up to four months to secure a PIN from the regulator, which added delays to taking up nursing posts.
It also said universities offered “bespoke” learning packages of clinical hours for each student based on their time out of work and highlighted that the return to practice route was still a faster way of plugging workforce gaps than training pre-registration student nurses on three-year courses.
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While HEE said there were some complexities involved in implementing the scheme, it maintained the initiative was a “quick and efficient way of boosting the current workforce”, adding that attrition rates were an average of 7%.
HEE’s director of nursing and deputy director of education and quality Lisa Bayliss-Pratt said she was “delighted” with the enthusiasm and interest shown in the scheme but noted there were complexities in delivering it.
“It is important to stress there are complexities involved in this work and it is simply not a case of one size fits all. We have to make sure that we take a number of factors into consideration in order to meet the needs of those nurses taking part,” she said.
“I firmly believe that the return to practice programme has shown some great results which is good news for patients but is also a quick and efficient way of boosting the current workforce,” she added.
Return to practice: A snapshot of how universities have fared
The data collected by Nursing Times via Freedom of Information requests in February found universities could have made at least 1,037 places available through HEE’s return to practice campaign during the academic year from September 2014 to August 2015.
But only around 79% of these possible places were filled. By the end of February 2016, 706 had completed the course from this cohort – around two thirds of the original maximum number of possible places.
Meanwhile, between the start of September 2015 and the end of February 2016 universities had a possible 891 places available funded via HEE, of which 83% were subsequently filled. By the end of February 2016 only 269 people had completed from this group.
The University of Worcester filled 26 funded places out of a possible 40 between September 2015 and February 2016, but no nurses completed in that period.
“The university is committed to supporting flexible study patterns”
The university said that, while it could have been commissioned for up to 40 places, it was only paid for the number of students that actually entered the course, and that 11 out of 14 students from its autumn cohort had now completed.
A spokeswoman added: “The University of Worcester aims to be as flexible as possible regarding practice hours for candidates who have not studied in theory or practice for some time and therefore students are able to complete the hours either full-time or part-time.”
At Anglia Ruskin University, between September 2014 to August 2015 funding was available for a possible 50 places, but only 26 former nurses took up places. By February 2016, 21 people had completed the course from the cohort.
A university spokesman said: “The number of applicants was less than anticipated in our part of the East of England. However, most of those who have engaged with return to practice have successfully completed and also evaluated the course very positively.”
The University of Wolverhampton could have offered 60 funded places in the academic year starting in September 2014. It filled 31 places and by February 2016, 29 people had completed the course.
Meanwhile, between September 2015 and the end of February 2016 it filled all of its 32 HEE-funded places, but no participants had completed in that time.
“For us this has been a successful enterprise”
Ann Cysewski, associate dean in the university’s faculty of education, health and wellbeing said the size of intake for the course had increased by around 60% in 2014-15 compared with the year before, and that eight students from the current academic year had now completed.
“The university is committed to supporting flexible study patterns taking into account their personal circumstances, as several students combine return to practice programmes with other employment,” she added.
At the University of Derby, 60 funded course places could have been offered in the 2014-15 academic year, but 38 ex-nurses took up places and by February this year 33 had reached the end of the programme.
In addition, between September 2015 and the end of February 2016 the university had 64 places available, resulting in 54 filled spaces and at the end of this period 17 former nurses had completed.
Bill Whitehead, head of the department for health care practice at Derby, said the university had decided not to offer the maximum number of funded places in 2014-15 because it was the first time it had run a return to practice course and wanted to ensure quality.
“Essentially we have filled all the places we intended to fill on both occasions…For us this has been a successful enterprise. The numbers we are counting is the number we recruited and the attrition from those is very small. So we’re not looking at the absolute maximum amount we were allowed to recruit to,” he told Nursing Times.
However, he did say his university was involved in discussions with the Nursing and Midwifery Council – which sets standards for nurse education – and HEE about whether return to practice courses should be delivered in set timeframes, rather than the current flexible model.
The University of Northampton had 30 funded placed available between September 2015 and February 2016, but filled 21 and saw 8 nurses complete the course in that time.
Senior lecturer in return to practice Ros Wray said the University of Northampton had made adjustments to the length of the course and level of training in November which meant some applicants had reconsidered and decided not to take up their place.
“To support students to study at graduate level, our response has been to increase the course length and reduce our annual intakes from four to three cohorts in order to maintain the quality of our provision,” she said.
“Our response has been to increase the course length and reduce our annual intakes”
Meanwhile, the University of Brighton saw 48 nurses take up funded places on its course out of a possible 60 between September 2014 and August 2015 and by February 2016, 35 had completed the programme.
In the first six months of the 2015-16 academic year, a maximum of 40 places could have been offered, but 31 were filled and by the end of February seven had finished.
A spokesman for the university said its 60 places last year were an upper limit and not a recruitment target and that while there was some attrition on courses most participants had gone on to secure nursing jobs.
It added that its estimated completion rate for this academic year was 94% and that course feedback had been “overwhelmingly positive”.