How To Plan For The Future Of Nursing

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1 WORKFORCE RISKS AND OPPORTUNITIES SCHOOL NURSES EDUCATION COMMISSIONING RISKS SUMMARY FROM 2012 AUGUST 2012

2 Welcome to the 2012 CfWI workforce risks and opportunities: education commissioning risks summary (WRO ECRS 2012) for school nurses. The WRO ECRS 2012 reports cover all professions across health and social care, except the medical profession, which was covered in a report in 2011 ( Each report describes the key issues facing the different professions over the next three years, and aims to support local decisions on future education and training commissioning. The reports do not make specific recommendations for local commissioning decisions as these decisions are made through consultation between the education and training commissioner and employers. The reports will be submitted to the Department of Health in several tranches between November 2011 and the end of August This is a time of great change in the NHS. Employers are considering how best they can transform their services to maximise the quality of patient care, improve productivity and release the 20 billion savings to be reinvested in front line clinical care. This work could have a major impact on the future shape of the workforce and so needs to be considered alongside education and training commissioning decisions that are being made now. Financial allocations are a pivotal component of the overall education and training annual process across England. Presently the Department of Health secures funding to invest in the workforce through the Multi-Professional Education and Training (MPET) levy which is around 4.9bn for 2011/12. This funding is currently allocated to Strategic Health Authorities (SHA) largely based on historic patterns of training. The Department sets out key priorities and holds SHAs to account through a Service Level Agreement. SHAs develop plans for education commissions based on local workforce plans and then commission and fund training from education and clinical placement providers. Looking towards 2012/13, a flat cash settlement for MPET is likely. This allocation will have to accommodate a range of cost pressures which will include new costs, price increases and volume changes. In setting local investment priorities for the MPET allocation, SHAs are encouraged to consider the evidence presented within the WRO ECRS 2012 and the medical specialty training numbers reports. We hope you find the reports useful, and as always, appreciate your constructive feedback. Professor Moira Livingston Commissioning Director CfWI 2

3 Purpose This information has been collated to inform decisions on education commissioning over the next three to five years. It considers the key factors influencing the estimate of future need of school nurses and gives an assessment of the current workforce supply. It includes regional perspectives and a summary analysis of risks in education commissioning. can be employed by the NHS through primary care trusts, or outside the NHS by local authorities, community trusts and schools. Depending on where they are employed, they may provide health and sex education, developmental screening, health interviews and immunisation. It is possible to become a school nurse straight after qualifying as a registered nurse, although nurses working in schools usually work towards the specialist practitioner school nursing/specialist community public health nurse qualification at degree and masters level (NHS Careers, 2012). KEY FINDINGS Next steps There is a shortage of available data for the non-nhs school nursing workforce that will need to improve for more detailed modelling to be carried out. The growing population of young people may increase demand for school nurses. There is an ageing workforce in school nursing. The role of school nurses may change when the Government publishes its new programme of development for school nurses. Following a growth in the number of NHS school nurses of 43 per cent from 2006 to 2009, there are planned reductions in commissions for school nurses, however postgraduate qualification is not mandatory for school nurses. The CfWI to feed into the Department of Health (DH) Information Architecture Review Board with identified gaps in data for this workforce to improve future modelling. 3

4 CONSIDERATIONS FOR FUTURE REQUIREMENTS Policy drivers Table 1 summarises the key policy drivers and the relevant references. Table 1: Policy drivers affecting the workforce school nurses Key drivers 1. Move to degree-level registration This is being rolled out in order to produce only graduate nurses from 2013 onwards. The potential impact of this is improved standards of care in nursing, a change in the number of people interested in becoming nurses, and a change in the student attrition rate. It is as yet unknown whether potential students will be attracted to the profession or discouraged by the removal of the diploma option. Similarly, it is unknown whether students will be more committed to the course or more likely to drop out. The changes to the pre-registration programme also place greater emphasis on the public health and preventive responsibilities of all nurses, regardless of the field of nursing. 2. School nursing programme of development The DH is developing a new vision for school nursing, which involved consultation with young people in November This may revise the role of the school nurse within the school and the wider community. Relevant policy Standards for pre-registration nursing education 2010 (NMC, 2010) School Nursing Development Programme engages with young people (DH, 2011a) Profession s view 1 The Royal College of Nursing (RCN) has called for sustained investment in school nursing, warning that in some regions school nurses are being poached to become health visitors in order to meet the Government s target for health visitor numbers (RCN, 2012). The RCN highlights the importance of the profession in helping to tackle obesity, teenage pregnancy and sexually transmitted infections. 1 The CfWI engaged with representatives from each profession to inform this report. Although in some cases the source is not explicitly named, this information may be available on a case-by-case basis. Please contact the CfWI if more information is required. 4

5 Demographics work with pupils, teachers and parents to promote good health and wellbeing in school-age children (NHS Careers, 2011). This population group is projected to increase by 1.7 per cent by 2016 (ONS, 2010). Additional drivers Sexual health From 2000 to 2008 the number of new diagnoses of chlamydia increased from approximately 60,000 diagnoses per year to over 100,000 diagnoses per year, which may be due to increases in awareness, testing and diagnosis of the condition. The number of new diagnoses of gonorrhoea declined between 2002 and 2010 from approximately 20,000 diagnoses per year to approximately 15,000 diagnoses per year (DH, 2010). The incidence of these two sexually transmitted infections has therefore increased overall. More school nurses may therefore be required to work with young people to reduce these rates of infection. Obesity The total number of children diagnosed as obese increased from 1506 to 2400 over the period (HSCIC, 2011). More school nurses may therefore be required to work with young people to reduce this level of obesity. CURRENT AND FORECAST SUPPLY Existing workforce Supply Table 1shows the headcount (HC) and full-time equivalent (FTE) figures for school nurses working in the NHS. This excludes school nurses working for other employers such as local authorities, and therefore does not represent the whole school nursing workforce, which may be significantly larger than table 1 indicates. Table 1: Current qualified NHS workforce school nurses Staff type HC FTE FTE/HC School nurse 1,467 1, Source: Health and Social Care Information Centre (HSCIC, 2011) Figure 1 demonstrates that the school nurse NHS workforce falls mostly within the age bracket, most of which are aged Representatives from the DH state that this is an ageing workforce. 5

6 Under and over Total Education commissioning risks summary Figure 1: HC and FTE age profile by ten-year age band, April 2011 school nurses 1,800 1,600 1,400 1,200 1, Age profile (HC and contracted FTE) - school nurses Contracted FTE Headcount Age bracket (years) Source: HSCIC Monthly Workforce Extract, April 2011 Note that the Under 25 age bracket only contains those between the ages of 21 and 24, whereas the other groups are in 10-year bands, therefore the relative numbers for that age band in figure 1 will be smaller. Current vacancies and employment The three-month vacancy rate for school nurses in the NHS is low, at 0.4 per cent. Students In order to become a school nurse, a registered nurse will usually undertake the specialist practitioner - school nursing/specialist community public health nurse qualification at degree and masters level (NHS Careers, 2012). Figure 2 shows the commissions for postgraduate training courses for school nurses. This shows that commissions for school nurses significantly increased between the 2006/07 and 2010/11academic years, with a significant planned reduction in 2010/11. 6

7 2006/ / / / / /12 Commissions Education commissioning risks summary Figure 2: Total national commissions of training places, planned and actual 2 school nurses 300 Planned and actual commissions of training courses, England (2006/07 to 2011/12) - school nurses Planned Actual Source: Multi Professional Education and Training (MPET) 02B - Non Medical Education and Training (NMET) Commissions, 2002/03to 2011/12 Recruitment Representatives from the DH indicate that school nursing is attractive to students, due to daytime working. Geographical distribution Year Table 2 shows the headcount of school nurses in each SHA in September 2010 (HSCIC, 2011), the actual commissions for training in the academic year 2010/11and the planned commissions for 2011/12 (DH, 2011b). The 2011/12 planned commissions should be regarded as indicative, as actual numbers recruited may differ. The CfWI recognises that it is also important that all training posts are of high quality, and high-quality training placements may not be equally available across England. The information is intended for use in conjunction with local knowledge. Table 2 shows that the East Midlands and East of England SHAs do not plan to commission any school nurses in 2011/12. However, the postgraduate qualification is not a mandatory requirement for school nurses, so this does not show the total numbers of school nurses planning to enter the profession. 2 The 2011/12 planned commissions should be regarded as indicative. 7

8 Table 2: NHS staff, planned and actual commissions by SHA school nurses Strategic health authority Headcount 2010 Actual commissions 2010/11 Planned commissions 2011/12 North East North West Yorkshire & the Humber East Midlands West Midlands East of England London South East Coast South Central South West Total Source: HSCIC Census 2011 (headcount); DH NMET Monitoring Quarter 4, 2010/11 (commissions). Supply projections There is insufficient data available to produce a supply-and-demand model for school nurses as the CfWI does not have access to non-nhs data. To produce supply forecasts for school nurses it would be necessary to collect as a minimum the HC, FTE and age data for those in each employment sector. Data on training numbers is also required to find out how many people will be joining the workforce. Registration data held by the Nursing and Midwifery Council (NMC) could have a valuable secondary use for workforce planning. The use of registration data in workforce planning should be maximised to save money on additional data collections and to support and verify workforce analysis. Data should be collected and published annually to allow assessment of change. Figure 3 shows the historical HC and FTE for school nurses. This shows an increase of 43 per cent in the number of school nurses from 2006 to 2009 followed by a reduction in This shows a similar trend to the commissions trend in figure 2 which implies the change in the number of commissions has affected the overall workforce profile for school nurses. 8

9 Figure 3: Total NHS headcount and full time equivalent since 2006 school nurses 1,800 1,600 1,400 1,200 1, Headcount and full time equivalent - school nurses HC FTE Source: NHC IC Non-Medical Bulletin Tables, (HSCIC 2011) Interplay with related groups may work alongside teachers, parents and other nurses. Any workforce changes in these other professions therefore may impact on the demands placed on school nurses. 9

10 CONCLUSION The population of young people is growing and has growing health needs relevant to school nursing, such as sexually transmitted infections and obesity. have a key role in preventing risky behaviours in young people, such as discouraging smoking, binge drinking and obesity, and fostering healthy patterns of behaviour to be continued into adult life. The increase in both prevalence of key health issues and the increase in the size of the young population overall therefore may increase the demand for school nurses. Employers are responding to the Government target to increase the FTE of the health visitor workforce by 2015, which according to the RCN is impacting on the school nursing workforce by drawing school nurses away to become health visitors. This could have an impact on the school nursing workforce as some of the current supply may leave. However there is currently no evidence to confirm whether this is occurring. The school nursing workforce as a whole is also ageing, which is a consideration for the commissioning of school nurse courses. The challenge for the health and social care system is to determine the clinical demand and proportion of trained nurses required. It would then be necessary to obtain data for the non- NHS school nurse workforce in order to forecast supply for the whole school nursing workforce, as there may be a significant contribution from other sectors such as those employed by local authorities. 10

11 REFERENCES Department of Health (2010) Health profile of England [online] Available at: pdf [Accessed November 2011]. Department of Health (2011a) School Nursing Development Programme engages with young people. [online] Available at: [Accessed January 2012]. Department of Health (2011b) Non-medical education and training (NMET) monitoring Quarter 4; Re: Quarterly Commissions data. [ ] (Personal communication, 27 June 2011). Health and Social Care Information Centre (2011) Statistics on Obesity, Physical Activity and Diet: England, [online] Available at: [Accessed November 2011]. Health and Social Care Information Centre (2011) Non-medical staff census as of 30 September [online] Available at: [Accessed June 2011]. NHS Careers (2011) School nursing. [online] Available at: [Accessed November 2011]. NHS Careers (2012) Nursing. [online] Available at: [Accessed March 2012]. Nursing and Midwifery Council (2010) Standards for pre-registration nursing education (2010). [online] Available at: [Accessed August 2011]. Office for National Statistics (2010) 2008-based Subnational Population Projections by sex and quinary age; England and Government Office Regions. [online] Available at: [Accessed June 2011]. Royal College of Nursing (2012) RCN calls for sustained investment in school nursing. [online] Available at: in_school_nursing [Accessed March 2012]. 11

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