The Government response to the Health and Social Care Select Committee Second Report of Session 2017-19, ‘The Nursing Workforce’

25 July 2018

The Government has published its response to the Health and Social Care Select Committee's Second Report of Session 2017-19 on 'The Nursing Workforce'.

In summary: the Government recognises that we need more nurses. It says, that is why additional clinical placement funding was announced by the Department of Health in August and October 2017 and why as part of changes announced on 15th June, the Government will be exempting nurses and doctors from the annual Tier 2 (General) cap on a temporary basis, pending a review by the Migration Advisory Committee on the composition of the Shortage Occupation List. Collectively, these changes will enable around 5,000 more nursing students to enter training each year from September 2018; an historic increase. Furthermore, we are working to broaden routes into nursing through the nursing associate role and the nurse degree apprenticeship. This will open up routes into the registered nursing profession for thousands of people from all backgrounds and allow employers to grow their own workforce.

The Government also accepts the need to give clear messaging to EU nursing staff working across health and social care and the need to develop ethical overseas recruitment programmes at scale. That is why, on 8 December 2017, the UK and the EU Commission reached an agreement to safeguard the rights of people who have built their lives in the UK and EU, following the UK’s exit from the EU.

The Department agrees on the need for robust, timely and publicly available data at a national, regional, and trust level on the scale of nursing vacancies. We would emphasise again that the latest figures estimate around 36,000 nursing roles were not filled by a substantive member of staff, of which around 33,000 were being filled by agency or bank staff. We also recognise the importance of transparent, robust supply and demand projections which include demographic and other demand factors alongside considerations of affordability, as well as the requirement to account for nurses working in the NHS, adult social care, primary care and other settings. Such robust and comprehensive data will provide the foundation for the flexible workforce of the future.

The main points of the report:

1. Retention - keeping the current workforce

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.

2. New nurses

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.

3. Nursing Associates

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.

4. Nurses from overseas

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.

5. Workforce planning

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.