Retention still a concern for children's nursing, despite rise in staff numbers

In January, the House of Commons health committee published its inquiry into the NHS workforce. Although the number of children's nurses has gone up, figures show 10.9% of posts in England are now unfilled. So how can workforce pressures be eased?

In January, the House of Commons health committee published its inquiry into the NHS workforce. Although the number of children's nurses has gone up, figures show 10.9% of posts in England are now unfilled. So how can workforce pressures be eased?

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On the face of it, children’s nursing did not seem to come off too badly in the recent review of the workforce by the House of Commons’ health committee.

The report warned there were ‘unacceptable’ pressures being placed on the workforce because of the shortage of nurses, recommending further reassurances for EU nationals post-Brexit, a fair pay rise and the creation of a well-being group to advise on improving working conditions.

But the figures highlighted by the cross-party group of MPs showed that, since 2010 the number of children’s nurses working in the NHS in England had actually risen by 10% to more than 16,500. Only midwifery had seen a bigger increase.

The bigger picture


More children’s nurses in 2017 than in 2010

It is a similar story in the rest of the UK too with Scotland, Wales and Northern Ireland all seeing rising numbers of children’s nurses.

But that only tells part of the story. While staff numbers may be on the increase, there are still severe shortages. The committee warned 10.9% of children’s nursing posts were vacant in England.

Even in Scotland, which tends to have the lowest nurse vacancy rates in the UK, it is telling that the most acute shortages are seen in children’s services.

Neonatal services under pressures

One of the most under pressure areas of hospital care is neonatal services. The number of nurses working in units in England has risen by nearly 800 in the past three years, but Neonatal Nurses Association chair Claire O’Mara says the NHS is still around 2,600 short of what it needs to achieve the recommended staffing ratios. She says the ‘single biggest issue’ neonatal nurses face is lack of access to QIS – Qualified in Specialty – training.


Children’s nursing posts are vacant in England

This has been caused by cuts to the CPD budgets, which was one of the core themes of the committee’s report. Ms O’Mara says in some areas hospitals have even resorted to using charitable donations from parents to fund the training.

She says: ‘Without the correct training nurses are being put into unfair situations caring for severely sick babies that they do not have the skills for.

'This inevitability results in babies receiving substandard care putting nurses under pressure with many leaving as they fear their registration could be at risk.’

What is being done to boost nursing in England

The government in England maintains plans are in place to tackle the workforce problems in nursing. So, what is happening?

  • The 1% pay cap in the NHS is being lifted in 2018, although details of the rise have yet to be revealed.
  • Training places are increasing by one quarter this year to over 25,000 places in England, more than 10% of which are expected to be children’s nurses.
  • New routes into nursing through apprenticeships and the nursing associate scheme.
  • The return to practice scheme is being extended with the aim of getting 1,000 joining up each year from now on.
  • A Homes for Nurses scheme, giving 3,000 NHS workers first refusal on affordable housing generated through the sale of surplus NHS land.
  • NHS Improvement is running a three-year retention programme providing direct support to all mental health trusts and half of hospital trusts.
  • Health Education England’s draft ten-year workforce strategy published in December promises to take a long-term look at the workforce, acknowledging there is a need to increase the numbers of child public health nurses in particular


But, if you look at other areas of nursing that provide care to children – the children’s nursing group used by the committee are mainly hospital-based staff – it is also clear that that there are severe pressures.

Learning disability and mental health vacancy rates at 16.3% and 14.3% respectively are even greater than those in dedicated children’s services.

The committee report also warned that these two sectors maybe even more at risk in the future as there was evidence mature students had been ‘disproportionately dissuaded’ from training following the scrapping of the bursary scheme.

The report said this was of ‘great concern’ as mature students made up the majority of nursing students on these courses. It wants this situation to be monitored closely.

Warning signs

Elsewhere there are other warning signs. There has been an 11% drop in community nurses since 2010 – this is a group that includes community children’s nurses and district nurses.

School nurse numbers are down 19% and while health visitor numbers may have gone up by over 800 to 8,700, that is still down from a peak over 10,000 in 2016.

School and Public Health Nurses Association professional officer Sharon White says these posts have become particularly vulnerable as they now come under the remit of councils, which have had their budgets cut by central government.


Fall in school nurses over past seven years

‘Posts are going and it is leaving those left under incredible pressure,’ she says. ‘We are seeing lots of weird and wonderful solutions developing with health visitors left to look after children between age 0-11 years and school nurses being given responsibility for 0-17 years. These nurses may not necessarily have the training for these age groups. It is concerning.’

'Serious shortages in palliative care'

RCN professional lead for children and young people Fiona Smith agrees, saying the decreases in school nurses have been significant, while also highlighting what she says are ‘serious shortages’ in palliative care alongside problems elsewhere.

She says that overall children’s services are under ‘immense pressure’, adding: ‘Demand is outstripping supply – so any rises seen are miniscule.’

And she says it could be even worse than what has previously been reported: ‘We need much better data when it comes to children’s services. We simply don’t have the full picture. A lot of nurses are employed outside the NHS, by local authorities and the independent sector. These are not always captured.’

Creative thinking in children's services

With children’s services under pressures, several organisations have been trying to think creatively in the way they deliver services and attract nurses.

In East Cheshire health visitors, children’s centres and early years staff have been brought together to provide an ‘enhanced’ healthy child programme offer.

All new parents are given 12 contacts in the first five years with health visitors linked to nurseries and childminders, to ensure children do not slip through the net.

Meanwhile, in the London borough of Haringey public health funds have been used to boost the pay of health visitors, allowing them to attract more into post.

And Whittington Health NHS Trust in London is trying to entice newly qualified band 5 nurses by offering them the opportunity to do three eight-month rotations across children’s hospital and community services now it is an integrated care organisation.



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