The shortage of qualified nurses means we are facing an unprecedented crisis.
I recently transferred my nursing skills to work in the adult social care sector and have had to think hard about this shortage and what it means for everyone involved.
Christie & Co’s excellent report, published last month, nails the factors underlying the crisis: the UK has 15,000 too few nurses; numbers of training places are not increasing fast enough; many nurses are reaching retirement age; and the government is choking the supply of overseas nurses through ill-targeted immigration curbs. All these factors combine to make far more than the sum of their parts - it’s a perfect storm.
Nursing homes generally attract older nurses who want a better work/life balance. They are interested in nursing that is big on patient contact, and fed up with the relentless pressures of life in the NHS. We offer similar remuneration, ongoing training and career pathways that allow personal development; we want skilled, confident, self-reliant nurses. If they are interested in career progression it’s a bonus - there are many options available.
But it’s still tough to recruit. The shortage is even more problematic in adult social care than in the NHS. Nursing and residential care employs about 8% of the available nursing pool. We have about 9% full-time equivalent posts vacant - it’s 7% in the NHS. Many nurses simply don’t have a career in adult social care on their radar.
There is no prospect of the crisis resolving itself so this sector has had to think about alternatives. Barchester Healthcare has created a role of care practitioner. This is founded on significant extra training for senior care workers, with the expectation that they will take on basic nursing tasks, freeing up registered nurses’ time for higher-level work. Many of our care staff are eager to skill up to take on this role.
Senior politicians have cautiously voiced support, the Royal College of Nursing’s Peter Hodges advocates a comparable approach and there is a general acceptance among care professionals that this may be the best solution if it is well thought through and properly policed.
But here there is the flaw: the Care Quality Commission has not agreed to recognise that care practitioners are able to manage low-level nursing tasks. I feel some sympathy: it must appear to be a near-omnipotent judge, stern enough to keep the political establishment happy while empathising with problems in the health and care sectors.
I understand not wanting to risk a political “Blitz-bombing” if the new role doesn’t catch the popular imagination but it’s a well-managed, exciting approach. It’s also the best hope we have of riding out the recruitment storm - it may even turn the tide. The CQC must take the lead on the issue rather than wait it out and react.
The new role promises some enticing changes. Care practitioners could also work in health environments, helping to replace the much-missed state-enrolled nurse role. The role would open up new career pathways for care home staff and, in time, perhaps community care workers. It undermines agencies that are exploiting the situation and removes the need to employ agency workers who are lazy, incompetent or simply unfamiliar with their environments. By so doing, it would improve residents’ quality of life significantly. The role will give nurses in care environments more time to plan care and work towards outcomes. It would galvanise the sector.
Creating, sustaining and developing this role is not just riding out the recruitment storm - it is reinvigorating the health and care environment.
Trish Morris Thompson is director of quality and clinical governance at Barchester Healthcare