Comment

Scotland’s integrated workforce plan is only a first step for district nursing

Amid service demand pressures, clinical complexity and nursing vacancies, delivering commitments will be challenging
Picture shows a nurse displaying her name tag at a patient's front door. Scotland’s integrated workforce plan is only a first step towards delivering commitments on district nursing.

Amid service demand pressures, clinical complexity and nursing vacancies, delivering commitments will be challenging

The Scottish Government has published its long-awaited integrated health and social care workforce plan . But does it go far enough on district nursing?

The RCN in Scotland has long championed the role of nursing in an integrated health and social care workforce, and the plan recognises the importance of getting this workforce right to support Scotlands communities.

However, with the pressures of increased demand and clinical complexity, and the current level of nursing vacancies across the NHS and care homes, delivering this is not without challenges.

Delivering a vision of shifting care from hospitals to community settings

Our district nursing workforce is crucial to achieving many of

...

Amid service demand pressures, clinical complexity and nursing vacancies, delivering commitments will be challenging

Picture shows a nurse displaying her name tag at a patient's front door. Scotland’s integrated workforce plan is only a first step towards delivering commitments on district nursing.
Picture: iStock

The Scottish Government has published its long-awaited integrated health and social care workforce plan. But does it go far enough on district nursing?

The RCN in Scotland has long championed the role of nursing in an integrated health and social care workforce, and the plan recognises the importance of getting this workforce right to support Scotland’s communities.

However, with the pressures of increased demand and clinical complexity, and the current level of nursing vacancies across the NHS and care homes, delivering this is not without challenges.

Delivering a vision of shifting care from hospitals to community settings

Our district nursing workforce is crucial to achieving many of the government’s priorities, such as the development of hospital-at-home services, improvements in out of hours care, a sustainable care home sector and increased commitment to public health interventions.

It was reassuring that the government’s plan recognised this essential role of district nursing in delivering a vision of shifting the balance of care from hospitals to community settings.

Its commitment to sustain the number of nurses in our communities with a 12% increase – or 375 whole time equivalent posts – in district nursing over the next five years is welcome and not before time. This is in the context of a current vacancy rate of 6.5% across Scotland and an ageing workforce – over 60% of district nurses on bands 6 and 7 are aged 50 or over.

Expansion of role an obvious solution to challenges of community services

Getting to this point has required sustained pressure. In spring 2018 the RCN secured agreement from the Scottish Government to work with us to understand what would be required to improve the long-term sustainability of the district nursing workforce and the level of investment needed to increase this essential group of staff.

The RCN worked with the government team to model the current workforce and project future district nurse requirements. This was a valuable exercise that arrived at the 12% figure, so it was disappointing that it took a further year before the government agreed to deliver on this commitment.

It is important to be clear that this growth model took into account what would be required to address current shortages and meet increasing demand for existing services over a five-year period. It did not consider any expansion of the district nursing role – something that could be considered an obvious solution to some of the challenges in delivering community services but would require significant further investment.

Then we come to the money. The integrated workforce plan was light on detail regarding the level of funding needed. Ministers have now set out welcome additional funding of over £4 million to deliver and sustain this growth.

Getting the right skill mix must be a priority

We will be pushing to understand how this funding will be allocated and will be calling for NHS Scotland to be clear on the financial support available to health boards and integration authorities regarding recruitment, training and resources for these additional posts in the longer term.

The approach taken must also recognise the need to have adequate numbers of senior clinical decision-makers – getting the right skill mix must be a priority in setting out the plans.

The RCN has been consistent in its championing of the district nursing team as a linchpin of integrated services and its role within the wider multiprofessional primary care team. This will continue to be a theme of our work during 2020 as we hold the Scottish Government to its commitments.


Picture of Theresa Fyffe, director of RCN Scotland, who says Scotland’s integrated workforce plan is only a first step on district nursing.Theresa Fyffe is director of RCN Scotland

 

 

Find out more

Health and Social Care: Integrated Workforce Plan (Scottish Government)

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