Nursing unions, nurse educators and other representative bodies have largely welcomed a range of recommendations made by MPs on tackling the key workforce issues affecting the profession.
The Commons’ health select committee has today published a major report looking at the current workforce crisis in nursing, following an inquiry by the cross-party group of MPs last year.
Below, Nursing Times has gathered together responses to the report, which made 17 recommendations, from the main organisations that either represent or affect nurses, from unions to regulators to education providers.
Royal College of Nursing
Janet Davies, chief executive and general secretary of the RCN, said: “This report is the latest in a litany of calls for investment in the existing and future nursing workforce. Without that, nursing will remain on its current dangerous path.
“The report should make for sober reading inside government. The shortages are now biting and, when it comes to solving them, it concludes there is little sign that will change.
“The cross-party committee paints a picture of today’s over-stretched staff unable to care for patients in the way they would like and serious problems with the supply of future nurses too. This double whammy leaves the profession shrinking.
“Ministers must stem the losses by easing the pressure in the NHS and social care, valuing staff with a pay rise above inflation and increasing training places. We particularly welcome the acknowledgement that holding down NHS pay has been a major factor in this challenge and that the government must now ‘be realistic’ in linking pay to supposed productivity gains.”
Royal College of Midwives
Jon Skewes, director of employment relations, policy and communications at the RCM, said: “The recommendations and advice set out by the health committee in this report come as no surprise to the RCM. The advice they have given to government in this report is in line with what the RCM has been long asking and warning of on vital workforce issues.
“The NHS in England remains 3,500 midwives short of the number of midwives it needs to deliver a safe and high quality maternity service. Indeed, the secretary for state, Jeremy Hunt in November himself exclaimed in the Commons ‘We need more midwives’ and now what the RCM would like to see is a clear commitment and plan from the government to eliminate the midwifery shortage.
Unions attack ‘ill-informed’ bursary reform plans
“The implications of Brexit on the midwifery workforce are also most concerning given the current shortage of midwives. The latest data clearly shows the number of EU nationals coming to the UK and registering as midwives has dramatically decreased since the vote last year.
“The RCM is again calling on the government to give assurances to midwives and to all healthcare professionals working in the NHS that they can remain working in our health service regardless of the outcome of Brexit negotiations.
“The impact of years of pay restraint is also without doubt affecting the ability of the NHS to retain midwives. It has never been so crucial that the NHS pay review body make a recommendation for a fair pay rise so that existing midwives feel valued and stay in the NHS.
“A fair pay rise for midwives and all NHS staff is the key intervention that should be made now and this would go towards solving the workforce retention issues highlighted in this report.”
Unison head of health Sara Gorton said: “This report is the latest alarm bell on the NHS staffing crisis. The government must heed these warnings if it wants to turn back the tide on NHS nursing shortages.
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“The reasons for the drop in the number of nurses are, amongst other things, the result of excessive workloads, ongoing pay restraint, a lack of on-the-job training, and uncertainty surrounding Brexit.
“Disturbingly, the report highlights that nurses feel undervalued – a damning indictment of the government neglecting a workforce held in high esteem by the public.
“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, so that young people are encouraged to join the nursing profession.”
Unite the union
Unite head of health Sarah Carpenter 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.”
Unite lead professional officer for regulation Jane Beach, who gave evidence to the committee, said: “The report could have gone further in its recommendations on bursaries.
“It acknowledges, for example, the impact of removing bursaries, but we don’t have the luxury of waiting another year to know how this will play out. The evidence of nursing shortages from NHS Digital is already stark and alarming.
“Nursing bursaries were the financial bedrock that enabled women and men, who may not have had the necessary financial resources or came from disadvantaged backgrounds, to embark on the training so that they could contribute to a vibrant and diverse profession.
“Their reintroduction should be a priority for health and social care secretary Jeremy Hunt.”
Mental Health Nurses Association
Dave Munday, professional officer for the Mental Health Nurses Association, which is part of Unite, said: “It’s good that the committee has shone another light on the significant cuts that are happening to individual nursing professions, especially mental health nurses which have seen significant cuts over the last seven years.
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“Hopefully this will deter Jeremy Hunt from using the same tired lines that ‘the number of ward nurses have increased’. In the same week that the CQC have reported that the numbers of patients being detained has gone up, partly due to lack of services, it’s critical that the number of mental health nurses are dramatically and urgently increased.
“Although there is much to agree with in the report, it’s unfortunate that it hasn’t included any recommendations on safer staffing legislation or in ensuring the public is better protected by looking at improved regulation of the ‘nurse’ title.”
Nursing and Midwifery Council
We welcome today’s report from the health committee about the UK’s nursing workforce. NMC chief executive and registrar, Jackie Smith said: “Today’s report from the Health Committee recognises the “unacceptable pressures” on nurses and the call for action at pace.
“Cuts to continuing professional development (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.
“While it is vital we create new routes in, urgent action is needed to retain the workforce as nurses are leaving the profession and our own data shows this. Developing a national data set is something we fully support.
“In January 2017, we were asked to become the regulator for nursing associates and the first group will begin practising next year. There must be clear blue water between the role of a nursing associate and a registered nurse. We welcome the committee’s recommendation that nursing associates have a clear professional identity, which is also of paramount importance to the public.”
Council of Deans of Health
The Council of Deans of Health, which represents UK university faculties engaged in education for nursing and midwifery, has welcomed the health committee’s call for an expansion of the nursing workforce “at scale and pace”.
In its report on the nursing workforce, the health committee also calls for Health Education England to reverse cuts to continuing professional development budgets.
Mental health nurse to be next chair of Council of Deans
Professor Brian Webster-Henderson, chair of the council, 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.”
The report also recommends that government closely monitors the impact of the removal of nursing bursaries and in particular the effect on mature students.
Professor Webster-Henderson 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.”
The council also remains concerned about the level of applications and enrolments for vulnerable areas such as learning disability nursing and some allied health professions.
Macmillan Cancer Support
Macmillan Cancer Support’s chief nurse Karen Roberts said: “It is no secret that the NHS workforce is at a real crisis point, and we are deeply concerned that these unprecedented pressures are impacting on the quality of care cancer patients are receiving.
“We know from our own research that a toxic combination of insurmountable workloads, rising patient numbers and a lack of support and training is creating unsustainable pressure on frontline staff.
“This report highlights the consequence of this unacceptable strain; that patients aren’t getting the support they need, and more nurses are leaving than joining at a time when the need for them has never been greater.
“We welcome Health Education England’s plans to develop a strategy focussed on cancer nursing, but it is crucial the government now prioritises rapidly improving working conditions and opportunities for nurses, before things get any worse.”
The head of analysis at NHS Providers, Phillippa Hentsch, said: “Our recent workforce report highlighted the depth of concerns in the NHS about staff and skills shortages. Today’s report is a further reminder of the difficulties trusts face in recruiting and retaining nurses to ensure the safe high quality care that patients deserve.
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“Trusts are working hard to improve retention rates, but NHS nurses are working in an extremely challenging environment, with many routinely working long hours, often under intolerable pressure. Add to these seven years of pay restraint, cuts to funding for professional development, the introduction of more stringent language testing and the uncertainty surrounding Brexit – all making it harder for trusts to recruit and keep the nurses they need.
“And, as the health select committee report recognises, these shortages are not confined to hospitals, but also affect mental health and community nurses who were already overstretched, often because of difficulties filling posts and the older workforce in these services nearing retirement.
“The recent draft workforce strategy published by Health Education England – currently out for consultation – marks an important step in starting to address these concerns. But we need to fill gaps in the short term as well as plan for the future. These findings in this report make clear there is a very long way to go.”
Care England, the largest representative body for independent providers of adult social care, welcomes the health select committee’s key report on the nursing workforce. Whilst it may not be in the headlines the report does touch on the extremely important issue of nursing in the social care sector.
Professor Martin Green
Professor Martin Green, chief executive of Care England, said: “The nursing workforce within social care settings is often overlooked by that of the NHS. A national workforce strategy needs to respond to the workforce pressures in social care as well as those within the NHS.
“There is evidence to show that the social care sector is facing significant challenges in retaining and recruiting registered nurses particularly as a consequence of competition with the NHS as the report acknowledges This fall in numbers is also replicated in the number of nursing home beds since the start of austerity measures”.
The report notes 8,000 nurses have left social care since 2012-13 and CQC reports a fall of 4,000 registered nursing beds over the last two years despite rising levels of demand and complexity of need (including increasing levels of patients being delayed in hospital due to availability of nursing home beds).
Professor Green said: “This market shift is being driven by rising costs not being compensated by fees being paid by local authorities and the NHS, and providers are being constrained in their flexibility to invest in nursing care services going forward.”
The report does set out a number of recommendations that cover nurses in all sectors such as the need to ensure the language testing for overseas nurses is monitored carefully and regularly in order to ensure that it is not placing unnecessary barriers to UK practice. In addition we cannot stress enough the importance of the report’s recommendation that the government must ensure reliable data from all sectors is available to inform workforce planning.
Professor Green added: “The English language tests are a vital safeguard but must be proportionately and realistically applied to ensure that good nurses from overseas can work in our sector. We hope the government and others will see this as a priority for review going forward”.
National Care Forum
Sharon Blackburn, nurse and policy and communications director at the NCF, said: “The inclusion of nurses working in social care, in particular care homes with nursing, is a welcome recognition of the 43,000 nurses that work in adult social care. The NHS is not the only place where registered nurses are employed.
“In care homes with nursing a range of complex care, (including people living with dementia), is delivered in the context of relationship centred care. Ensuring that there are sufficient nurses to meet people’s health and care needs in a safe, effective and compassionate way is essential”.
Read more about the report’s findings and recommendations in our news coverage and analysis:
- HSC: CPD cuts must be reversed to stop nurses from leaving jobs
- HSC: Thousands of posts not covered despite use of agency nurses
- HSC: Language testing must be ‘closely monitored’ by NHS England
- HSC: CNO should lead drive to ensure safe nurse working conditions
- ‘The nursing workforce must be expanded - at scale and pace’
More response to follow…