Reinstate nurse training budgets and make realistic pay offer, MPs tell the government

Commons health committee's report on the nursing workforce issues sweeping recommendations, including monitoring of tuition fee changes and action on CPD funding

• RCN hails ‘the most important report on nurse staffing for many years’
• Report cautions government on linking nurses’ pay rises to productivity
• Government response urged on mature student applications and undersubscribed courses

Cuts to nurse training budgets should be reversed as an immediate way to tackle the current workforce crisis, according to the Commons health committee.

Too little attention has been given to stemming the tide of departing nurses, the influential group of MPs say in a report on their inquiry into the nursing workforce.

The committee issues sweeping recommendations to the government, including a demand that ministers ‘be prepared to act quickly if there are signs the number of nurses in training are declining’ following the removal of the nursing student bursary.

Nursing vacancies

The 51-page document, called the Nursing Workforce, says there are between 36,000 and 40,000 nursing vacancies in the NHS in England alone – though it notes a lack of consensus on how the shortage should be measured.

The report quotes Health Education England (HEE) as suggesting the shortfall is so high that around 3,000 of the vacancies cannot be covered by bank or agency staff.

The MPs say vacancy rates have risen in part as a result of the report into failings at Mid Staffordshire NHS Foundation Trust, following which many new nursing posts were created – but without the nurses to fill them.

The health committee calls for more focus on retention, quoting HEE as saying in its evidence: ‘If we had kept the 2012 retention figure right the way through, we would have 15,000 more nurses than we do at the moment, which is about 50% of all the vacancies we have in the NHS.’

NHS pressures

The report says government policy has focused on increasing the number of new nurses rather than striving to retain existing nurses.

The committee fears newly qualified nurses will quit the NHS if pressures on staff are not reduced in the immediate future.

RCN general secretary Janet Davies called the report ‘the most important report on nurse staffing for many years’, and said she welcomes the fact it reflects so many of the concerns the college has been raising repeatedly.

She says the report also acknowledges the two main reasons for nurses quitting – extremely difficult working conditions and significant cuts to CPD.

Training budgets slashed

A major contributor to nurses leaving the profession has been cuts to nurse education, the report says.

Using RCN evidence, the committee says CPD budgets have been cut from £205 million in 2015-16 to £83.5 million in 2017-18.

The committee says NHS Employers had raised this as a ‘fundamental’ priority for national action, as not only are opportunities for advanced practice becoming limited, it is also becoming difficult to pay for standard training for nurses in specialist areas such as intensive care and community settings.

The committee believes access to training for nurses working in social care is even worse.

It says HEE – which suggested cutting CPD funding to increase investment in new nurses – must reverse the cuts. It must demonstrate within a year ‘clear action’, including producing an audit trail on funding reaching its intended destination, the MPs say.

Open University head of nursing Julie Messenger welcomed the call to ring-fence CPD funding, saying it would ‘help boost support and retention for existing nurses’.

Pay and productivity

On pay, the MPs say the government must come forward with realistic proposals during pay negotiations.

They welcome the lifting of the 1% pay cap but say: ‘We caution that linking productivity to any pay rises must be realistic and recognise the existing pressure on, and productivity gains by, the nursing workforce.’

Chancellor Philip Hammond made clear in his autumn budget that any forthcoming pay rise would be dependent on productivity and negotiations with health and social care secretary Jeremy Hunt.

Yet the committee report cites a paper by the University of York Centre for Health Economics showing NHS productivity is already higher than in the wider economy.

Ms Davies says: ‘We particularly welcome the acknowledgement that holding down NHS pay has been a major factor in this challenge and that the government must now be realistic in linking pay to supposed productivity gains.’

But the MPs caution that pay increases are not the ‘sole solution’ to retention.

Overseas nurses and Brexit

The committee says an immediate priority should be the development of an ethical, national overseas recruitment programme that will reduce the vacancy rate.

England’s chief nursing officer Jane Cummings told the committee a national recruitment drive for overseas nurses had been considered a few years ago but not pursued.

HEE told the MPs about its scheme to bring foreign nurses to the UK on an ‘earn, learn and return’ basis, with an initial cohort of 500 nurses in Harrogate, and an intended expansion to 5,500 nurses.

The MPs urge HEE and NHS England to work together to supply overseas nurses quickly and in sufficient numbers, while acting responsibly and ethically.

The report says English language tests have been a significant barrier to recruiting overseas nurses and urges the Nursing and Midwifery Council to avoid unnecessary barriers to UK practice.

Commenting on Brexit, the committee calls for greater assurances for EU nurses’ right to remain in the UK and recommends the Home Office keep nursing on the shortage occupation list.

Nursing associates

Greater clarity is needed to define the nursing associate role, and those taking up the role deserve their own professional identity, the health committee says.

The report is largely supportive of the new role, suggesting it has ‘potential to greatly enhance patient care’ and to offer a clear route for healthcare assistants to develop their careers.

But the committee warns: ‘Where nursing posts cannot be filled, it will be essential to keep those posts open rather than fill them with nursing associates and then withdraw the advertisement for the post.’

The NMC will regulate nursing associates when the first cohort begins practice next year.

Welcoming the recommendation on nursing associates, NMC chief executive Jackie Smith says: 'There must be clear blue water between the role of a nursing associate and a registered nurse.'

Newly qualified nurses and students

Delays in increasing the number of clinical placements available for nursing students risk putting more pressure on newly qualified nurses, the committee says.

The government scrapped bursaries in England last year in favour of tuition fees, with the aim of increasing the number of nursing students. But the move led to 585 fewer students starting courses last September than a year earlier, the report says.

The government had intended some universities to expand nursing courses and others to run courses for the first time, but a shortage of clinical placements scuppered this aim.

Ministers have committed to funding an extra 5,000 clinical placements per year from 2018-19, but the committee is concerned by this delay.

Decline in mature students

The committee also raises concerns over the decline in the number of mature student applicants immediately following the bursary’s removal, and the difficulty in filling some learning disability and mental health nursing courses.

Council of Deans of Health chair Brian Webster-Henderson says: ‘We have previously identified mature students as being one of the groups most vulnerable to the move away from bursaries. This is something that requires careful monitoring, alongside innovative approaches to recruitment, and if necessary targeted interventions to ensure that we do not lose mature students from the professions.’

The committee recommends close monitoring of the impact of tuition fees, calling on the government to state how it will respond to any further declines in applications from mature students or incidences of undersubscribed courses.

It also calls on HEE to respond to attrition rates and ensure they are factored into future workforce projections.

Specialty shortfalls

The MPs say the number of learning disability nurses fell by 2,023 (38%) between May 2010 and May 2017, while mental health nurse numbers fell by 5,168 (13%) over the same period.

The number of children’s nurses has risen by 1,168 (10%) since 2010.

The RCN welcomes the acknowledgement of a drop in numbers in learning disability and mental health nursing, and supports the call to monitor of the impact on student numbers of the switch from bursaries to loans.

Read more

• Janet Davies: Nursing Workforce report demands solutions to problems facing the profession
• MPs draw up nurse workforce plan to halt exodus from the register
• Commons health committee report: The Nursing Workforce