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Letter to the Secretary of State for Health and Social Care on retaining the nursing workforce

23 December 2021

Dear Secretary of State, 

As pressure intensifies in the final days of the year, you will share my concerns at how we support the nursing workforce for the difficult times ahead. 

With the vacancy rate in England’s NHS already at a concerning level, I expect you will agree with me that the system can ill afford to lose experienced professionals. 

I am writing to you today to urge you to delay the implementation of two key policies in order to support nursing workforce retention, and to relieve pressures and enable safe care in health and care services: the mandatory vaccine rollout and the removal of the temporary suspension of pensions abatement for NHS staff. 

Patient acuity and demand on the health service has been rising for a number of years, and in conjunction with the pandemic, is creating an unsustainable situation for our health service and staff. As our recent Ten Unsustainable Pressures on the Health and Care System in England report outlined, health and care services are currently under unsustainable levels of pressure and action must be taken to tackle serious staffing pressure, sickness, burnout and the growing backlog of undelivered care.

As you know, we entered the pandemic with a severe shortage of nursing staff and with rapidly rising cases of COVID-19, services and their workforce are increasingly pressured. The risks to nursing workforce retention are significant, with data demonstrating a downturn in the numbers. There are growing absences from sickness and self-isolation of staff which is affecting services which are already struggling to clear a backlog of postponed procedures and treat normal winter sicknesses alongside COVID-19 patients. We are deeply concerned about retention as nursing staff face a more difficult winter then they have ever seen.

Many retired nurses stepped forward during the earlier waves of the pandemic and their contribution was vital to the efforts to tackle COVID-19, sustain our health and care services and treat patients. 

However, with the temporary suspension of a number of measures, specifically pension abatement, coming to an end in March of 2022, we are concerned that this will serve as a disincentive to remain working in services.

As of September 2021, approximately 75% or over 10,000 staff, on the temporary nursing and midwifery register were over the age of 55, many of whom could be affected by a change to abatement rules. 

In addition, as of September 2021, 21% of those on the permanent register were over the age of 55 (158,061 people), meaning 1 in 5 of those on the register are approaching retirement age. 
In order to retain as many of the staff as possible in this current context, we ask that the temporary suspension of the pension abatement rules should continue until at least workforce requirements of the health and care systems are understood and, requirements met, all of which must be transparent to stakeholders and public.  
The other current policy which the RCN asks for delayed implementation in support of nursing workforce retention is vaccination as a condition of deployment in the NHS. The RCN recognises vaccination as a key pillar in infection control and disease prevention in healthcare settings and believes that all health and care staff should receive the COVID-19 vaccine to keep themselves and their patients safe.

However, it is our view that mandating vaccines as a condition of deployment may further marginalise those who remain unvaccinated, rather than support them to access vaccination, and the potential impact on retention would put further pressure on service capacity. We have consistently urged Government to mitigate and monitor risks to staff retention associated with the introduction of the mandatory vaccination regulations. We ask therefore that implementation is delayed until risks have been thoroughly, and transparently, understood and mitigated, with relevant professional and trade union organisations engaged throughout.

I will take this opportunity to remind you that RCN members continue to call for the Health and Care Bill to include Government accountability for assessing the workforce requirements of the health and care workforce, and for workforce planning and supply. We also call for a fully funded health and care workforce strategy now to meet the needs of the population in the immediate and longer term. 

I look forward to your reply, specifically with regards to our call for delays to the removal of the temporary suspension of pension abatement rules, and on implementation of vaccination as a condition of deployment in the NHS. If you wish to discuss any of these matters in further detail, please do not hesitate to contact me. 

Yours sincerely,

Pat Cullen, General Secretary & Chief Executive 

Page last updated - 23/12/2021