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A children’s palliative care workforce in crisis

News and comment
Andy Fletcher

2020 marks the International Year of the Nurse and the Midwife. As it dawns, the cold reality is that seriously ill children are unable to access enough nurses with the skills and experience to provide them with the palliative care they need. When it ends, the government and others need to have begun a journey to put the children’s palliative care nursing workforce on a sustainable footing.

At the start of a new year, we have a government with a new mandate and a set of new priorities. Yet many of the challenges remain the same. Surely one of the most pressing is making sure seriously ill children and their families can access the palliative care they need, when and where they need it.

We have known for some time that the extent to which this is happening depends on where children live. The decisions that local NHS organisations and local authorities make about funding are key and the money that NHS England and NHS Improvement has committed to children’s palliative care services in the Long Term Plan are very positive developments. However, these funding boosts will be meaningless unless children’s palliative care teams have the staff to deliver new and expanded services. Worryingly, we know there are simply not enough doctors, nurses and other professionals available to meet the demand for children’s palliative care, which is growing both in volume and complexity.

In October, Together for Short Lives published ‘A workforce in crisis: children’s palliative care in 2019’, which showed staffing levels are at breaking point:

  • There are just 17 children’s palliative care consultants in the UK – the Royal College of Paediatrics and Child Health (RCPCH) suggests there should be 40-60.
  • There are too few community children’s nurses (CCNs) employed by the NHS: safe staffing levels recommended by the Royal College of Nursing (RCN) suggest there should be around 5,500 CCNs in England. In fact, the NHS in England employs just 574.
  • The nursing vacancy rate in children’s hospices is growing, with posts increasingly difficult to fill. On average, children’s hospices told Together for Short Lives that they had a vacancy rate of 12.2%. This is higher than the overall NHS nursing vacancy rate of 11%, which is also worryingly high. Two thirds (67%) of children’s hospice nursing posts remain vacant for three months or more.
  • There are shortages among other important health and care professionals: the vacancy rate for allied health professionals (AHPs, including physiotherapists, occupational therapists, and psychological therapists) is 14%. In 2018, the overall vacancy rate for children and family social workers in England was 16%.

These staff shortages are having a direct impact on terminally ill children and their families. Despite being assessed as needing 24-hour support by the NHS, some children and young people are not getting around the clock care. This is because there are too few professionals with the skills and experience needed in hospitals, children’s hospices and the community.

The NHS Long Term Plan identifies children’s palliative care is an important priority for the NHS. Together for Short Lives called on ministers to end the children’s palliative care workforce crisis by making sure the following measures are included in the NHS People Plan:

  • Health Education England to urgently assess the gaps in the children’s palliative care workforce, include the demand from children’s hospices in its planning models – and develop a competency framework for professionals providing children’s palliative care.
  • NHS England and NHS Improvement’s specialised commissioning team to urgently fund NHS trusts and children’s hospices to create specific specialist medical training posts.
  • Boost nursing numbers by taking the actions recommended by the Royal College of Nursing, including at least £1 billion a year into nursing higher education, and at least £360 million per year for nurses’ continuing professional development.

The government’s decision before Christmas to fund a £2 billion package of financial support for trainee nurses in England is a good start. However, more is needed now.

We can all play a role in pressing ministers to take these actions. Please sign our open letter to Health and Social Care Secretary Matt Hancock now asking him to make sure that these vital steps are taken. I will deliver our letter in person to the Department of Health and Social Care later in January.

Families cannot wait any longer for the workforce crisis to end. Many children who need palliative care now will not be alive when the International Year of the Nurse and the Midwife draws to a close. Please make signing our letter one of your first resolutions of 2020.

Please sign our open letter to Health and Social Care Secretary Matt Hancock now asking him to make sure that these vital steps are taken. I will deliver our letter in person to the Department of Health and Social Care later in January.

Andy Fletcher, Chief Executive of Together for Short Lives

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