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Letter gives first glimpse at future nurse workforce strategy

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Nursing shortages in England are “unlikely to improve” without seriously ramping up efforts to recruit more students and stop those already in the workforce from leaving.

That is the warning delivered in a letter to all NHS trust leaders and commissioners by those developing a new 10-year workforce plan for the health service.

“It is clear that we have not been investing sufficiently in CPD”

Letter authors 

The letter, obtained by HSJ and seen by Nursing Times, gives a first glimpse at the “emerging vision” of the future staffing strategy and calls for feedback on early proposals.

It is signed by Baroness Dido Harding and Julian Hartley, who are overseeing the development of the NHS workforce implementation plan.

In the letter (see attached) they say gaps in nursing and midwifery is the “biggest single challenge we currently face nationally” in terms of staffing.

“We currently have vacancies across all branches of nursing, with the most significant shortages in mental health, learning disability and community nursing,” they add. “We have also seen a decline in mature students choosing to train as nurses.

“Our initial analysis suggests that this position is unlikely to improve in the near future without a serious focus on the supply, development and retention of the nursing and midwifery workforce,” they say. 

NHS Improvement

Dido Harding

Baroness Dido Harding

They say they are “examining all available options” for boosting entrants to nursing and midwifery courses – describing the need for this as “urgent”.

However, they add that there are actions that can be taken in 2019/20 “within existing budgets” to tackle the situation, including:

  • · Funding 5,000 extra clinical placements for the September 2019 intake
  • · Launching a new annual recruitment campaign targeting school leavers and linked to work experience
  • · Reviewing current return to practice processes
  • · Securing a job guarantee offer for newly qualified staff
  • · Boosting preceptorship and early career support

In the longer-term, higher education institutions must be “more actively engaged with” to ensure there are enough places for those wanting to become a nurse or midwife, Ms Harding and Mr Hartley say.

They add “maximising the contribution” of the apprenticeship and the new nursing associate routes into the profession must be a focus.

The need to reduce the number of students dropping out of courses and helping newly qualified nurses manage the transition from education to employment is also highlighted.

“The government will need to provide significant extra resources to make these plans a reality”

Dame Donna Kinnair 

Nurses should also be able to move more easily between employers and sectors to give them “fulfilling careers”, the letter authors note.

They highlight the importance of fostering a “culture of continuous development that supports our nursing and midwifery staff to meet their personal aspirations”.

They are proposing a review of the priority areas for clinical professional development (CPD), admitting that previous investment in this has fallen short.

“It is clear that we have not been investing sufficiently in CPD and the development of our workforce more broadly,” Ms Harding and Mr Hartley say. “We know that this has an important bearing on the morale, and ultimately the retention, of our people.

Julian Hartley

Julian Hartley

Julian Hartley

“It is also a critical enabler of new and extended practice which will enable our people to adapt to the changing skill mix that will be required in the future,” they add. “This is why we want to review how current funding is being targeted to ensure it is being used to upskill our people.”

They also want to help employers “identify and fully utilise” advanced level nurses and other practitioners, including by updating the electronic staff record to track numbers and plan their deployment.

The letter also reveals plans to devolve more workforce activities locally through the emerging integrated care systems.

The Royal College of Nursing is part of the workforce implementation group, which is drawing together the plan.

Dame Donna Kinnair, acting chief executive and general secretary, said she was pleased to see through the letter that many of the college’s suggestions had been taken on board.

However, she questioned whether the proposed actions for 2019/20 set out in the letter specifically targeting nursing and midwifery could really be implemented “within existing budgets”.

“It’s good to see the workforce implementation group formally acknowledge what the RCN has highlighted for many years – that the single biggest challenge the NHS faces nationally is workforce shortages in nursing and midwifery,” she said.

“As members of the group, it is positive to see many of our points in this letter to chief executives – such as the increase in the number of clinical placements for nursing students, a recruitment campaign targeted at school-leavers, and the aim to reduce the drop-out rate from nursing degrees,” Dame Donna added.

“However, as a constructive member, I will keep saying it won’t be possible for all these actions be implemented ‘within existing budgets’,” she said. “The government will need to provide significant extra resources to make these plans a reality and to deliver the ‘transformed workforce’ described.”

The workforce implementation plan will set out how ambitions laid out in the NHS Long Term Plan, released in January, around staffing will be achieved.

The first draft of the workforce blueprint is to be published in early April with the final version due within two months of the conclusion of the government’s comprehensive spending review.

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