18. Opportunities outside the NHS
Public Health Forum
(MFD) That this meeting of RCN Congress discusses the benefits and opportunities for nursing staff who work outside the NHS
Debate report
Jason Warriner, from the RCN Public Health Forum, asked Congress delegates to discuss the benefits and opportunities for nursing staff who work outside the NHS.
He said an increasing number of nursing staff in the independent sector are working in a range of settings. But sometimes they are viewed as the opposition and are asked why they do not work in the NHS.
There are a number of reasons why this may be the case, including work-life balance, pay and career opportunities, said Jason. He commented that even within the RCN, independent sector staff can be seen as second class citizens. But he said there are many skilled and excellent nurses working outside the NHS. “It is not because we do not believe in it, but because we have made that career choice.”
Jason said he was lucky to work for a charity with excellent opportunities to work at a board level, while maintaining his work in clinical care. But he acknowledged there were challenges throughout the independent sector, including recruitment and retention, pay and pensions. The independent sector was doing a good job and its work complemented that in NHS services, he said.
Career opportunities were a key theme, with student nurse Stephen Walton saying that independent sector employers need to reach out to nursing students. Laura Falconer expressed concern that nurses are labelling people as “nursing home staff” without appreciating their vast experience.
Brian Williamson highlighted the range of roles carried out by nursing staff working in criminal justice settings. He said they faced every conceivable health care community need, but that patient expectations were higher. The personal development opportunities were “enormous”, he added.
Jane Valle said she welcomed the debate because it showed there was an increasing recognition from the RCN of the independent sector. She “absolutely loved” her job and there were lots of benefits and opportunities to working outside the NHS, she said.
Catriona Forsyth reminded delegates that many nursing staff work in both sectors and encouraged delegates to reference staff working in both sectors in future debates.
Complete autonomy was the reason that Christopher McDonnell chose to work for a charity. His work was patient-focused, not target-focused, he said. He was bothered by “them and us” attitudes, pointing out that his work provided free care at the point of access for
Background
Today over 100,000 RCN members work outside the NHS, and this number is set to increase due to the changes taking place across the UK in relation to health and social care provision.
The independent sector is both diverse and complex, ranging from individual consultants, single care homes, primary care organisations, to large acute providers and primary care organisations. Specialist services delivered by the sector include prison health care, walk-in and treatment centres, school nursing, end of life and hospice care, sexual and reproductive health, maternity, and industrial occupational health provision.
Many independent sector providers are contracted to provide care for the NHS or social services at a set tariff or within a set budget; other reimbursement rates are set by insurance companies while a smaller amount is self-funded. Providers are governed by care quality regulations that expect staff are of good character and have the qualifications, skills and experience necessary for the work to be performed.
Squeezed by budget constraints, many independent sector employers report challenges in recruiting and retaining staff and being able to pay the equivalent to NHS pay, terms and conditions, with low pay reported in residential care. In contrast, many companies provide clinical expertise to improve patient care and have developed highly autonomous or specialist nursing roles which attract higher salaries.
Indeed, a recent RCN survey of members in the independent sector revealed over 70 per cent preferred working in the independent sector because of flexible working arrangements, better working conditions and the type of care and career opportunities. Respondents also cited greater opportunities in relation to training and development.
The independent sector has a significant presence in England. The previous Labour government developed policies to create more opportunities for the independent sector through the Independent Sector Treatment Centre programme and the push for Social Enterprise in community services. The current coalition government is encouraging further independent sector development with the introduction of the Any Qualified Provider scheme into community services.
While the SNP Government is strongly committed to a publicly funded Scottish NHS, significant areas of care in Scotland are delivered by independent providers. For example, over 3,000 independently run homes provide care for the elderly.
In Wales there is an active independent sector and there are many examples of partnership working in relation to prison health, hospices, mental health placements and residential and nursing care homes. Northern Ireland has a sizeable independent nursing home sector, although the private health care sector is extremely small.
The benefits for nurses who work outside the NHS are not always recognised; these range from skill and knowledge development, career progression and a different experience of providing care. Independent sector organisations also enable nurses to develop services and promote innovation in patient care to complement NHS services or deliver services the NHS cannot provide.
References and further reading
Royal College of Nursing (2010) Policy briefing 1/2010: The Independent Sector in health and social care in England in 2009 and prospects for the future, London: RCN. Available to download
(accessed 5/3/12).
