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'We need to be more innovative if we want to solve the nursing recruitment crisis'

Lynne Gell
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No one in the health sector could doubt after the latest set of official figures that nursing is facing an unprecedented recruitment challenge

Even if the situation hasn’t deteriorated markedly from the beginning of the year – when statistics revealed that more nurses were leaving than joining for the first time in NHS history – we are still in uncharted territory. 

Three factors suggest there will be no short-term fix. Brexit is suppressing the supply of nursing candidates from the European Union. A healthy jobs market offers ample opportunity for employment alternatives (over half those leaving the NHS are under 40).

And demography is against us – the number of young people entering the workforce is set to decline just as demand for NHS services inexorably increases as the population ages.

“It isn’t going to be easy to plug the recruitment gap”

Given such headwinds, it isn’t going to be easy to plug the recruitment gap. As things stand, only one in seven nursing and midwifery vacancies are being filled, with trusts in some areas reporting miniscule fill rates of 1% or 2%.

Thankfully, and not before time, the government has recognised the scale of the problem. Last month, it approved an £8 million advertising blitz to convince 14-18 year olds of the benefits of a career in nursing.

Welcome though this is – especially the implicit acknowledgment that we won’t make long-term headway with healthcare recruitment until we persuade youngsters in school that nursing could be for them – it doesn’t go far enough. What is needed is a far more imaginative, long-term approach to the skills shortage.

First, we need to think and act locally. The profession has relied too much on training healthcare workers outside communities and expecting them to move once qualified to areas they may have little association with. Invariably, people with children or other family commitments are not that mobile. We need to acknowledge the relative immobility of much of the healthcare workforce if we want to upskill communities.

It makes sense, therefore, for training to come to the community rather than the other way around. Technology can play a big part in this by delivering online courses, flipped learning and targeted mentoring. But it also requires a change in attitude – an acknowledgement that training has to be accessible and flexible enough to adapt to the needs of the learner.

“It makes sense for training to come to the community rather than the other way around”

Second, more use should be made of clinical apprenticeships. The NHS has always supported structured apprenticeships in a range of roles, but these have tended to be in non-clinical areas.

I appreciate that converting existing courses into apprenticeships isn’t always straightforward, particularly when funding historically has come from elsewhere and the roles are supernumerary. 

Yet NHS trusts are already paying vast sums through the apprenticeship levy and must meet a government-imposed requirement to have 2.3% of their workforce as apprentices by 2020. It makes sense for them to expand their apprenticeship programmes into nursing and related areas, which will allow them to recoup levy spend and secure their talent pipeline.

There is an added benefit – all the evidence suggests apprentices tend to stick around longer than other recruits, so retention problems could be reduced.

Finally, we have to double down on efforts to upskill healthcare assistants. Support staff already provide 60% of patient care but until recently, only received 5% of the national training budget.

The Talent for Care initiative four years ago accepted the need to redress that skills deficit but we have to ensure progress is sustained and expanded. The bald truth is that if we cannot entice enough new recruits into nursing, then we have to upskill those in supporting roles. 

The more far-sighted trusts are of course already adopting some or all of these measures. But we need a more concerted and widespread effort across the system if we want to avoid this crisis becoming entrenched and permanent.

Professor Lynne Gell is Dean of BPP University School of Nursing

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