The Ward Round: Nurses divided

Staffing is the issue keeping NHS leaders awake at night – and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, ensures you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce.

The line repeated on placards and posters at the Royal College of Nursing’s annual congress this week – that if successful, the next ballot for industrial action could result in “the biggest strike mandate we’ve seen” – will make NHS leaders nervous. And with good reason; if successful, nurses at all trusts will be able to strike well into the winter, again disrupting and potentially endangering patient care.

In her speech to the congress, RCN chief executive and general secretary Pat Cullen urged members to vote and “force the government to act once more”, adding she was confident “we will win” if nurses stood together. 

Ms Cullen also revealed Steve Barclay had been in touch the night before and requested a meeting (not a negotiation, she was clear), “and it is important that I go, and I tell him again, why many of you voted to reject the pay offer”.

Doubling down on her decision to split from other Agenda for Change unions and enter “intensive talks” with the government alone earlier this year, she added: “Prime minister, you did the right thing to open negotiations with me in February… before the 75th birthday of the NHS this July, let’s get the job finished.”

Notably, Ms Cullen’s retelling of events contained no acknowledgement that the union had backed the pay deal when it was offered in March or that its members had only narrowly rejected it by 54 per cent or that the RCN had been forced to cut short strike action earlier this month following a High Court judgment. 

Her speech was given a standing ovation, but, when I spoke to RCN members afterwards, views were more mixed. One senior community nurse working in London said her team were divided, with most “supportive” of the strikes, but many feeling unable to walk out because of concern for their patients’ wellbeing. Others pointed to a noticeable age divide, with younger members “more militant” and less willing to accept the status quo.

Apprenticeships (again)

Aside from strikes and pay, Ms Cullen used her speech to champion nursing as a graduate profession and hit back at plans to potentially train a third of nurses through apprenticeships over the coming years, as reported by the Press Association.

She was critical of Amanda Pritchard’s backing of this last week, where during a speech at her old comprehensive school in Durham, she described apprenticeships as a “radical, new approach”.

Of course, there is nothing particularly radical or new about apprenticeships. If anything, the scheme has been a bit of a disaster. Despite several pushes to improve uptake, they are not well-used in the NHS, while the lack of flexibility and the restrictiveness of what the apprenticeship levy can be spent on means millions of pounds have been left unused by trusts.

Ms Cullen was clear: beefing up the apprenticeship model is a “move in the wrong direction” and the union “settled this debate some years ago”.

However, it feels like the debate around nurse training often rears its head, most recently with the introduction of the nursing associate role in 2016, which some argued devalued nurses and saw money spent on more unregistered staff who, according to some reports, are used to make up for nursing shortages.

Any real detail about how apprenticeships will be used to grow the workforce is yet to appear, although talk at the congress suggested it could be out before Whitsun recess next week. 

Mental health nursing on the brink

Away from the congress, a joint report this week by the Nuffield Trust and the NHS Confederation has warned “thousands of mental health nurses must be recruited and retained” to address dreadful shortages in the profession – one that has lagged behind adult and children nursing recruitment. 

The research also pointed to an older workforce, with a fifth of mental health nurses over 55 and with some eligible to retire at this age. Concerns were also raised about attrition during training – one in seven students who start a pre-registration course in mental health nursing will not graduate – and participation in the NHS following graduation. 

The fall in mental health and learning disability nurses in recent years is well known, but this research adds to the weight of evidence this really is a sub-group of staff on the brink.

Nuffield Trust senior fellow and lead report author Billy Palmer said, although last year’s review of mental health nursing had “concrete steps for improvement… action cannot be delayed any longer”.

The research called for the workforce plan to include the mental health workforce, not just focus on acute care, and to contain “tangible strategies” for addressing problems around “the portrayal and status of mental health nursing and the support and funding for educational courses”.

However, when speaking to those close to the workforce plan, there was a lack of confidence mental health and LD would be addressed, with a view it already has its own plan. If this is the case, last year’s workforce review has a lot of heavy lifting to do.