In too many areas and specialties, the nursing workforce is overstretched and struggling to cope with demand. Over the course of our inquiry, we heard concerns about the impact of these pressures on morale, retention, and standards of care for patients.
Major changes have recently been made to routes in to nursing. However, too little attention has been given to retaining the existing nursing workforce, and more nurses are now leaving their professional register than are joining it. There are many causes for the shortfall in the nursing workforce, including workload pressures, poor access to continuing professional development, a sense of not feeling valued, ongoing pay restraint, the impact of Brexit and the introduction of language testing.
Access to continuing professional development (CPD) was clearly a major issue and we recommend that the cuts to nurses’ training budgets should be reversed and greater attention be given to ensuring nurses can access CPD. The Chief Nursing Officer should write to all Directors of Nursing asking for assurance that their nurses have time to carry out appropriate handovers, and to take their breaks; and that they have access to food and drink near their place of work.
The nursing workforce needs to be expanded at scale and pace. We heard a clear message about relentless pressures which, at their most extreme, meant that nurses felt their professional registrations were at risk because they were struggling to cope with demand. Without increasing the workforce, nurses will continue to experience unacceptable pressure, and their skills will continue to be lost to patients across the NHS and community settings.
We welcome the Government’s development of new routes into nursing, including apprenticeships and the fast track Nurse First programme as well as the new Nursing Associate role. However, traditional three year nursing degrees remain the main route into nursing, and it is essential that the Government closely monitors the impact of recent changes to funding for nursing degrees. The Government must be prepared to act quickly if there are signs that numbers of nurses in training are declining.
In particular, we are concerned about the potential impact of these reforms on mature students, and on branches of nursing already experiencing shortages, such as learning disability and mental health nursing. We ask the Government to set out specifically how it plans to respond if these concerns are realised.
We welcome the new role of Nursing Associate, which has the potential to add further support for patient care and which adds diversity to the workforce as a route onwards for aspiring nurses for whom the traditional undergraduate route is not an option. It will enable Healthcare Assistants, who previously had few career progression options or opportunities for further training to become Nursing Associates (NAs) and if they so wish progress from there via the apprenticeship route into degree nursing. Nursing Associate is a role in its own right, not a substitute for registered nurses, and those undertaking this training deserve a clear professional identity of their own. We recommend the development of a clear, plain English guide to this new role, which will be helpful for patients, the public, team members and employers alike, setting out NAs’ scope of practice across a range of settings.
Nurses from across the EU working in the UK need and deserve further reassurance about their right to remain, following the vote to leave the EU. They need a clear message that they are welcome and appreciated and that they will be able to remain working as nurses in the UK.
The UK depends upon nurses recruited from overseas, and will do so for many years to come. Whilst recognising the need for communication skills, it is essential that changes to language testing for overseas nurses wishing to practice in the UK must be carefully and regularly monitored to ensure that they are not placing unnecessary barriers to UK practice. Overseas recruitment must continue to follow clear ethical principles, and we recommend that this should also be co-ordinated at a national level. Moreover, migration policy needs to ensure that the UK continues to have access to the nurses it needs. We call on the Home Office to extend the period that nurses are on the shortage occupation list.
We welcome Health Education England’s decision to publish a draft workforce strategy and also to take a longer-term view. The Government and HEE must act to ensure that reliable data is available from across all sectors to inform workforce planning. Moreover, future projections of demand for nurses should be based on demographics and other demand factors, rather than on affordability.
Pay restraint is a factor in the recruitment and retention challenge and we welcome the announcement that the cap has been lifted as well as reassurance that funding for the rises will not come out of existing NHS budgets. We caution that linking productivity to any pay rises must be realistic and recognise the existing pressures on, and productivity gains by, the nursing workforce.
25 January 2018