The health service will need “more registered nurses, not fewer” in future, according to the chief executive of NHS England, who also backed more advanced practice and primary care roles.
Simon Stevens told an audience of senior nurses this week that it was one of those “concrete things” that nursing associates and apprentice nurses should not replace registered nurses.
“There is no doubt whatsoever we are going to need more registered nurses in future, not fewer”
Mr Stevens was speaking at the chief nursing officer for England’s summit in Birmingham on Tuesday, when he sought to reassure those with concerns about the substitution of roles.
“Notwithstanding the importance of the reforms that have been made to new ways into nursing – nursing associates and apprenticeships,” he said. “None of that must obscure the fact that in my mind there is no doubt whatsoever we are going to need more registered nurses in future, not fewer.
“Whatever else we do, needs to supplement that fact and not replace it,” he said. “Particularly as we go into this uncertain environment around the Brexit debate, our ability to attract and train and retain qualified nurses is going to be essential to what needs to happen in the NHS.”
However, he highlighted that nurses would also find themselves working in different settings and in different ways – hinting at the health services 44 sustainability and transformation plans.
“We’ve slightly dropped the ball” over the last decade or two on “some of the expanded roles that we want for nursing”, he told the audience.
“We are going to have to be serious about expanded opportunities for nurses”
Mr Stevens highlighted endoscopy as an example, noting that it was now 15 years or since the NHS first introduced nurse endoscopists.
“Really, have we applied that thinking at scale – no we have not,” said the NHS chief executive, who added that the potential of nurse consultant roles had not been realised either.
“If we’re serious about improving cancer outcomes, then we are going to have to be serious about expanded opportunities for nurses and the training that goes with that, and that is true in many other aspects of nursing practice,” he said.
“We had a debate in the early 2000s…around the role of nurse consultants,” he said. “Actually in some places we’ve seen those roles being eroded – the opposite direction to what we want.”
“Let’s be clear – nursing and qualified nurses – we’re going to need more colleagues to join us and everything we do has to mobilise round that reality,” he stated.
Mr Stevens told the audience of nursing directors and other senior members of the profession that he wanted to give them an “honest assessment” of the current situation facing the NHS.
He that such an assessment had to “begin with recognition of the huge pressure that your staff – our colleagues – are working under”.
“The leadership role of nurses in that is going to be absolutely essential”
In explanation, Mr Stevens said there were “three paradoxes” in the NHS at the moment.
Firstly, he said that, despite “those hugely well-known pressures”, particularly in emergency care and waiting times for surgery, the clinical outcomes for care were the “best they’ve ever been”
If people had the choice of being treated five years ago or now, “of course we would choose now”, he told the audience, noting that more patients were surviving serious illnesses like cancer.
“Yes, there’s pressure, but on the things that matter, outcomes are continuing to improve,” he suggested.
The second of the paradoxes, he said, related to the fact that the country as a whole was getting healthier, while the pressures and expectations on the NHS continued to increase.
“Amazingly life expectancy in this country is going up by five hours a day,” said Mr Stevens.
“The quality of care for pregnant women and the risks associated with childbirth have now improved to such an extent that the chances of dying for a woman during pregnancy are lower than that of her male partner at the same time,” he said.
“The journey that nursing has taken over the last four or five years is a hugely welcome, if often under-noticed one”
But he highlighted that there were still health inequalities in life expectancy and health status and that healthcare was “not a one-way street” in terms of progress.
“Outcomes are better but pressures are more intense, we’re getting healthier but inequalities persist and the treatments go up and the expectations on the NHS expand,” he said.
The third paradox, the NHS England chief executive said, was that there were more staff working in healthcare than ever before, yet more were still needed.
“Yes, of course we’ve got more staff – clinical staff – working in the NHS than we’ve had but the expectations on our frontline staff, the transparency the honesty about the gaps in care that exist in this country…. Mean that it has probably never been a more challenging time,” he said.
Mr Stevens went on to highlight the immediate challenges facing the health service, in particular patient flow from admission via accident emergency to discharge.
Health service will need more registered nurses, says NHS chief
“In order to give ourselves and the people we look after a better experience going into next winter, we’ve got to sort out what you might call the front door issues and some of the back door issues in hospitals,” he said. “The leadership role of nurses in that is going to be absolutely essential.”
He welcomed the spring budget announcement of an extra £2bn social care funding, and referred to a new target agreed with other NHS leaders to use the money try and free up 2,000-3,000 beds.
He told the audience it was “vitally important, you as nurse leaders” actively engaged with local councils to meet care needs, which would in turn, would improve discharge arrangements.
“If we can free up 2,000-3,000 hospital beds worth that will be able to look after people coming into A&E better and will also be able to review what we need to do on planned surgery and routine operations,” he said.
It was “absolutely mission critical” for nurse leaders to help try and achieve this bed target over the next six months, as was equivalent to between five and six new hospitals, he told the delegates.
In order to meet the target, Mr Stevens called for more uniformity of systems, referring to a junior doctor he had spoken to who was working on three wards in the same hospital that each had a different model for discharge.
The was “whole set of other things we need to so as well”, he said, highlighting moves including GP streaming at the front end of A&E, more NHS 111 patients able to talk to a clinicians and more time for ambulance crews to use their judgement.
Similarly, Mr Stevens stated that in primary care there was a “much stronger role” needed for practice nurses, going on to cite new Health Education England framework document.
“We know what has got to get done over the next couple of years,” he said. “We know why we are doing it. But the how is critically dependent on our fellow staff and, in particular, on the largest, the most trusted professional group in the health service – namely nurses, midwives and health visitors.”
Mr Stevens also praised the chief officer for England Professor Jane Cummings, calling her a “fantastic advocate for nursing”.
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“Despite all of the pressures… actually the journey that nursing has taken over the last four or five years – beginning with 6Cs and many other changes as well – is a hugely welcome, if often under-noticed one,” he added.
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