The nursing workforce Contents

Conclusions and recommendations

Retention–keeping the current workforce

1.We note the work that is already under way by NHS Employers and NHS Improvement to support trusts with retention, and we recommend that this work should continue, with a specific focus on initiatives that will increase the opportunities for nurses to access high quality continuing professional development, flexible career pathways and flexible working. NHS England, NHS Employers and HEE should facilitate transfers and training for nurses who wish to move between departments, organisations and sectors and remove unnecessary bureaucratic barriers which prevent recognition of their skills (Paragraph 45)

2.Health Education England must reverse cuts to nurses’ continuing professional development budgets. Funding allocated to trusts should be specifically ringfenced for CPD for nurses, and specific funding should be made available to support CPD for nurses working in the community. We also recognise the need for Health Education England to be able to support training in areas where the NHS has skills shortages. We heard a clear message that access to continuing professional development plays an important role in retention. It will also need to reflect skill shortages and patient needs. This change should be clearly communicated to nurses both by national bodies and by employers, and a clear audit trail should be available to ensure that funding reaches its intended destination. We will review progress on this recommendation in one year, and will expect HEE to be able to demonstrate clear action on each point. (Paragraph 46)

3.The Chief Nursing Officer should take a lead in setting out how to ensure that nurses are working in safe and acceptable working conditions. Nurses must be able to hand over patients to colleagues safely, without routinely staying late; nurses must be able to take breaks; and nurses must have access to facilities to make food and drink near their place of work. (Paragraph 47)

4.There needs to be a greater focus on staff wellbeing in all areas. This work should be driven forward as a national policy priority, and nurses of all grades and from all settings should contribute to it. (Paragraph 48)

5.As a first step, we recommend that the Chief Nursing Officer should write to all Directors of Nursing, including in social care providers, asking them to confirm whether their nurses are able to complete handovers without routinely staying late, and whether they have time to take their breaks. (Paragraph 49)

6.The Chief Nursing Officer should establish a nursing wellbeing reference group, with membership of nurses from all grades, career stages and settings, which should design and oversee a programme of work to monitor and help to advise on improving nurses’ working conditions. (Paragraph 50)

New nurses

7.While it is too early to draw firm conclusions about the impact of the withdrawal of bursaries and the introduction of student loans and apprenticeships, there are early warning signs of emerging problems. In its response to this report, the Government should set out a) how it is monitoring this situation, and b) what specific actions it will take i) if applications, especially from mature students and to courses in shortage specialities, continue to fall, and ii) if courses are undersubscribed. (Paragraph 73)

8.We were particularly concerned to hear that 30% of nursing undergraduates do not complete their course, and we would like further assurance from HEE that attrition rates have been taken into account in future workforce projections. There is stark variation in the attrition rate for nursing degree courses. This must be closely monitored, and HEE and the Government must hold universities and NHS provider organisations to account for investigating and addressing the causes. In response to this report we want to see action to reduce variations in attrition rates between institutions and will follow this up in a year to ensure progress has been made in bringing low performers up to the level of the best. (Paragraph 74)

Nursing associates

9.Nursing associates need and deserve a clear professional identity of their own and we recommend that development and communication about this role should be led nationally. Clarity about the NA role, and the scope of their practice, is also essential for patient safety. There must be a clear understanding that NAs are registered professionals in their own right, supplementing rather than substituting for nurses. Alongside the professional standards being developed by the NMC against which NAs will be regulated, we recommend that a ‘plain English’ guide to the new role should be developed, published and communicated at both a national and a local level. This guide should include examples of tasks that NAs will, and will not, be expected to undertake, but will need also to reflect the scope of their practice across a range of healthcare settings. (Paragraph 89)

Nurses from overseas

10.Whilst welcoming the proposal for a central recruitment programme for overseas nurses, we have not seen evidence that it is being made to happen at the scale and pace needed. We recommend that Health Education England should work closely with NHS England, as well as working directly with health and social care providers, to develop an ethical overseas recruitment programme that will deliver the numbers of new overseas nurses needed in England in the short to medium term. This should be done as an immediate priority, and HEE’s draft workforce strategy should be updated to include such a programme. (Paragraph 106)

11.NHS England must closely monitor the situation regarding language testing to ensure it is at an appropriate level whilst not proving an unnecessary barrier to recruiting trained international nurses. We recommend that in response to this report NHS England provide us with a report setting out how they are monitoring the situation, what the data show following the NMC’s changes, and what action they are taking as a consequence. We will then expect an update on that report on 1st November 2018. (Paragraph 107)

12.Further assurance is needed to retain EU nursing staff in England. We urge the Government to set out what further measures they will take to ensure the message—that they will be able to remain in the UK, irrespective of the final outcome of negotiations—is getting through. (Paragraph 108)

13.It is in the national interest to ensure that migration policy ensures that the UK is able to recruit and retain the nursing workforce it needs. We ask the Department of Health to provide us with further evidence that it is taking this forward with urgency with other relevant Government Departments. We recommend that nursing remains on the shortage occupation list and that the current period is extended and kept under regular review. (Paragraph 109)

Workforce planning

14.We recommend the development of a nationally agreed dataset to enable a consistent approach to workforce planning and an agreed figure for the nursing shortfall. This dataset should include figures on how many nurses have taken up advanced practitioner roles. The Department of Health and its arm’s length bodies must ensure there is robust, timely and publicly available data at a national, regional and trust level on the scale of the nursing shortage. (Paragraph 115)

15.Future projections of need should be based on demographic and other demand factors rather than just affordability. They also need to include proper consideration of the interrelated nature of the social care and other non-NHS nursing and wider healthcare workforce. HEE should publish detailed projections for nursing staff for the coming years—both numbers entering the workforce from different routes and the anticipated need for staff—and must clearly set out the basis on which its future projections of need for nursing staff are made. These projections must include nurses working in and outside the NHS. (Paragraph 116)

16.The Draft Workforce Strategy describes plans to improve workforce data. This is long overdue, and we will ask the Department and HEE to provide us with an update on these plans in six months’ time. (Paragraph 117)

17.Sustainability and Transformation Partnership and Accountable Care System workforce plans need full scrutiny from HEE. This scrutiny should be carried out in a timely and transparent manner and take account of, and look to redress, shortages in community nursing. In response to this report, Health Education England must set out its planned timescales for undertaking this scrutiny, and we will expect it to supply us with a report of its scrutiny of STP workforce plans when they have been completed. (Paragraph 118)

25 January 2018