Nursing associates need ‘effective’ leadership to succeed

Getting this leadership right would go some way towards tackling the serious issues facing the health service around staff supply and retention, according to NHS Employers, an organisation that acts on behalf of health service trusts.

“The successful implementation of nursing associates is dependent on consistent approaches to leadership”

Danny Mortimer

Reversing cuts to the continuing professional development (CPD) budget and making it easier for employers to take on apprentices were also highlighted as key ways to address workforce problems.

The measures were set out in a document submitted by NHS Employers to the NHS pay review body, the expert group that advises government on the pay levels of health service staff.

The purpose of the annual report is usually for employers to detail expectations for staff pay rises. However, because a five-year pay deal was agreed in 2018, this report instead offered the review body an update on current areas of concern.

The report (see PDF attached below) stated that the “most pressing issue” for NHS leaders at present was workforce, with demand for services increasing faster than employers could increase the supply of staff.

“Staff shortages pose a substantial risk to the health service’s ability to sustain high quality care,” the report added. “The NHS needs to adapt and change quickly.”

The authors made a series of recommendations for how issues around recruitment and retention could be tackled. They called for “new and effective national professional leadership for newly created roles, for example medical associates and nursing associates”.

“Staff shortages pose a substantial risk to the health service’s ability to sustain high quality care”

NHS Employers report

Danny Mortimer, chief executive of NHS Employers, said: “The successful implementation of the nursing associate role is dependent on consistent approaches to leadership and regulation.

“The good work done to date by the Nursing and Midwifery Council and national nurse leaders reinforces some of what is needed to support other new roles, including medical associate professionals, who would benefit for example from a clear regulatory framework,” he told Nursing Times.

“Clarity in these areas allows employers to make the very best use of new roles where they are developed,” Mr Mortimer added.

The first qualified nursing associates are due to enter the workforce this month. The role was created to act as a bridge between health care assistants and registered nurses.

Ian Cumming, chief executive of Health Education England, has previously said that out of 45,000 nursing associates set to be trained by 2027, 17,000 were expected to become registered nurses.

In a survey carried out by NHS Employers in March 2018, 82% of trusts that responded said nursing associates would feature in their future workforce strategies.

The pay review report noted that trusts were using the trainee nursing associate role to “improve skill mix, support staff development, staff experience and retention”.

In addition, the document highlighted the need for “restoration and sustainable new investment” in CPD for nurses and other care staff.

Meanwhile, in the new NHS long-term plan for Enlgand, which was released on Monday, leaders promised to increase funding for CPD each year.

Their pledge comes in the wake of severe cuts to this area in recent years. As previously reported by Nursing Times, the CPD budget fell by 60% in two years from £205m in 2015 to £83.49m in 2017, and was initially frozen at £83.49m for 2018-19.

The authors of the report also called for greater flexibility around the use of the apprenticeship levy, “particularly in terms of being able to address the costs to employers of back filling for staff released to their training”.

The levy is paid into by employers and is handed out by the government to organisations taking on apprentices. However, it can only be used to cover training and assessment fees and not associated costs such as additional staff to stand in for apprentices while they are learning.

The report highlighted that nurse degree apprentices were required to spend more than 50% of their time in off-the-job training when they would be considered “supernumerary” and could not be included in the normal staffing rota.

Their concerns echoed those raised by a committee of MPs last year, which warned that take-up of the nurse degree apprenticeship had been far too slow with no more than 30 people starting training through the scheme in 2017.

They said there were currently “too many obstacles” in the way of making the programme work, noting that there was a lack of incentive for trusts to take on nurse apprentices due to rigid rules around funding and supernumerary status.