Here we unpack the key points made in a vital report contributed to by Nursing Times readers on the current state of the nursing workforce, the challenges facing it and the possible solutions.
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.
- Nursing organisations welcome major report on workforce
- ‘The nursing workforce must be expanded - at scale and pace’
- Ann Marie Rafferty: ’Nursing on the critical list’
The Commons’ health select committee published a major report on 26 January looking at the current nursing workforce crisis in England, following an inquiry by the cross-party group of MPs. It warned that the nursing workforce needed to be expanded “at scale and pace” but also highlighted that more nurses were now leaving the register than joining it.
Among the report’s 17 recommendations were calls to reverse cuts to continuing professional development to stop nurses from leaving jobs, for language testing to be closely monitored and for the chief nursing officer to lead drive to ensure safe nurse working conditions.
The report was compiled with the help of the Nursing Times. The MPs held focus group sessions with nurses attending the Nursing Times Team Leaders’ Forum in Birmingham as well as a separate discussion with nurses in London, which was also organised by Nursing Times.
Below we sumarise the four key stories to come of the report, plus reaction to. For full coverage, analysis and comment on the report, visit our dedicated web page.
Reverse CPD cuts to stop pressured nurses leaving
Cuts to continuing professional development budgets for nurses should be reversed as part of efforts to retain an often “overstretched” and “struggling” workforce, MPs have concluded.
The health select committee warned that not enough attention had been paid to keeping hold of the existing nursing workforce, noting that Health Education England had reduced nurse CPD funding to prioritise paying for more student nurses.
“[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 MPs. They called for funding allocated to trusts to be specifically ringfenced for nurse CPD and that specific funding should be made available to support CPD for community nurses.
More widely, the MPs said they welcomed new routes into nursing, such as apprenticeships, fast-track programmes and the nursing associate role, but stressed that three-year nursing degrees remained the main route into the profession.
Nursing associates should not be a substitute for nurses and deserved a professional identity of their own and there was an “urgent need for greater clarity” on the role’s introduction, they said. For example, it said clarity about scope of practice was essential for patient safety and called for a “plain English guide” guide to be developed, which should include examples of tasks that associates will, and will not, be expected to undertake. This should be in addition to standards being produced by the Nursing and Midwifery Council, said the MPs.
They also warned the government it “must be prepared to act quickly” if the number of student nurses decreased following the removal of bursaries. “While it is too early to draw firm conclusions, there are early warning signs of emerging problems,” said the MPs, citing a recent drop in applicant levels and course numbers towards the end of last year.
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 MPs. They also noted concern on current dropout rates from nursing courses, with around 30% of undergraduates not completing their courses.
Thousands of nurse posts not covered despite use of agency and bank staff
The NHS in England is unable to fill round 3,000 empty nurse posts despite the use of bank and agency staff, according to the health select committee.
The MPs noted that, though temporary staff were being used on shifts to cover 33,000 empty posts, a further 3,000 were going unfilled, based on estimates given them by Health Education England.
They said that, while temporary staff offered flexibility, the priority “must be to recruit and retain permanent staff” to provide “the best standards of care and continuity”. “Permanent posts must not be deliberately left vacant or recruitment delayed to ease financial pressures,” the MPs said.
They noted the number of NHS nurse vacancies had gone up in recent years, partly due to the so-called Francis effect after the 2013 Mid Staffordshire Foundation Trust inquiry. But they highlighted there were not enough nurses to fill the substantive posts and that temporary staff were being used to fill some of the vacancies.
As was recently stated in a draft workforce plan published by HEE, the MPs noted that the highest vacancy rate was in learning disabilities – at 16.3% – followed by 14.3% for mental health nursing, 10.9% for children’s nursing, 10.1 for adult nursing and around 9.5% for community nursing.
But the MPs warned there was still not a nationally agreed figure of the exact size of the nursing shortage. They called for the government and HEE to publish “robust, timely and publicly available” data at a national, regional and trust level on the scale of the nursing shortage.
Language testing must be ‘closely monitored’
Language testing of nurses from outside the UK must be “closely monitored” by NHS England to ensure checks are set at an appropriate level while not hindering recruitment, according to the health select committee.
The MPs were told that language testing for those wanting to join the UK register, overseen by the Nursing and Midwifery Council, was a “significant barrier” to nurses coming to work in the NHS. In November, the NMC started accepting nurses who had passed the Occupational English Test as well as the widely criticised International English Language Testing System that it had solely backed before.
But the MPs said they had heard evidence that this change was still “insufficient” to ease overseas recruitment delays and recommended that NHS England “closely monitor” the situation. They also called for NHS England and Health Education England to develop an ethical overseas recruitment programme “as an immediate priority” now that trusts had begun to turn their attention to countries such as India and the Philippines due to Brexit. The MPs said: “It is essential that overseas recruitment is undertaken responsibly and ethically”.
CNO should lead drive for safe working conditions
The chief nursing officer for England should take a lead in setting out how nurses are able to work in “safe and acceptable” working conditions, the health select committee has said.
The MPs heard how nurses often arrived early for shifts and finished late, and were unable to take breaks because there were too few staff. “Nurses also told us that they lack even basic facilities on the wards where they work to prepare food and drink for themselves,” said the MPs.
They called on the CNO to ensure nurses were working in “safe and acceptable” working conditions, and that staff wellbeing be a “national policy priority”. The CNO should set up a nursing wellbeing reference group to monitor and help to advise on improving working conditions, they said.
The CNO should also write to all directors of nursing, asking them to confirm whether nurses were able to complete handovers without routinely staying late, and if they had time to take their breaks, said the MPs.
What they said: Views on the nursing workforce crisis
Hunt hints that pay rise will be linked to staff contract changes
“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”
Sarah Wollaston, chair, health select committee
Mental health nurse to be next chair of Council of Deans
“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”
Brian Webster-Henderson, chair, Council of Deans of Health
Jenni Middleton (Serious)
“The most important aspect of this report is what it is calling for above all else – that efforts must be made to expand the nursing workforce ‘at scale and pace’”
Jenni Middleton, editor, Nursing Times
Royal College of Nursing appoints new leader
“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”
Janet Davies, chief executive and general secretary, Royal College of Nursing