Making sure that there are enough children's palliative care nurses

The number of children with life-limiting and life-threatening conditions who rely on children’s hospice services is increasing. Yet the nursing shortfall means that children’s hospices are increasingly being forced to cut back the vital palliative care they can offer to families. We have to change this so every child can have the expert care they need.

Children who need palliative care often have complex and unpredictable health conditions. They rely on qualified children’s nurses with the right skills to manage their pain and the distressing symptoms they can experience.

It is really worrying therefore that the UK’s children’s hospices have a growing shortage of nurses. The gaps mean that children and young people with life-limiting and life-threatening conditions are missing out on lifeline palliative care, including short breaks which can help prevent their families from separating.

Our latest survey of children's hospices found that the average nurse vacancy rate was 11% in mid-December 2016 (an increase of 1% on the rate in 2015). It is the same as the overall NHS nurse vacancy rate in England and higher than the equivalent rates in Northern Ireland (5.1%) and Scotland (4.1%).

Many hospices report that it is getting harder to fill nursing posts, with nearly two thirds (65%) of the unfilled posts vacant for more than three months. A quarter (25%) remain vacant for over a year. The survey suggests there is an increasing shortage of experienced nurses to care for children with rare and complex health conditions: the number of vacancies was highest at salaries equivalent to NHS Band 6 (in 2015 it was Band 5).

The majority of services say that vacancies are having an impact on care, including a reduced offer to families or reduced short breaks (58% of respondents compared to 43% in 2015). Nearly one fifth (17%) stated that they were being forced to close beds. For the first time, three (13%) services reported that vacancies affected their ability to provide 24/7 care. Short breaks are a lifeline to families and can reduce parental stress and the risk of family breakdown. Together for Short Lives is very concerned that a reduction in short breaks and hospice care could have a big impact on family wellbeing.

For the first time, Together for Short Lives has also surveyed university child nursing undergraduate degree courses to find how they are teaching children’s palliative care. A small sample of 15 (25%) course leads responded. Although there were many positive signs that courses included elements of best practice in their curricula, over a quarter of those who responded (27%) stated that they had not devised children’s palliative care competencies for their students. Together for Short Lives found that a third of universities which responded (33%) are planning to increase their children’s undergraduate nursing course intake in the future.

What we recommend

Together for Short Lives’ overall objectives for our nursing workforce campaign are for:

  • the average nursing vacancy rate among children’s hospices organisations in the UK to be less than 10% and not higher than the NHS nurse vacancy rate
  • no more than 25% of vacancies reported by voluntary sector children’s palliative care organisations to be defined as hard to fill (vacant for over three months)
  • all university undergraduate children’s nursing courses to reflect good practice in children’s palliative care education.

We are conscious that children’s hospice organisations represent just one element of the wider children’s palliative care sector; as such, we are keen to campaign to reduce nursing vacancies (particularly those which are hard to fill) in other providers, including acute children’s palliative care and community children’s nursing teams.

Together for Short Lives launched the #YouCanBeThatNurse campaign last Autumn to highlight what a rewarding role children’s palliative nursing is and to encourage school leavers, student nurses and existing registered nurses to consider a career in the sector. For job and volunteering opportunities in children’s palliative care please visit our jobs page.

We also believe that the UK’s governments, workforce planners and universities all have an important role to play in making sure there are enough nurses available to care for children with life-limiting conditions. Together for Short Lives is keen to work with them all to increase the number of nurses in the UK who are able to provide children’s palliative care. We would like:

  1. The Council of Deans of Health to encourage university undergraduate nurse programmes to adopt the elements of our recognised good practice in curricula for children’s palliative care nursing education, which we set out in part II of this report.
  2. The Nursing and Midwifery Council (NMC) to review its standards for pre-registration nursing education to make sure that it reflects competencies in children’s palliative care and good practice elements of children’s palliative care nursing education.
  3. Health workforce planners to assess the demand for nurses from children’s hospice organisations and include it in their planning models. If it is found that there are too few children’s nurses likely to fill posts across all types of healthcare provider, we call on universities to increase the number places they offer to undergraduates. We would like the UK’s governments to recognise the importance of children’s hospice nursing by including these vacancies in the wider NHS nurse vacancy figures.
  4. An urgent UK-wide summit to discuss the children’s palliative care nursing workforce with the UK’s governments, the NMC, the Council of Deans of Health and the agencies who are responsible for commissioning nurse education places across the UK.
  5. Health workforce planners in Northern Ireland, Scotland and Wales to commission sufficient undergraduate places for people to study to become children’s nurses.
  6. Children’s hospice organisations to satisfy themselves that they have a compelling offer of pay, conditions and shift patterns to attract children’s nurses to work for them. They should also communicate the additional, unique benefits which they may offer compared to other providers - for example, free workplace parking, free food and/or free childcare.
  7. Children’s hospices to be reimbursed for the placements they provide to undergraduate nurses in a consistent and transparent way across the UK. This would help make sure that providers can maximise the number and quality of placements on offer. In England, we call for children’s hospices to be given access to the education and training tariffs determined annually by the UK Department of Health.
  8. The UK Government to make sure that the UK’s exit from the European Union does not have an adverse impact on the supply of nurses available to children’s hospices. Consistent with the Royal College of Nursing, we call on the UK Government to preserve the rights of European Economic Area nationals currently working in the sector. We also ask ministers to put appropriate education and regulatory frameworks in place to make sure that providers can continue to recruit from other European countries.
  9. Health Education England to focus specifically on outlining career pathways and providing guidance for delivering outcomes-led education for children’s palliative care nurses.

You can Read Together for Short Lives full report: The state of the UK children’s hospice nursing workforce - a report on the demand and supply of nurses to children’s hospices.