Analysis

NHS funding: ‘Prioritise nursing and listen to front-line staff’

It’s not just how much the NHS gets, but what the money is spent on that matters, say healthcare leaders and unions

It’s not just how much the NHS gets, but what the money is spent on that matters, say healthcare leaders and unions


Picture: iStock

NHS leaders will be spending the next six months forming a plan for how to spend the extra money the government announced to mark the 70th anniversary of the health service and nurses will be among those with a shopping list.

Prime minister Theresa May indicated that some of the £20.5 billion a year in the four years up to 2023-24 would go towards making NHS careers more flexible and family-friendly, as well as improving the use of technology, supporting professional development and increasing focus on mental health.

Further details are expected in the chancellor’s autumn statementbut in the meantime all professions will be angling for a share of the 3.4%-a-year funding boost in England.

Areas to target

Nursing has been coping with staff shortages, high turnover, and until recently, a pay freeze.

With this in mind, it is no surprise that healthcare leaders believe money should be spent on recruiting and retaining staff, targeting areas such as continuing professional development (CPD), the community workforce and affordable housing. 

Some have warned that investment in the NHS cannot work in isolation, and support for social care is needed to underpin improvements to the health service.

3.4%

The funding announcement represents a 3.4% increase per year in NHS England’s annual budget. Some economists have warned a 4% increase is what the NHS needs 

After the prime minister’s funding announcement, unions and social service directors said that any boost the NHS received would be ineffective if social care was not adequately funded too.

RCN general secretary Janet Davies said at the time: ‘Theresa May must be under no illusion that there can be no long-term solution for the NHS without a solution for social care too.’

However, following the announcement then health and social care secretary Jeremy Hunt delayed a green paper on social care funding until the autumn, saying he wanted to defer decisions on social care provision until the NHS formed a plan for how it will spend the funding boost.

Nursing ‘an obvious choice’

Ms Davies says while nurses, health organisations and politicians of all parties ‘will have a shopping list of spending plans for the NHS’,  the need for greater investment in nursing is obvious.

‘It is beyond doubt that we need sustainable investment in the nursing workforce,’ she says.

‘The funding promised by the prime minister should be used to attract new people into the profession and retain the staff we have.’

‘Investing in community nursing infrastructures to support population health improvements must be a priority’

Janet Davies, RCN general secretary

The RCN estimates there are around 40,000 nursing vacancies in England, although in May NHS Improvement put the figure at 35,794.

Ms Davies argues that safeguarding the pathways into the profession for nursing degree apprentices, as well as the development of those who will tutor them should be key priorities.

‘As new routes into nursing open up, we need investment in nursing education to ensure that students have access to safe learning environments, and that the nurses who are training them have the support and skills to do so,’ she says.

What do the other countries think of the deal?

The NHS funding announcement for England means extra investment is on the way for the health service in the rest of the UK too.

Under the Treasury’s Barnett formula, every year for the next four years the health service in Scotland will receive £2.2 billion more, Wales £1.37 billion more and Northern Ireland £0.75 billion more. 

Nursing Standard asked the RCN in each of these nations how they would like to see the money invested.

Scotland

An RCN Scotland spokesperson identified the following priorities:

  • Safe staffing With a nurse vacancy rate of 4.5%, according to the RCN, investment in the nursing workforce is urgently needed if the ambition of the Health and Care (Staffing) (Scotland) Bill, which has been put before parliament, is to be met in practice
  • Community nursing Expand the community nursing workforce, and district nursing in particular, to meet the needs of patients and shift the balance of care from hospitals into our communities
  • Care homes Nurses in care homes make up almost 10% of the total nursing workforce in Scotland, the RCN says. Given the predicted rise in the number of older people and the increasingly complex nature of the care and treatment they will need, more funding for care homes is needed
  • Mental health Scotland requires a more long-term approach to ensure skilled staff and sufficient resources are in place to achieve genuine parity between physical and mental health services and to improve outcomes

Wales

An RCN Wales spokesperson identified the following priorities:

  • Safe staffing Despite the welcome continuation of the bursary for students, there are still not enough nurses being recruited to replace those who are leaving the profession, whether for retirement, alternative working conditions or because they have concerns about their position post-Brexit
  • Community services The Welsh Government’s recent report A Healthier Wales: our Plan for Health and Social Care proposes that more people are cared for in their homes rather than in hospitals. Sufficient funding for more district and community nurses needs to be in place for this to be effective, and so that older people, children and young people and the most vulnerable can be treated in the community
  • Mental health Additional funding, particularly for children and young people, as well as a school nursing service will make sure the emphasis is on public health and well-being

Northern Ireland

RCN Northern Ireland director Janice Smyth says that because of the political situation in Northern Ireland, with the suspension of the devolved institutions and the absence of direct rule from Westminster, it is important that, where possible, decisions on funding are made by the Northern Ireland civil service and particularly the Department of Finance. 

She identified two priorities for the country:

  • Vacancies Address the severe workforce pressures, including almost 2,000 unfilled nursing vacancies in the health and social care service alone, with a similar number estimated in the independent sector
  • Health and social care Ensure the transformation of the health and social care system ‘moves from rhetoric to reality’

 

Resources for professional development

Ms Davies adds the funding must give nurses the resources to tackle non-communicable diseases such as heart disease, diabetes and stroke. 

‘Nurses see first-hand the pressures put on the NHS due to non-communicable diseases,’ she says. ‘Investing in community nursing infrastructures to support population health improvements must be a priority.’

NHS Employers chief executive Danny Mortimer says the organisation wants to see a reinstatement of funding for staff professional development following cuts.

60%

Health Education England's workforce development budget has been cut by 60% over the past 2 years. In 2015-16 it was £205 million, this year it stands at £83.49 million

‘Top of our wishlist would be the restoration of CPD funding, which has fallen from £205 million to £83 million in recent years,’ he says.

Mr Mortimer cites access to affordable housing for front-line staff and greater support for employers taking on nursing apprentices as other priorities.

He adds that while he hopes the funding will improve conditions for staff, there is no ‘quick fix’ to workforce shortages.

Able to make long-term plans

However Anita Charlesworth, director of research and economics at the independent charity and healthcare research group the Health Foundation, says the extra money for the NHS will get it out of 'crisis mode'.

Professor Charlesworth says NHS trusts will now be able to stop living day-to-day and instead be able to make long-term plans.

‘The government will have to demonstrate a plan for social care that provides a clear way forward’

Anita Charlesworth, Health Foundation director of research and economics

But she emphasises the money is ‘a big part of the jigsaw, but not the whole puzzle’; the social care green paper and how the government addresses preventative care will also determine how the NHS will fare.

‘In the autumn, the government will have to demonstrate a plan for social care that provides a clear way forward,’ Professor Charlesworth says.

If not, pressures from an ageing population over the next 15 years will drain the NHS, she warns.

‘The risk is that all of this funding is eaten up keeping the current system alive,’ she says.

Professor Charlesworth says this would result in further disparity in other areas of care. ‘Areas where we are lagging behind, like mental health, will get crowded out,’ she says.

She adds the government’s recent focus on preventative health initiatives to tackle issues such as childhood obesity and smoking is encouraging.

‘Listen to front-line staff’

Unison head of health Sara Gorton urges the government to listen carefully to healthcare workers on where funding should be allocated.

‘It’s crucial that the voices of healthcare staff are listened to when it comes to decisions over where spending is allocated,’ she says.

‘They are the ones at the sharp end of the NHS, and they know better than anyone the real pressure points in the system.’

How we’d spend the money: what nurses have to say

Justin Walford, pictured, senior practice development nurse at Royal Sussex County Hospital Emergency Department, says:

‘This added investment should be aimed at three main areas:

  • Community services – this would improve the patient experience and reduce the number patients needing to attend the emergency department
  • Childcare for staff, enabling staff to work their entire shifts, not just part of them
  • Better training for nurses, healthcare assistants and support workers

The lack of increased social care funding is very shortsighted. For example, I know of one patient whose 24-hour-a-day home care package was withdrawn at the weekend, resulting in immediate admission to our short stay ward on the emergency department and one-to-one care for this patient for 60 hours. It was arranged at short notice, so this care was covered by agency staff at up to £34 an hour. This is not cost-efficient.’

Rachel Kent, pictured, senior nurse practitioner in London says:

‘Front-line staff are best placed to identify gaps in care and provision, and to come up with innovative ways to address these gaps using limited resources.

I would like to see some of the promised money going directly to front-line staff and their quality improvement projects because this is what the NHS needs to become sustainable and responsive to the changing needs and demands of our patients.

Unfortunately, the support and funding to implement quality improvement projects is scarce, and so great ideas stay just that – ideas – even if they would be more cost-effective than current processes in the long-term.’


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