Cuts to continuing professional development (CPD) budgets for nurses should be reversed as part of efforts to retain an often “overstretched” and “struggling” workforce, a group of MPs has concluded in a major report.
The Commons’ health select committee has warned today that the nursing workforce needs to be expanded “at scale and pace”, but has also highlighted that more nurses are now leaving the Nursing and Midwifery Council register than joining it.
“We heard a clear message about workload pressures as well as ideas about how to address these”
Nurses were under “relentless pressures” which in some cases meant they believed their registration was at risk because they were struggling to cope with demand, said the committee’s report, which was compiled with the help of Nursing Times and published today.
It said these “unacceptable” pressures, in combination with poor access to CPD, a sense of not feeling valued, ongoing pay restraint, the impact of Brexit and the introduction of language testing were all contributing to the shortfall in staff.
Not enough attention had been paid to keeping hold of the existing workforce, said the report. It noted that the workforce planning body Health Education England had said reductions to nurse CPD had been a conscious decision to prioritise paying for more student nurses.
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“[HEE] indicated that they now intended to increase funding again for nurses’ CPD. We would like to see evidence of a clear plan for re-introducing this,” said the committee in its report – titled The nursing workforce.
Among its 17 recommendations, the committee called for funding allocated to trusts to be specifically ringfenced for CPD for nurses. It also said specific funding should be made available to support CPD for nurses working in the community.
More widely, the MPs said they welcomed new routes into nursing, such as apprenticeships, fast-track programmes and the new nursing associate role, but stressed that three-year nursing degrees remained the main way to becoming a nurse.
“We would like to see evidence of a clear plan for re-introducing funding for nurses’ CPD”
Health select committee report
Nursing associates should not be a substitute for nurses and deserved a professional identity of their own, said the report. There is an “urgent need for greater clarity as this important role is developed and introduced,” it said.
For example, it said clarity about the role’s scope of practice was essential for patient safety and called for a “plain English guide” guide to be developed – in addition to the standards being produced by the Nursing and Midwifery Council.
This should include examples of tasks that associates will, and will not, be expected to undertake, said the MPs.
The MPs also warned the government it “must be prepared to act quickly” if the number of student nurses in training decreased following the removal of bursaries,
There were already “particularly worrying shortfalls” in certain sectors and specialties, such as mental health and learning disability nursing, district nursing and in nursing homes, noted the report.
“While it is too early to draw firm conclusions about the impact of the withdrawal of bursaries and the introduction of student loans and apprenticeships, there are early warning signs of emerging problems,” said the MPs, with warning signs on applicant levels and course numbers towards the end of last year.
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Specific plans must be provided by the government about how it would deal with reductions in the number of mature students, learning disability and mental health nurses being trained, said the committee in its recommendations.
In addition, the committee said it was concerned that around 30% of nursing undergraduates were not completing their course, based on recent research carried out by HEE looking at student nurses due to finish their studies between 2016 and 2017.
“We would like further assurance from HEE that attrition rates have been taken into account in future workforce projections,” said the group.
HEE and the government must hold universities and NHS providers to account for tackling the causes behind variation in attrition, it added.
Chair of the health select committee, Dr Sarah Wollaston, said: “We met many frontline nurses during the course of this inquiry. We heard a clear message about workload pressures as well as ideas about how to address these.
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“We will return to this subject in a year to make sure that improvements have been made in nurse retention, working conditions, and continuing professional development,” she said.
Responding to the report, NMC chief executive and registrar, Jackie Smith said: “Cuts to CPD are a major issue and I fully support the committee’s recommendation that funding allocations should be ring-fenced.
“Providing much needed development opportunities is key to career progression and ensuring that we are investing in a workforce that can meet the demands of a population with complex needs,” she said.
Meanwhile, Professor Brian Webster-Henderson, chair of the Council of Deans, said: “We have long been concerned about the risks to the NHS posed by cuts to CPD funding, not just for nurses but also for midwives and allied health professionals, and fully support the committee’s call for these cuts to be reversed.
“We trust HEE will take these recommendations into account when producing their final workforce strategy,” he said, citing plans expected later this year.
Professor Webster-Henderson also highlighted the report’s recommendation that the government closely monitor the impact of the removal of nursing bursaries, noting in particular the effect on mature students.
He said: “Mature students form a significant part of the student population, often studying and then working in their local communities. We have previously identified them as being one of the groups most vulnerable to the move away from bursaries.
“This is something that requires careful monitoring alongside innovative approaches to recruitment and, if necessary, targeted interventions to ensure that we do not lose mature students from the professions,” he said.
“We have long been concerned about the risks to the NHS posed by cuts to CPD funding”
Likewise, some unions focused on the report’s warnings about the potential impact of the scrapping of the bursary for student nurses.
Unison head of health Sara Gorton said: “The foolishness of abolishing the NHS bursary for healthcare students is laid bare in the report. The government needs to reverse this ill-thought-out decision, as well as provide proper funding for nursing apprenticeships.”
Sarah Carpenter, Unite’s head of health, said: “We feel that the foot needs to be put firmly on the accelerator in addressing the shortages of nurses, health visitors and community nurses. One of the best ways would be to immediately reintroduce bursaries for those wishing to train as the nurses of tomorrow.
“Abolishing the bursaries last summer was a big mistake and we now have a situation where student nurses face the prospect of chalking up debts of £50,000 during their three-year course – that’s short-sighted and blinkered thinking by the government.”
Dave Munday, professional officer for the union’s Mental Health Nurses Association, said it was “good” that the committee had “shone another light” on individual nursing professions, especially mental health nurses, which he noted had seen significant cuts over the last seven years.
“The foolishness of abolishing the NHS bursary for healthcare students is laid bare in the report”
The report, which covers a range of issues affecting the nursing workforce was compiled with the help of the Nursing Times. The MPs held two focus groups where they met with frontline nurses from across the country, from a wide range of specialities and at different stages of their careers.
Dr Wollaston visited our Team Leaders’ Conference in Birmingham in November and found out what life was like for sisters and other managers who are charged with trying to fill their rosters.
She and her team also visited a group of nurses in London, with representatives present from hospitals and the community working in a range of specialties, including theatre and mental health. The evidence heard from nurses at these events is recorded in the report’s two annexes:
- Note of discussions with nurses held by the chair on 9 November 2017
- Note of committee visit to Royal London Hospital, 23 November 2017
Read more about the report’s findings and recommendations in our news coverage and analysis:
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- HSC: Language testing must be ‘closely monitored’ by NHS England
- HSC: Nursing organisations welcome major report on workforce
- ‘The nursing workforce must be expanded - at scale and pace’