In its mandate for 2019-20, which sets out key goals for the year ahead, Health Education England said it was committed to increasing the number of nurses.
“We are confident this mandate is more closely aligned than ever with the needs of NHS patients and the public”
Sir David Behan
Under the mandate – the first to be developed jointly by HEE, NHS England and NHS Improvement – the body will be expected to dramatically increase the number of clinical placements for nurses, start training an extra 7,500 nursing associates, and develop plans for a new-style nursing degree that makes the most of technology and online learning.
“There are vacancies across all branches of nursing, with the most significant shortages in mental health, learning disability, primary care and community nursing,” said the document.
The mandate was published at the same time as HEE’s annual report, which revealed the dire shortage of learning disability nurses was perhaps the most critical issue it was facing.
HEE is warning of a 30-35% shortfall in learning disability nurses by 2020 unless action is taken.
The annual report for 2018-19 shows that by the end of the year the lack of learning disability nurses and potential gap between supply and demand was the only issue rated red in the body’s corporate risk register.
However, it also set out the steps being taken to mitigate the risk of a major shortfall including the introduction of a new fast-track graduate training scheme for learning disability and mental health nurses and a campaign during the university clearing period to encourage people to apply for available places on learning disability nursing courses.
Meanwhile, a national “Learning Disability and Autism Spectrum Condition Workforce Strategy” is in the pipeline, revealed HEE.
In the coming year, the mandate said HEE would undertake a detailed review of learning disability and mental health nursing “to support growth in these areas”.
It will also work with partners to look at how best to boost the primary and community nursing workforce, including district nursing, general practice nursing, health visitors and school nursing.
According to the annual report, key achievements in 2018-19 include recruiting 5,000 trainee nursing associates while graduates from the first 2,000-strong cohort joined the Nursing and Midwifery Council register.
The body also recruited more than 1,000 nurses through its Return to Practice programme, joining more than 3,000 who have already completed the scheme, and supported 58 employer-led groups in developing new apprenticeship standards across nursing, midwifery, advanced clinical practice, and allied health professions.
When it came to supporting international recruitment and the development of nurses from other countries, the report shows HEE has placed more than 500 nurses through its Global Learners Programme.
“We look forward to the continued task of creating fulfilling lifelong careers through first-class education and training”
Professor Ian Cumming
Under pilot Earn, Learn, Return projects – which have seen HEE work with various countries including India, Pakistan and Jamaica – a total of 531 nurses have been enrolled into three-year programmes of training and learning in the NHS.
However, the report shows a goal of boosting homegrown nurse training places in England by 25% is taking longer than expected in part due to lack of clinical placements.
According to the report, HEE has been working with providers to build on the expansion of places, which kicked off in 2017-18.
“Placement funding has been made available to support the increase although nurse training uptake across England in 2018 has been lower than expected,” said the report. It said a “deep dive” investigation had been undertaken to understand why this was the case.
Meanwhile, HEE regional teams are piloting local schemes aimed at “increasing placement capacity and capability”.
“The programme is also looking into how funding levers can be applied to help meet the expansion target by adopting a place-based system. This is aimed to support the increase in nurse training by 25% by 2021,” said the report.
The mandate for 2019-20 states HEE will “deliver a rapid expansion programme to increase nursing clinical placement capacity by 5,000 for September 2019 intakes”.
It said HEE would work directly with directors of nursing to “assess organisational readiness and provide targeted support”.
It also said the body would undertake a comprehensive review of the current availability of placements which would include identifying organisations offering significantly fewer placements than others and looking at ways to address issues getting in the way of trusts and others providing more placement opportunities.
“This will include options for expanding the provision of placements in primary and social care and explore how innovative approaches and best practice can support expansion,” said the document.
According to the mandate, increasing the nursing workforce will require a “multi-faceted and carefully co-ordinated strategy, including a strong focus on improving retention of our existing workforce”.
It sets out HEE’s vital role in promoting nursing as an attractive career and boosting numbers of people applying to nursing degrees, providing new routes into the profession, and in supporting nurses to develop their skills and careers.
“We are working to deliver the immediate actions set out in the interim People Plan to help make the NHS the best place to work”
Baroness Dido Harding
It also highlights the need for more work to prevent people dropping out of nursing courses and the profession.
Efforts to encourage more people to apply to nursing courses will include reaching out to young people aged 15 to 17 through ambassador, work experience and nursing cadet schemes.
Meanwhile, the mandate states HEE will work with other national partners to consolidate current recruitment campaigns “into a single campaign that reflects the realities of a career in modern nursing at the cutting edge of clinical practice”.
This will focus on branches of nursing with the highest numbers of vacancies and areas of England with the worst shortages.
Efforts to improve the experiences of nursing students and prevent people from dropping out of courses will include working with universities “to ensure every learner is well prepared for each practice placement and that every learner reports a meaningful placement experience”.
The body will also work with the Office for Students to ensure better data on attrition rates to help inform workforce planning.
Meanwhile, HEE will develop new resources for supervisors and assessors to “enable them to support the wide diversity of learners”.
According to the mandate, HEE will support “a significant increase” in the international recruitment of nurses by continuing to develop partnerships and exchange schemes with other countries as well as developing a best practice guide for employers.
When it came to promoting alternative routes into nursing, goals include developing a clear model that sets out the different ways people can get into the profession.
In addition, HEE will expand the pilot programme for nursing associates wishing to extend their studies to become registered nurses.
It will also develop proposals for a “blended learning nursing degree programme” that “maximises the opportunities to provide a fully interactive and innovative programme through a digital approach”.
Other specific goals for 2019-20 include:
- Support for new practice nurses: Under the mandate HEE is expected to support NHS England and NHS Improvement in rolling out a voluntary two-year Primary Care Fellowship programme for newly qualified nurses and GPs entering general practice.
- New district nursing apprenticeship: When it comes to boosting district nursing, HEE will work with providers to increase student placements in community nursing team. It will also work with providers to implement the new Apprenticeship Specialist Qualification for District Nursing and the core capabilities for advanced nursing practice in the community.
- Boost sepsis awareness among community nurses: Another goal, aimed at supporting the NHS’s action plan on anti-microbial resistance, is to increase awareness of sepsis among health and care workers in primary and community settings including health visitors, community nurses, care home staff and commission projects to address training gaps.
- Create a clear career pathway for neonatal nurses: HEE has been tasked with implementing a career pathway for neonatal nurses, including development of the advanced neonatal nurse practitioner role. This will include looking at ways to increase access to Qualified in Service training programmes and ensuring training providers are meeting all elements of the core syllabus.
- Ensure access to cancer nurse specialists: Another goal is to help ensure all cancer patients have access to the right expertise and support including a clinical nurse specialist or other support worker.
- Develop standards for advanced nursing practice across the board: HEE will enable nurses and other clinical staff to maximise their professional competencies by agreeing education and training standards for advanced clinical practice programmes. This will include specific frameworks for individual branches of nursing.
HEE chair Sir David Behan said he was confident the new mandate would deliver.
“We are confident this mandate, under our new working arrangements with NHS England and NHS Improvement, is more closely aligned than ever with the needs of NHS patients and the public, as well as HEE’s longer-term goals,” he said.
“The mandate sets out the key delivery priorities for the current year whilst also signalling our ambition to support the development of more joined up care with staff working together in multi professional teams. HEE will work across the system to ensure that education and training is in place to support this transformation and prepare the workforce for this future,” he added.
HEE chief executive Professor Ian Cumming added that the body had made “real progress” in meeting recruitment objectives as show by the annual report.
“The changing needs of patients, together with advances in science and technology, mean that we not only need more people, we need new ways of working. HEE has a fundamental role to play in improving the quality of healthcare, and we look forward to the continued task of creating fulfilling lifelong careers through first-class education and training,” he said.
Baroness Dido Harding, chair of NHS Improvement, highlighted the fact HEE, NHS England and NHS Improvement were committed to working much more closely together at national and regional levels.
“Health Education England, NHS England and NHS Improvement are committed to speaking with one voice, offering the NHS and its people a clear direction of travel to better serve patients and deliver the Long Term Plan,” she said.
“Together, we are working with local health systems, frontline staff and stakeholders to deliver the immediate actions set out in the interim People Plan to help make the NHS the best place to work,” she added.