Together for Short Lives
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Ensuring a sustainable children’s palliative care workforce

A growing shortage of skilled children’s palliative care doctors and nurses across England is at a crisis point. Together for Short Lives’ October 2019 workforce report has revealed that the crisis is leading to terminally ill children and their families missing out on crucial specialist care and support.

Government, NHS England and NHS Improvement and Health Education England are not taking the steps needed. Together for Short Lives is calling on ministers to commit to specific action on the children’s palliative care workforce crisis in the NHS People Plan.

What do we know about the children’s palliative care workforce in the UK?

There are shortages in NHS-provided community children’s nursing (CCN). The Royal College of Nursing (RCN) recommends that for an average-sized district, with a child population of 50,000, a minimum of 20 whole time equivalent (WTE) community children’s nurses are required to provide a holistic community children’s nursing service. The Office of National Statistics estimates that there are 13,770,873 children aged 0-18 in England. If the RCN recommendation were to be met, this would therefore require approximately 5,508 community children’s nurses. There are currently just 574 community children’s nurses in England.

Together for Short Lives estimates that there are currently just 15 specialist paediatric palliative medicine consultants in the UK, meaning there are many regions without access to a consultant.

From a survey of children’s hospice organisations which we undertook in 2019, we know that:

  1. The nurse vacancy rate among children’s hospice organisations in England is higher than that of the NHS in England. The average vacancy rate was this year found to be over 12% which is an increase on 2016’s findings of 11%, and 2015’s findings of 10%. This represents over 120 whole time equivalent (WTE) posts unfilled.
  2. There is an increasing shortage of experienced nurses in children’s hospice organisations. In 2019, the number of vacancies was highest at a salary equivalent to Band 6 compared to salaries equivalent to Bands 5 and 7.
  3. There is a lack of skilled nurses available to fill posts. More than half (58%) of children’s hospice organisations cited lack of available appropriately skilled nurses being available to fill posts – similar to the 61% which reported this in 2016.
  4. It is getting harder for children’s hospice organisations to fill nursing posts. Over two thirds (68%) of vacancies are described as hard to fill (vacant for over three months). This is much greater than the 57% reported in 2015.

There are also 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 round the clock care. This is because there are too few carers with the skills and experience needed. This is undermining children, young people and their families’ ability to make choices about where they receive care. Without this crucial care and support many families could find themselves relying on emergency care, causing great distress to them and incurring unnecessary costs for the NHS.

What are the UK’s governments doing to make sure there are enough professionals with the knowledge, skills and experience needed to care for children with life-limiting conditions?

In September 2019, the Chancellor of the Exchequer announced a £210 million package of measures designed to better educate and train NHS staff. This included funding for a £1,000 personal development budget for every nurse, midwife and allied health professional to support their personal learning and development needs over three years.

Despite this, Together for Short Lives is concerned by the extent to which the government, NHS England and NHS Improvement, Heath Education England, health workforce planners and universities in England are taking the action needed to address the shortfall in children’s palliative care professionals.

What would Together for Short Lives like to happen?

Together for Short Lives is calling on ministers to end the children’s palliative care workforce crisis by making sure the following measures are included in the NHS People Plan:

  1. 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 a core skills education and training framework for children’s palliative care.
  2. 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.
  3. Boost nursing numbers by taking the actions recommended by the Royal College of Nursing, including:
  • investing at least £1 billion a year into nursing higher education
  • investing at least £360 million per year for nurses’ continuing professional development
  • legislating to make clear who is accountable for workforce supply and planning in England – and what establish safe nursing staffing levels in law.
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