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Summary: What ministers said on key nursing workforce concerns

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Here is your guide to the government’s response to a major report from MPs on a range of key nursing workforce issues

Earlier this year, the Commons’ Health and Social Care Committee made 17 recommendations from its inquiry into the nursing workforce.

As reported today by Nursing Times, the government has this week published its official reponse to the report.

Here is a summary of what the government said on key questions raised by the MPs:

 

STAFF RETENTION

Recommendation 1: Work to boost retention should continue with a focus on boosting CPD. It should be easier for nurses to move between departments, organisations and sectors and get training

The government said it was pleased the committee had acknowledged work already under way to support retention in trusts and said it believed the new pay deal, which will see the starting salary for a nurse increase to £24,907, will have a “significant impact on recruitment and retention issues”.

  • The document sets out plans for the second year of the NHS Employers and NHS Improvement retention scheme - starting this month. The key areas this will focus on include supporting people new to the NHS, supporting those mid-career who need flexibility and a good work-life balance, developing initiatives for nurses aged 50 and over, CPD and housing and transport
  • In addition to looking at retention in trusts, the documents says NHS England will invest in the recruitment and retention of practice nurses through the General Practice Forward View
  • When it comes to making it easier for staff to move around within the NHS, the response highlights the fact work is under way on “place-based” models to make it easier for staff to switch between multiple employers
  • Other work designed to boost retention includes addressing housing issues. The department is working with NHS land owners on a scheme that will see NHS employees offered first right of refusal on affordable housing on land sold with the aim of benefiting 3,000 families

Recommendation 2: Reverse cuts to CPD with ring-fenced funding for CPD for nurses and specific funding to support CPD for community nurses. CPD must reflect skills shortages and patient needs.

The importance of CPD and its role in boosting retention was one of the key messages to come out of the select committee enquiry. However, the government has yet to respond. The documents states the department will consider the recommendations on CPD in more detail and “set out potential options as soon as possible”

Recommendation 3: Nurses must be able to hand over patients safely to without routinely staying late and must be able to take breaks and access food and drink near their place of work

The document does not include a specific response to this recommendation but does say the CNO should write to nursing directors – see recommendation 5.

Recommendation 4: There needs to be a greater focus on wellbeing in all areas with nurses at all levels contributing to national policy.

The response sets out a range of measures the department and its arm’s length bodies have already taken to improve staff wellbeing including the launch of a Health and Wellbeing programme. However, there is no mention of specific efforts to involve nurses in this work.

  • The response highlights the NHS’s Healthy Workforce programme, which has been running since September 2015. Key goals including identifying effective interventions to target the main causes of sickness absence and looking at leadership in this area.
  • Other work flagged up in the response includes work with a handful of trailblazer organisation to develop best practice. In 2017/18 NHS England funded five trusts and one clinical commissioning group to explore different ways of boosting staff wellbeing. Examples of projects include Northumbria Healthcare providing resilience training to 500 nurses.
  • More recently NHS England published a Health and Wellbeing Framework to set the standard all NHS organisations should live up to alongside a diagnostic tool to help employers assess how they are doing and make improvements.

Recommendation 5: The CNO should write to all directors of nursing, including in social care, to ensure nurses are able to complete handovers safely without routinely staying late and have time for breaks.

The response says the CNO will write to nursing directors “in line with this recommendation” but does not say when that will happen or what the CNO will say.

Recommendation 6: The CNO should establish a “nursing wellbeing reference group” including nurses of all grades, different stages of their careers and different types of settings, which would “design and oversee a programme of work to monitor and help to advise on improving working conditions”.

There do not appear to be plans for a standalone group with its own programme of work. However, the response states the CNO has set up a nursing reference group to support the work of the NHS’s Healthy Workforce programme advisory board chaired by Professor Dame Carol Black.

 

NEW NURSES

Recommendation 7: Government must monitor the impact of scrapping the nursing bursary especially when it comes to mature students and courses in shortage specialties and set out the action it will take if numbers continue to fall.

In its response the government is adamant the bursary system “was not working”. While it acknowledges applications to nursing courses have dropped it maintains there is still strong demand for nursing courses with more applicants than places and highlights measure it has put in place to those who need extra help to study – such as people with children – and protect low earners who may struggle to pay back a student loan

  • Work to boost applications includes the recent launch of a campaign to promote nursing to encourage applications through clearing in 2018
  • Other key developments include the fact postgraduates can now access student loans to do pre-registration nursing courses and the response highlights a new “golden hello” incentive scheme for postgraduates embarking on courses starting in September this year who go on to work in specific fields such as mental health, learning disability and district nursing
  • The government says it is monitoring the impact of the move to loans and will publish an update in autumn this year

Recommendation 8: More action is needed to tackle the high attrition rates for some nursing courses and reduce variation.

The committee said it was startled to hear that 30% of nursing undergraduates do not complete their courses but the government is quick to point out this was a “misrepresentation” of the data from its Reducing Pre-registration Attrition and Improving Retention (RePAIR) scheme focusing on four fields of nursing, midwifery and therapeutic radiography. The confusions comes over the fact 30% of students included in this scheme do not complete their course on time.

  • The response highlights work by the RePAIR project with 16 sites that are exploring different approaches to reducing attrition such as buddying schemes and looking at the design of preceptorship programmes.
  • The document states the government had expected the move from bursaries to loans would reduce attrition but it is “too early to say” if this is the case

 

NURSING ASSOCIATES

Recommendation 9: More clarity is needed on the nursing associate role to ensure people understand they are registered professionals in their own right and not “substituting nurses”.

The government agrees more work is needed to publicise and communicate the nursing associate role and to this end has established a Nursing Associate Communications Group. “We do not want to set out a list of tasks which nursing associates can and cannot perform as we all believe this will be too restrictive,” says the document. However, it says there will be further guidance on how nursing associates should be deployed

 

NURSES FROM OVERSEAS

Recommendation 10: A central recruitment programme for overseas nurses is not happening at the scale and pace needed. Developing an ethical overseas recruitment programme to deliver the number of nurses needed in England in the short to medium-term should be an “immediate priority”.

The government accepts ethical international recruitment “clearly has a role to play in meeting the short-term staffing needs of the NHS” as well as a longer-term role in ensuring access to world class expertise. HEE has designed the Global Learners Programme as a temporary measure and is working to develop large-scale ethical recruitment programmes but this is complex as each country requires a different approach, says the document. The aim is to recruit more than 1,000 nurses from overseas per year from 2018/19.

Recommendation 11: More assurance is needed for EU nursing staff in England that they will be able to stay in the UK

The government says it “hugely values” the contribution of EU staff and “understands the need to give them certainty”. It maintains steps have already been taken in this regard. In December last year the government and EU agreed to safeguard the rights of people who have built lives in the UK post-Brexit – this includes the 150,000 EU national working in health and social care. Meanwhile the document highlights the fact nurses are on the Shortage Occupation List, making it easier for those from outside Europe to come and work in the UK. Nevertheless the government goes on to stress it is also focusing on increasing the supply of home-grown nurses in response to this recommendation.

Recommendation 12: Need to ensure language testing is appropriate and not an “unnecessary barrier” to recruiting international nurses

The government makes it clear this is a matter for the Nursing and Midwifery Council, which started a review of language testing in summer 2017. Changes introduced in November year included accepting the Occupational English Test alongside the International English Language Test System. The department says it will be monitoring the situation.

Recommendation 13: Migration policy should reflect the need to ensure the UK can recruit and retain the nurses it needs.

The response makes it clear this is a work in progress. The Migration and Advisory Committee is gathering evidence on patterns of EU migration ahead of Brexit with a report due out in September. The department has provided evidence to the committee to “ensure the position of staff in health and social care is fully understood and taken into account”

 

WORKFORCE PLANNING

Recommendation 14: Develop a nationally agreed dataset to enable a consistent approach to workforce planning and an agreed figure for the nursing shortfall – including advanced practitioner roles. Department must ensure robust data on the scale of the nursing shortage at a national, regional and trust level

The government says it recognises the importance of establishing the scale of nursing shortage. The response says the department is working with its arm’s length bodies to work out the most accurate way to count and report the shortage of nurses but “this is not a simple task”

  • Measure set out in the document include the creation of a “vacancy subgroup” led by NHS Digital to investigate the current provision of vacancy stats and how this might be improved in the future
  • Meanwhile HEE and NHSI will jointly collect data to provide an annual picture of staffing shortages for individual professions such as nursing and different parts of the nursing and midwifery workforce
  • The response acknowledges more work is needed in a number of key areas to ensure better data on bank and agency staff, flow of staff – number of joiners and leavers and reasons for leaving, over-arching workforce trends in specific care pathways and settings and in advanced and supporting roles, local and regional patterns, the workforce beyond the NHS
  • The response says updated coding of the nursing workforce should boost understanding of trends in advanced nurse practitioner roles

Recommendation 15: Future projections of the need for nurses must be based on demographics and demand – not just affordability and take into account the inter-relatedness of health and social care. There is a need for detailed projections for nursing staff – both in terms of numbers entering the workforce through different routes and anticipated need. Projects must include nurses working in and outside the NHS.

In its response to this recommendation the department emphasises the fact the NHS has finite resources and affordability must be factored into workforce projections. The document highlights work under way to improve workforce planning practice and collect better data on nurses including work to better understand the flow of nurses in and out of the workforce and between different sectors.

Recommendation 16: Plans to improve workforce data are “long overdue”.

The government starts out by making it clear that understanding, analysing and acting on NHS workforce data is difficult with 1.3m people in 350 different roles moving between 1000s of employers making it “almost certainly the most complex and dynamic workforce picture in the world”. The response department and its arm’s length bodies will review data requirements across the system, working with professional regulators to “understand the dynamic of the whole workforce not just that employed by the NHS”. Health Education England will continue to publish “profession specific” analysis to inform local and national policy

Recommendation 17: More scrutiny of Sustainability and Transformation Partnership (STP) and Accountable Care System plans when it comes to tackling shortages in community nursing.

The response does not mention community nursing but does say HEE is working with STPs to develop service and workforce plans as well as working with individual providers. It states workforce delivery plans will be devised to support national programmes and STPs, which will form the basis for conversations about “who needs to do what and when”.

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