18. Nursing workforce

Resolution submitted by the RCN London Board

That this meeting of RCN Congress urges Council to lobby all UK governments to ensure nurses play a key role in workforce planning, education commissioning and the design of the future nursing workforce

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Progress reports

Submitted by: London Board
Council lead and committee assigned: Ann Griffiths (until October 2011), Sue Fern (from October 2011), Nursing Practice and Policy Committee
Committee decision: Existing work addresses this issue
Members involved: Members extensively consulted on the Government white paper

Final update at May 2012

Education, workforce and training issues did not feature in the original Health and Social Care Bill.

Following the first round of the NHS Future Forum last year the Government agreed to insert a specific duty “to secure that there is an effective system for the planning and delivery of education and training to persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England.” This was introduced in the House of Lords Committee stage of the Bill at the end of 2011.

In response to the second Future Forum Report on education and training the Government published its report “Delivering the Healthcare Workforce - From design to delivery” in January. This set out a new approach to workforce planning and the education and training of the health and public health workforce. This confirmed that there are two central planks to the new system - Health Education England (HEE) and the Local Education and Training Boards (LETBs).

The RCN lobbied, both in our response to the White paper and in our submissions  to the Future Forum, that these groups should not be medically led and that it was vital that both HEE and the LETBs had independent chairs and took into account the nursing, and equally as important the Band 1 – 4, workforce. It has now been stated that both these groups will have independent Chairs.

In the raft of Government amendments introduced at the Report Stage of the Bill in House of Lords this month the Government introduced further amendments that stated that  NHS Commissioning Board and CCGs will “have regard to the need to promote education and training”. This was intended to ensure alignment between service commissioners and workforce, education and training plans, encourage collaborative working between the Board and Health Education England at a national level, and Local Education and Training Boards and CCGs at a local level, and promote the use of service contracts to support good education outcomes. 
Consequently we envisage links being created between nurses on the CCGs and the LETBs.

At the House of Lords committee stage the Government accepted an amendment which placed a requirement of all providers of services commissioned as part of the health service, including NHS and public health providers as well as private alternative providers, to co-operate with the Secretary of State in the discharge of his duty to ensure an effective system for education and training. This means all providers will be expected to participate in education and training activities, and Health Education England will invest only in organisations which do that.

Also at Health and Social Care Bill at Committee stage in the House of Lords an amendment gave the secretary of state a duty to secure medical education and training.

At this stage the Government made a commitment to publish draft legislation regarding medical education and training in the next parliamentary session. The RCN will continue to lobby at this stage for nurse involvement at all levels.

Update at November 2011

In England, following the publication of the NHS white paper, Equity and Excellence, Liberating the NHS the RCN lobbied hard to ensure that nurses were involved in the commissioning of education, workforce planning and future workforce. In July 2011 an amendment to the Health and Social Care Bill, which means nurses will sit on English commissioning boards, was passed by the Government.

Consequently any further work on this resolution is by way of a watching brief to ensure that this amendment is in fact enforced.  A task and finish group has been established for this, and the watching brief will also become a part of the ongoing work that Frontline First (the RCN’s campaign on protecting services and improving care on the frontline) and the RCN are already doing.

In Scotland nurses are heavily involved in all levels of commissioning and the RCN maintains close contact with these nurses.  Northern Ireland also has nurses employed and working in all commissioning areas.  In Wales there is a group which looks after both non-medical and medical commissioning and which has nurses involved in it, including the RCN. 

GP Commissioning groups have now been changed to clinical commissioning groups (CCGs) and there is mandated nursing involvement on both the governing bodies of the CCGs and the National Commissioning Board.

Work is being done on guidance of the skills and competencies these nurses will require.

Debate report

Congress voted overwhelmingly in favour of a resolution to campaign for nurses to play a full part in planning Britain’s future nursing workforce.
Hannah Marriage of the Inner North London branch, proposing, said that cuts to the NHS and education meant fewer nurses were beginning and completing their training, which was having an “unacceptable” impact on the quality of care.

“It could be argued that the future of the NHS workforce is in jeopardy,” she said. “We are in a unique position. The Government wants patients’ voices to be heard and the nursing community can help with this.”

The majority of speakers echoed Hannah’s comments, but  Mike Travis of Greater Liverpool and Knowsley sounded a note of caution, urging the RCN to “skill up” its stewards with workforce planning skills to allow nurses to play an informed part in the process.

And Anne Balson of Bradford and Airedale said: “I am increasingly confused about what a nurse is. Can somebody please explain to me who these nurses are who will be giving this information to Government?”

Graham Revie of Greater Glasgow recommended the approach taken in Scotland, in which he said Area Partnership Forums allowed RCN members to shape the future workforce.

Result

The resolution was passed

For: 96.54% (418)
Against: 3.46% (15)
Abstain: (20)

The recent consultation paper Liberating the NHS: developing the healthcare workforce (Department of Health, 2010b) outlines a new structure for planning and developing the health care workforce in England. Local employer skills networks will take on many of the workforce functions currently discharged by strategic health authorities (SHAs), while the quality of education and training will remain under the stewardship of health care professionals working in partnership with universities, colleges, and other education and training providers. These proposals do not impact on the existing structures in place in Scotland, Northern Ireland or Wales.

While Liberating the NHS outlines the roles of the skills network - which include managing and coordinating workforce data and plans for the local health economy in response to GP consortia strategic commissioning plans - there is no reference to the role of lead nurses in either GP consortia or health education (England) boards, or the NHS Commissioning Board.

The 2007 RCN report Nurse workforce planning in the UK (Buchan, 2007) identified a number of conditions for effective workforce planning, in particular the need to plan for change and to link planning to workforce and activity data to create more robust scenarios. The 2007 House of Commons Health Committee report on workforce planning similarly reported that strategic long term planning was often hampered by constant organisational changes and that plans were set aside when funding difficulties hit the system. They also observed that workforce plans did not seem to reflect the changing context of care and that pre-registration education budgets were being ‘raided’ by some SHAs to address funding deficits.

Liberating the NHS acknowledges the changing demands of health care provision in the face of an ageing population and suggests health care providers will need to employ staff with the skill mix appropriate to deliver a high quality service to patients in this changing environment. It further outlines how the NHS needs a coherent professional voice, and promotes strong clinical engagement for:

Currently nurse leadership is present at all levels of workforce planning and educational development, from the Department of Health to SHAs, and actively involves local directors of nursing. However, while Liberating the NHS acknowledges the need for clinical professional engagement there is no specific mention of nurse leadership within the proposed local networks, Health Education (England) Board or the NHS Commissioning Board.

The RCN Frontline First campaign has gathered evidence that NHS trusts have already substantially reduced their nursing workforce to address financial deficits. This has primarily impacted on middle and senior nurse management posts – creating a key challenge for future nurse development, succession planning and recruitment.

References and further reading

Buchan J (2007) Nurse workforce planning in the UK: a report for the Royal College of Nursing, London: RCN. Available at: www.rcn.org.uk
(accessed 10/2/11) (Web).

Department of Health (2010a) Equity and excellence: liberating the NHS, London: DH (Cm7881) Available at: www.dh.gov.uk  (accessed 3/2/11) (Web).

Department of Health (2010b) Liberating the NHS: developing the healthcare workforce: a consultation on proposals, London: DH. Available at:
http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_122590 (accessed 10/2/11) (Web).