Another view on the future nursing and care workforce

The NHS Confederation’s Chief Executive shares his thoughts for best practice for staff experience and retention ahead of a session he is co-leading with Professor Mark Radford, NHS Improvement’s Director of Nursing:

There is a wealth of good employment practice. There are brilliant undergraduate and postgraduate courses. And there are imaginative retention schemes – but it is not enough.

As I am constantly told by everyone in the service, we do not have the resources to deliver what is expected, we also do not have the staff, and too often we struggle to keep the ones we do have.

So there is the challenge – a justified one to the leadership of the service at the front line.

The future will lie more in using data to understand the people who work for us. Do our staff stay in some roles or departments longer than others? Are they transferring to other teams? Are we losing them to other employers in the sector or, much more seriously, from the profession to other industries?

What does the staff survey, local pulse survey or exit interview tell us? And how good are appraisals? Not just how many have we completed?

It is pointless achieving some arbitrary target unless such encounters are outcome-focussed and valued by those who are being appraised. How happy are your middle managers, sandwiched between the world of targets and money and the reality of frontline clinical care? What do we need to talk to them and clinical staff about? What can we improve ourselves and what about the bigger opportunities of working with our partners in the sustainability and transformation partnership (STP) or local area? What are we missing?

You will have your own issues driven by location, the local labour market and the organisation’s culture. If you have not already done so, you may find some resources produced by NHS Employers (which is part of the Confed) helpful.

But there is also a need for national action. Just as local organisations and departments within them have an impact on morale, motivation and whether staff leave or stay, so too does what takes place on the national stage.

Pay: delivering fully funded NHS pay reform; and while the promise to cover rises for Agenda for Change staff is welcome, the NHS will need help for other staff. For social care, they also must receive extra support for extra pay to help sustain their nursing numbers.

Continuous Professional Development (CPD): we have been calling for the re-investment in the NHS CPD budget following year-on-year reductions. This is vital to support additional training and development.

Flexibility in the apprenticeship levy: there has been significant interest in apprenticeships, particularly in nursing roles. If this is to be viable, it must be affordable. If we can secure some flexibility from the levy we could increase take up.

Spiralling housing and travel costs: in London, the surrounding area and other high cost cities, the lack of affordable housing and high travel costs affect choice of employer.

Future migration:  as we negotiate the UK exit from the EU we need an immigration system which enables the service to attract and retain talent from outside the UK. We are operating in both a global and local talent market. The Health Education England (HEE) draft workforce strategy suggests that if nothing changes, we will need 190,000 additional clinical staff by 2027.

Last but not least, leaders at all levels working in highly pressurised environments need time to reflect and connect with colleagues. As the voice of NHS leaders across the whole health sector, we need to continue to support managers and clinical leaders through our networks, by sharing good practice and representing the reality on the ground in the corridors of power. The CNO Summit provides an opportunity to do that.

I look forward to meeting you all at the CNO Summit where Mark Radford and I will be leading a session focussed on the future nursing and care workforce – best practice on retention and staff experience.

Niall Dickson

The former head of the General Medical Council, Niall Dickson, was appointed Chief Executive of the NHS Confederation in February 2017.

During his time at the GMC from 2010 to 2016, Niall delivered a raft of reforms. These included an expansion of its responsibilities for medical education and training; the introduction of revalidation in 2012; the introduction of language checks for doctors from Europe in 2014, and the establishment of the Medical Practitioners Tribunal Service to provide a clear separation between the GMC’s investigation of complaints and the adjudication of hearings.

He worked as Chief Executive of the King’s Fund from 2004 to 2009 before being appointed as Chief Executive and Registrar of the General Medical Council in January 2010. Niall also led the International Association of Medical Regulatory Authorities (IAMRA) until 2016.

He was the editor of the Nursing Times from 1983 to 1988 before joining the BBC as health correspondent and progressing to the position of social affairs editor for BBC News from 1995 to 2003, broadcasting mainly on the BBC1 Ten O’clock News and Radio 4’s Today programme. Niall was awarded a CBE in the Queen’s Birthday Honours List in 2017.

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  1. iqra says:


    Could you please tell me if you have any Nursing apprenticeships if you would like to be a childrens Nurse and if i have to go to sixth form or not

    thank you

    kind regards Iqra

  2. Kassander says:

    It’s about time that the Board of NHS England was cleared out – especially the lightweight who are NEDs. Just watch the videos of their meetings and you’ll see how little they do or say – money for old rope.

    Lord Whatsit was supposed to head up the relaunch of the Citizen on-line Comment program. that was over 18 months ago – NOTHING, even to it was to relaunch 16 months ago.

    About time the Executive Directors were told to concentrate on what they’re paid for = working for the NHS.
    Ms J Cummings has plenty to do without all her work in the academic sector and meddling in various charities.
    Do the job you’re paid for doing, Ms Cummings