The worrying finding from the Nursing and Midwifery Council (NMC) that, for the first time in nearly a decade, more nurses and midwives are leaving the profession than are joining it will not be a surprise to those working in children’s palliative care.
Together for Short Lives’ recent nursing survey echoes the NMC report, with voluntary sector children’s palliative care providers across the UK facing the same nursing vacancy rate (11%) as the NHS in England.
Unless things change radically, the long-term impact of this nursing gap could be devastating. Put simply, as things stand we do not have sufficient number of qualified nurses and consultants in this country to meet the complex needs of babies, children and young people with life-limiting and life-threatening conditions. In fact, children’s palliative care services are already being cut - including vital short breaks provided by children’s hospice services.
As a result, despite the brilliant dedication and hard work of those providing children’s palliative care, our ability, as a society, to provide all these children with the quality of life and end of life care they deserve is inconsistent and patchy - largely dictated by geography and a post code lottery of provision.
“The number of children and young people with life-limiting and life-threating conditions is growing”
This is desperately frustrating for families and for the dedicated children’s palliative care charities, but should also be frustrating for the UK government in their ambitions to deliver on their commitment to choice for children and young people in England who reach the end of their lives.
The nursing shortfall will get far worse – unless there is urgent action. We know that the number of children and young people with life-limiting and life-threating conditions is growing. It’s vital that the recruitment of qualified and experienced nurses keeps pace with a growing population.
There are 49,000 children and young people living in the UK with conditions that are life-limiting or life-threatening - and the number is rising. A recent report, ‘Children in Scotland requiring Palliative Care’, based on a study by University of York, showed a 50% increase over a ten-year period in the number of children and young people with life-shortening conditions in Scotland; their numbers have risen from 4,334 in 2004 to 6,661 in 2014. This is a dramatic increase and, if the increase has occurred across the UK, this suggests that current estimates of 49,000 children and young people with life-shortening conditions could be a significant underestimate.
These babies and children have increasingly complex needs – recruitment of qualified nurses is not keeping pace with that need.
In their response to the new research by the NMC, the government has stated that there are 13,000 more nurses working on wards since 2010, but this increase has not been felt by voluntary sector children’s palliative care providers, where the vacancy rate has risen since 2015. This is having a real impact on services and the children and families that they support.
“One in five children’s hospices have been forced to close beds”
Together for Short Lives’ research found that a majority (58%) of voluntary sector children’s palliative care providers say that the nursing shortage is impacting care and one in five children’s hospices have been forced to close beds. For the first time since our survey began, three (13%) services reported that vacancies affected their ability to provide 24/7 care.
Worryingly, the NMC report also highlights that the average age of those leaving the nursing and midwifery register has fallen from 55 in 2013 to 51 in 2017. This is particularly concerning for voluntary sector children’s palliative care providers, which require highly skilled and experienced nurses to provide complex care for children with life-limiting and life-threatening conditions. Our latest survey shows that the number of vacancies at these organisations was highest at salaries equivalent to NHS Band 6 (in 2015 it was Band 5). It is vital, therefore, that we retain our highly experienced nurses to fulfil these posts.
How can we help address the shortage in voluntary sector children’s palliative care nursing? Together for Short Lives is calling for a three-pronged action plan.
Firstly, it is crucial that the university undergraduate nurse programmes include rigorous children’s palliative care nursing education.
“All political parties made strong commitments to the NHS”
Secondly, workforce planners should include voluntary providers in their planning, to give a full picture of workforce shortages - we want to work with government to build a full picture of shortages and effective plans to get workforce planning right in the future.
Thirdly, we are calling on the UK government to make sure that the UK’s exit from the European Union does not have an adverse impact on the supply of nurses and to preserve the rights of European Economic Area nationals currently employed as nurses in the UK.
All political parties made strong commitments to the NHS in their general election manifestos. The Conservative Party manifesto committed to ensuring that the ‘NHS and social care system have the nurses, midwives, doctors and other health professionals that it needs’.
We want to work with government to help make this a reality, so that the 49,000 children with life-limiting and life-limiting conditions in the UK can access the lifeline services that they depend on.
Shaun Walsh, executive director of external relations, Together for Short Lives