A few weeks into the year, the challenges for nursing, primary care and the NHS more widely seem greater than ever before. Nursing in Practice asked nurse leaders including Deborah Sturdy, Crystal Oldman and Mike Padgham for their thoughts on their key concerns, and where solutions may lie.
>> Adult social care: ‘We have to find a way to make social care work again’
One area of nursing that has not been far from the headlines already this year is adult social care. The much sector is now taking a key role as part of the Government’s plan to free up hospital beds, but continues to suffer from extensive staff shortages.
Deborah Sturdy, England’s first ever chief nurse for adult social care, told Nursing in Practice that workforce woes are likely to persist as the sectors biggest challenge in the coming months.
‘It’s a universal challenge and its not exclusive to social care,’ says Ms Sturdy, ‘its a very competitive employment market but there is a lack of exposure to social care in the undergraduate [nursing] experience.
‘We are looking at the opportunities around international recruitment so we might see some people come in. But we have to be conscious of the fact we’re working against a backdrop of a global workforce shortage.’
Mike Padgham, chair of the Independent Care Group, and care home operator, is in agreement on the workforce challenges ahead.
Mr Padgham told Nursing in Practice: ‘We are in a winter where the number of people who can’t get care is more than 1.6m, where 13,000 NHS beds are occupied by people who cannot go home because of a lack of social care packages and ambulances are queuing outside, where there are 165,000 staff vacancies and where residential care home insolvencies are up by 59%.’
‘Social care staff deserve better pay as shown in a recent report which highlighted an £8,000 pay discrepancy between them and their NHS counterparts. The NHS and social care sector both need to be funded properly so that staff are recognised and rewarded adequately.
‘In 2023, between us we have to find a way to make social care work again, to get more money to the sector and better pay and recognition to our front-line staff, giving them parity with their NHS counterparts and tackling the crippling staff shortages. Then we can fix social care, free up hospital beds and get people the care they need.’
Ms Sturdy also said that the social care workforce needed a boost, but suggested that the solution lies in talking up the praises of the work done by nurses in social care.
‘One of the things I talk a lot about,’ says Ms Sturdy, ‘is how we have got to change the narrative. If you look at nurses just within the four walls of a care home, what they are actually doing is running a nurse-led service.
‘If you start to use a different narrative around this, it brings a different kind of thinking and a different kind of recognition for what the career is. The sector itself needs to talk up the phenomenal skills that nurses in social care have.’
>> General practice nursing: ‘Opportunity for ANPs to take a bigger role in primary care’
For Helen Lewis, advanced nurse practitioner (ANP) and non-medical independent prescriber at Cwm Taf University Health Board in Wales, 2023 is a year of opportunity for nurses working in general practice.
‘With all the financial trouble, there’s more opportunity for ANPs to take a bigger role in primary care,’ said Ms Lewis, ‘I think there will be more ANPs working in general practice than there will be GP locums, because we do a similar job for less money. And if somebody wants career progression, then that is a big part of that process.
‘Nurses are trained differently to doctors: we have more of a human link with the patient, whereas medics’ treatment is about treating to the problem and moving on. Patients want the continuity of care from an ANP; we treat someone in the fullest sense.’
Ms Lewis, who is self-employed, also predicts that this year more ANPs will follow her example and set themselves up as self employed nurses. ‘There are ANPs working in general practice who that [self employment] would give the flexibility they want, because they are not constrained to a practice.’
However, the year ahead will not be without its challenges. Ms Lewis highlighted the ongoing impact of strikes in nursing and the ambulance service as an immediate problem.
‘I understand why they are striking,’ said Ms Lewis, ‘but that will have an impact on community care. We have more patients who will come into surgery as they see that as the next port of call. We’re having to send patients to hospital and they are having to make their own way there.
Also preparing for a challenging year to come is Pauline Brown, a general practice ANP working in Dumfries and Galloway, who was recently awarded an MBE for her contributions to healthcare in Scotland.
Ms Brown says that things have been particularly challenging for the past few years, with levels of staff burnout high and pressure on the service mounting.
‘A lot of patients moved into our area from the cities at the time of Covid, and there was a great influx of patients moving to rural areas,’ said Ms Brown. ‘The impact of that is a greater number of patients to deal with. Our district nurse colleague are finding that really challenging because they lack investment.
‘We are also seeing that the national situation has a knock on impact in the community, because we are getting patients who are a sicker being cared for in their homes since patients are put out of hospitals much quicker and waiting lists for care are longer.
‘What we have also found is that patients are now coming forward with significant pathologies who didn’t want to come in during Covid, because they didn’t want to bother us or were scared of infection.’
However, Ms Brown remains confident that nurses in the community will rise to meet the challenges, saying: ‘The last two years taught us that we need each other and that team work is important. This is an opportunity to look at the core values of nursing and think what we are trying to achieve.’
>> Community nursing: ‘People need time to reflect and focus’
In the community, nursing’s leaders are looking ahead to a year full of opportunities for development, with nursing professionals at the forefront.
Dr Crystal Oldman, chief executive at the Queen’s Nursing Institute (QNI), argues that ‘although we work in challenging times, nurses are talented professionals with the skills and ingenuity to make a real difference to the quality of care if their voice is heard and if they are provided with enough resources and recognition for their work.’
From her perspective, the greatest opportunity in the year to come, believes Dr Oldman, will be for the QNI to build on its partnerships with other health organisations and ‘nurses working in every community specialism and at every level.
‘New national policies to integrate care make it essential that nurses in the community and primary care are fully represented in all the decision-making bodies,’ she says.
However, Dr Oldman also cautions that giving nurses a bigger voice in the NHS will require nurses to ‘balance the need to support the delivery of care to patients in the community and primary care with the need to support the nursing workforce itself.
‘We know that nurses are under great pressure, and they need the personal and professional support, and the right tools to deliver excellent care. People need time to reflect and to focus on the exciting opportunities linked to advances in science, technology, and nursing research. This would include population health management, genomics, and personalised care.
‘Nurses need the time and encouragement to build on their learning throughout their careers – this is only possible if they have protected time.’
Dr Oldman added that the QNI continues to offer a range of networks for learning and sharing professional experience, including bespoke CPD.
>> School nursing: ‘We know we’ve got a bumpy ride ahead’
Another key area of nursing with an eye on the year ahead is school nursing. School nurses play a vital role in providing preventative healthcare for young people and are on the frontlines of developing public health issues.
Sharon White, chief executive of the School and Public Health Nurses Association (SAPHNA), told Nursing in Practice that a major challenge for 2023, apart from the unavoidable workforce issues, is that school nurses are facing an ‘unprecedent’ wave of mental illness among children.
‘We [school nurses] are specialists trained to deliver public health, which is about prevention and early intervention. But what we’re doing now is pulling children out of the flames rather than stopping them falling in the fire in the first place.
‘Our specialism is all about getting in early to do brief interventions that don’t cost a fortune, and getting job satisfaction in seeing quick wins with children and young people, but all that is being stripped away now.’
This year, the number of children and young people accessing NHS mental health services jumped by a third year on year, with 22% of all 16-year-old girls accessing the services. This is all taking a serious toll on the school nursing workforce.
‘I’m hearing all the time that nurses are broken, weary, exhausted; lacking job satisfaction,’ says Ms White. ‘When you’re a nurse and have training to Master’s level it’s personally and professionally insulting when you feel that you can’t use those skills.’
However, no matter how hard the coming year may be, Ms White, like so many nurses, still remains hopeful.
‘Last year was hard, but you’re more resilient this year in a way. We’ve been through this before and its been hell. We know we’ve got a bumpy ride ahead but we can do it again.
‘The workforce is like that, they’re tenacious and passionate and compassionate. They’ll get tired, they’ll get exhausted, but they won’t be phased by it.’