Leading care home providers, HC-One, Runwood Homes and Avery Healthcare tell CHP the Government needs to do more to tackle the national nursing shortfall.
The national shortfall of health and social care nurses is not a new phenomenon and has been exacerbated by government inaction over the last 10 years.
While overall nursing registrations climbed to a historic high last year, NMC chief executive and registrar, Andrea Sutcliffe CBE, warned severe shortages remain in health and social care, particularly in specialist areas such as mental health and learning disabilities.
According to Skills for Care’s latest figures, there are 4,000 nursing vacancies in social care in England. The NHS, for its part, has around 43,000 vacancies, according to the Royal College of Nursing.
In terms of specialist nursing, the latest NMC figures reveal that, although the number of learning disabilities nurses grew marginally over the six-month period to September 30 2019, there were still 1,000 fewer than five years ago.
The NMC also highlighted the ticking time bomb of an ageing nursing demographic with the number of nurses in the 61-65 age bracket growing by 2,220 (5.57%) compared with 1,659 (1.48%) in the 21-30 age group.
Although the number of nurses leaving the register fell during the six-month period to a four-year low of 13,479, this was more than offset by the 17,932 people joining the register. The amount of people leaving the profession remains a major concern with Skills for Care projecting that social care will need an extra 580,000 workers by 2035 due to the ageing population.
In its Interim People Plan in June 2019, the NHS blamed the abolition of the nursing bursary for the 40,000 shortage of nurses in England. The nursing crisis has been further exacerbated by uncertainty over government immigration policy following Brexit.
The latest NMC figures reveal the number of nurses registering from the EU and EEA fell by over 1,000 during the six months to the end of September 30 2019, although this was more than offset by a 4,000 increase in non EU-EEA nursing registrations.
Gavin O’Hare-Connolly, chief operating officer, Runwood Homes, told CHP: “The removal of nursing bursaries, lack of university places and an uncertainty around Brexit have all formed as significant contributory factors in the sector with a genuine sense of unease and instability felt both in the profession and the wider sector they support.
“Brexit has certainly impacted on the arrival of EU nurses across the sector. Coupled with the uncertainty of what the long term future looks like, nurses from EU countries are considering more certain and stable options across the world.”
Former CEO Justin Hutchens said Brexit had had a “limited impact” on HC-One as the UK’s largest care home provider had a limited number of EU workers. He said the “severe drop-off” in EU nurse supply predated Brexit, beginning in 2016.
Justin said the early confirmation of the EU Settlement Scheme and the fact it was preferential for health and social care workers had helped provide reassurance for European colleagues that they could continue to live and work in the UK.
He stressed the challenge going forward was how the post-Brexit immigration scheme would impact the ability of care providers and the NHS to recruit overseas. The former HC-One boss said comments about a potential fast track NHS Visa raised worries that social care would be left out in the cold once again when seeking support to recruit abroad.
Faced with the continuing nursing shortage, leading care home providers such as Care UK, have been quick to act and source nursing recruits from alternative markets such as Dubai, India and Jamaica.
Similarly, HC-One has invested in developing its overseas nurse recruitment programme. Justin said its “hugely successful” programme, which has supported 32 nurses through the immigration process, includes assistance with the administration process, pastoral care, bespoke training and practical relocation help. The former chief exec, who announced he was stepping down earlier this month, added HC-One would build on its programme this year.
However, despite their efforts to counteract shortages, pressures have been so acute that many care home providers, notably not for profit provider Anchor, have exited nursing altogether, while others, such as Avery Healthcare, HC-One and Runwood Homes, have been forced to end nursing at individual homes.
Gavin said: “As an operator, we have had to be proactive and consider adapting the business model to navigate through the current uncertainty and instability. We have reviewed the categories of care that we offer and looked at innovative ways to support our services to maximise our person-centred care provision.”
Runwood Homes cited the national shortage of nurses and reliance on agency as the reasons for ending nursing provision at its Maun View care home in Mansfield last year.
Private pay focused care home operator, Avery Healthcare, meanwhile, de-registered nursing care at three services in 2019 blaming the sector-wide issue of a lack of qualified staff.
Justin said local recruitment conditions for providers were key when deciding whether they could safely provide a nursing service.
“Put simply, if you can’t hire a permanent nursing team for a home, you simply can’t operate a nursing service,” Justin said.
As a result of providers de-registering services, the number of nurses in adult social care has declined by 20%, or 10,500 since 2012, according to Skills for Care’s ‘The state of the adult social care sector and workforce in England 2019,’ report. Nursing was one of the few roles to see a decline as the overall adult social care workforce has increased by 22% since 2009.
Care home providers who have sought to remain in nursing have had to innovate to relieve workforce pressures and stay in business.
As part of a review of its retention strategy, Runwood Homes has conducted a programme of meaningful engagement with its staff to gain an understanding of what is important to them as nurses and employees.
Clinical development and managerial pathways have been developed and the operator has enhanced its support to registered staff by valuing both their clinical expertise and professional and personal development.
As a result, the business has almost zero nursing vacancies across its network of 5,000 beds.
“As a nurse, I have immense pride in the profession and lobby to see nurses recognised for the positive daily impact they have on people’s lives – this must start locally and I believe we are doing this,” Gavin said.
Avery Healthcare has developed and rolled out its advanced senior carer (ASC) role over the last three years through an intensive six-month course, which is certified every twelve months by world-respected body, City & Guilds. ASCs relieve workforce stress by taking on some of the lower level nursing tasks under supervision and freeing up nurse time for higher level needs, which have been exacerbated by the trend of local authorities in classifying more people as residential to save on care costs.
Justin said HC-One, for its part, had implemented a “range of initiatives” to improve nurse job satisfaction and boost recruitment and retention.
This began in 2016 with the provider’s creation of its nursing associate programme, which was accredited by the Royal College of Nursing. The programme is designed to offer a care development pathway for senior carers and provides nurses with a leadership and mentoring role, whilst benefiting from the increased support a nursing assistant provides them.
“Our nurses have told us that they have a higher job satisfaction if they are supported by a nursing assistant, which really underlines the value and importance of the programme,” Justin told CHP.
Technology has also been key to improving job satisfaction at HC-One with nurses taking an active role in the creation of an emeds system that will help reduce many administrative tasks, giving staff more time to focus on residents.
While encouraged by recent government measures such as the announcement by Prime Minister Boris Johnson of additional support for student nurses living costs, Avery Healthcare commercial director Mark Danis noted it would take some years for any impactful increase in nurse availability due to the time taken for qualification.
Mark said more government funding was required to reverse the trend of declining nurses. He called for more training money for new nurses as well as the delivery of greater incentives to persuade those in the sector to stay.
The commercial director said the government should also look at ways of attracting back some of those who have left the profession in recent years and use experienced returning nurses as supernumerary mentors and coaches to bring newly qualified nurses up to speed more quickly.
Justin said social care was stuck in a vicious circle when it came to nursing recruitment as greater shortages added to pressures on providers and staff, leading to more shortages and fewer people seeing nursing as an attractive career.
“It’s beholden on all of us to take steps to protect our nurses from this pressure, to champion the work they do and the value they bring to our residents’ lives, and to tell a positive story about the benefits of being a social care nurse,” Justin said.
The former HC-One boss said the nursing shortage had had a “disproportionate impact” on social care and resulted in a growing gulf between the number of nurses going into the NHS and social care. Justin said social care had the additional problem of being in direct competition for nurses with the NHS which often paid more and gave better terms and conditions, particularly around pensions.
“It is widely known that the social care sector loses nurses in droves to the NHS, and while shortages in NHS nursing are described as ‘the single biggest and most urgent issue we need to address’, the similar challenges in social care are often overlooked by the Department of Health & Social Care,” Justin noted.
He called for the social care workforce to be planned and prioritised nationally in the same way as the NHS, adding a “comprehensive, coordinated and supported strategy covering ‘both sides of the coin’ was urgently needed.”
With 2020 being the WHO International Year of the Nurse and Midwife, Justin said there was a “significant opportunity” to invest in the nursing workforce.
“In order to increase nurse numbers, we need to improve the wages and working conditions for social care nurses so that they are aligned to those of NHS nurses,” Justin said.
“That can only happen when a long-term, fair funding settlement is agreed for social care and I’d encourage the Government to move forward with the promised cross-party talks at the earliest opportunity.”
Justin said social care nursing needed to be an “appealing and worthwhile choice for young people today”, which meant tackling “historic misconceptions” and demonstrating the societal and career development value of becoming a nurse.
Given the current stress faced by the care home sector. CHP asked the DHSC how it intended to provide more support for care home providers.
A DHSC spokesperson said: “We are committed to creating a health and care workforce fit for the future and our adult social care recruitment campaign is currently running, encouraging more people to choose a job in social care.
“From September, nursing, midwifery and many allied health students will benefit from additional support of at least £5,000 of non-repayable funding, with up to £3,000 additional funding for some students, who choose to study in regions or specialisms struggling to recruit, or to help with childcare costs.”
The DHSC also highlighted the Prime Minister’s pledge to increase nursing numbers by 50,000 by 2025. The department also indicated how the new nursing associate role and nurse degree apprenticeship had opened new routes into registered nursing for thousands of people.
Additionally, the DHSC said the Government had announced £10m in incentives for postgraduate students who go on to work in mental health, community and learning disability nursing fields.