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Children’s palliative care nursing workforce in crisis

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Nurse giving tube feed to young boy at a children's hospice

A worrying shortage of skilled and experienced nurses means that it is becoming harder for seriously ill children in England and their families to access vital short breaks for respite provided by children’s hospices.

New Together for Short Lives research carried out with children’s hospices in England has been revealed in an ITN story tonight (Wednesday 11 May). The story focuses on the workforce challenges faced by Noah’s Ark Children’s Hospice and the impact they are having on the care and support they are able to provide to families.

Regular short breaks for respite are a lifeline for seriously ill children and their families. The pressure on families caring for a seriously ill child with complex needs is immense. The impact of caring for a child 24/7 and the knowledge that your child will die young can be too much to bear, so having access to regular short breaks is vital to relieve this stress, spend time as a family and do the things that other families do.

Together for Short Lives’ new research carried out with children’s hospices in England has revealed:

  • The average vacancy rate for nurses and other non-medical care and support professionals working at the equivalent of NHS Agenda for Change bands 5-9 inclusive has grown to 18.6% in 2022, compared to 12.2% in 2019, 11% in 2016 and 10% in 2015.
  • This is higher than the NHS nursing vacancy rate in England in quarter three of 2021/22, which was 10.5%.
  • Within this, one in four (26%) band 5 posts in children’s hospices are vacant.
  • Over two thirds (70%) of children’s hospices report higher care and support professional vacancy rates compared to April 2019.
  • Among those children’s hospices who are experiencing a higher vacancy rate, over half (58%) say that this has led to them cutting or stopping their short breaks for respite for families of seriously ill children.
  • Almost all (93%) cite a lack of professionals with the skills and experience to recruit as a significant or very significant factor in explaining their care professional vacancy rate. 89% cite competition from other local healthcare providers as significant or very significant. 78% state that the fact that children’s palliative care is a challenging field to recruit to as a significant or very significant factor.


Andy Fletcher, Chief Executive of Together for Short Lives, said:

“Children’s hospices need professionals with the skills and experience to meet the complex needs of seriously ill children and young people. It is therefore very worrying that children’s hospices are struggling to recruit the staff they need to meet these needs.”


Shortages have worsened over the past three years as services compete for the limited number of professionals available.

Andy Fletcher, CEO, Together for Short Lives

“Like NHS-run services, children’s hospices need access to skilled and experienced professionals. It is vital that the government, the NHS and health workforce planners act to urgently boost the number of nurses and other professionals in England who can care for seriously ill children. They should also include children’s hospices and other charity services in their workforce planning, just as they do for NHS hospitals and community services.”

“If they do not, sustainable services will simply not be available for integrated care boards to plan and fund in a way that meets their new legal duty to commission palliative care for children and young people. And more and more families will reach breaking point as they miss out on lifeline care and support, including regular short breaks for respite,” added Andy Fletcher.

Together for Short Lives’ workforce survey also found:

  • The average vacancy rate for all non-medical care and support roles across NHS Agenda for Change bands 2-9 inclusive is also high, running at 18.4%. This includes healthcare assistants and nurse associates, for example, which play an important role in providing lifeline children’s hospice care.
  • Two thirds (67%) of vacant non-medical care and support roles in children’s hospices were proving hard to fill (vacant for three months or more).

Together for Short Lives is calling on the government, the NHS and other partners take the following urgent action: 

  • Ministers should make sure that the additional 50,000 nurses that the government has committed to by the end of this parliament includes children’s nurses with the skills and experience to provide palliative care to children and young people.
  • NHS England and Health Education England should urgently assess the gaps in the children’s palliative care workforce across the range of professions who care for seriously ill children, across hospitals, children’s hospices and community services.
  • Education providers should make sure that children’s palliative care is embedded in undergraduate and postgraduate nursing courses in a way that is consistent with existing regulations. Universities should consider increasing the number of places they offer to undergraduates.

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