The Ward Round: All change at HEE

Earlier this year, The Ward Round suggested a new era could be dawning for Health Education England. Its new chair Sir David Behan set the record straight about some of the difficult decisions the organisation had to make over the years and defended its “respectful” relationship with NHS Improvement.

Sir David was clear with HSJ that much work needed to be done to restore faith in HEE and dispelled rumours a merger with NHS Improvement was on the cards.

However, earlier this autumn, it was announced England’s deputy chief nursing officer Mark Radford would be made full-time chief nurse at Health Education England and would also join HEE’s board — a significant move that would help NHS England and Improvement bridge the work of all three organisations.

And then, a few days ago, HEE’s first and only chief executive since it was established in 2012, Ian Cumming, announced he would be departing next year.

Eight years is a considerable period of time to give to an organisation and Professor Cumming said he was leaving to take up a role in academia and as chair of a West Midlands ambulance trust.

However, on Professor Cumming’s watch, the organisation has had its budget slashed steadily since 2012. In 2017, it fell from £190m to £84m, which, according to Sir David, resulted in “trade-offs”.

To the outside observer, these trade-offs may not have been apparent and HEE has come under fire from a health service beset with staff shortages and problems with workforce planning.

The organisation’s independence has also been called into question over the last year, after it was announced it would be made “accountable” to NHS Improvement — many saw Professor Radford’s appointment as indicative of this — and with NHSI chair Baroness Dido Harding prominently leading the review of workforce policy known as the “NHS people plan”.

Professor Cumming’s replacement is currently being recruited, and whether the top job is given to someone already at NHSE/I — under some form of joint appointment — is a pivotal decision.

This, as suggested by some HSJ reader comments, might be a mistake for HEE. An independent education and training organisation is essential to ensure these important issues – and the funding for them – are not eaten up by performance and service pressures.

A signal will certainly be sent by whoever is appointed in Professor Cumming’s place.

District nurse deterioration

On the subject of staff shortages, the Queen’s Nursing Institute’s latest report on the district nursing workforce made for shocking reading.

It is known the profession has been in decline over the last decade; a 40 per cent drop in the number of district nurses working in the NHS since 2010, according to NHS Digital figures. And with the long-term plan’s emphasis on care closer to home and in the community, reversing this trend should be a priority for any workforce planner.

The QNI’s report has delved into why this vital profession is under threat. It found a lack of support and career development opportunities for district nurses has deteriorated again since 2014.

Some of the biggest concerns highlighted were unpaid overtime — a third of district nurse respondents said they were working an extra seven hours a week for free — and an ageing workforce. The majority of respondents to the QNI’s survey were aged over 45 and nearly half were planning to leave or retire from the health service in the next six years.

Unsurprisingly, a lack of continuing professional development was given as a key factor by many looking to leave the profession, something that is a problem for the whole of the nursing profession. A multiyear spending review with CPD levels increased to 2012 levels would be a minimum requirement to reverse this.

The QNI also launched a new “international community nursing observatory” in London this week, which will analyse community nursing workforce data in greater depth and aims to boost understanding of it.

Alison Leary, chair of healthcare and workforce modelling at London South Bank University, has been appointed as director of the observatory in a part-time role. She said being able to help fill the gaps in the community nursing evidence based was a “great privilege” but warned the “perfect storm” of circumstances affecting district nursing would, if left unattended, “directly threaten patient safety”.

“We need to seriously address what that crisis will look like for local communities in the future and what such a shortage of qualified district nurses will mean for people in our community with complex care needs,” Professor Leary said.