Managing mental health issues and learning disabilities requires multidisciplinary input, and nurses are an invaluable part of that team.
They are at the front line of delivering strategies to address challenging behaviour and help inpatients towards fulfilled, integrated lives back in the community. Mental-health nurses also provide the day-to-day support and interaction that are crucial facets of relationship-building and facilitating a return to stability.
Yet recruitment and retention of mental-health nurses are hampered by the broader crisis affecting nursing supply nationwide – and to an even larger extent, given the particular demands of working in the sector.
Shortfalls in the nursing workforce
Estimates of current shortfalls in the nursing workforce vary, but they are substantial. According to a report by the House of Commons Health Committee, there are anything between 36,000 and 40,000 nursing vacancies in NHS England alone, with Health Education England (HEE) estimating that 33,000 of the 36,000 nursing vacancies in the National Health Service are filled by bank or agency staff.
The report also noted that vacancy rates vary between specialities: nursing for learning disabilities has the highest vacancy rate, at 16.3% within NHS England, followed by mental-health nursing at 14.3%. A recent briefing paper by HEE and the NHS Confederation highlighted a 13 per cent reduction in full-time equivalent mental health nurses working for the NHS between September 2009 and August 2017.
These challenges can be all the more daunting for companies providing specialised services to the NHS. They benefit only tangentially from new government initiatives such as ‘golden hello’ incentive payments for postgraduate nursing students taking up NHS positions, overseas recruitment to fill short- to medium-term staffing gaps, or the 21,000 new posts promised by 2021 under the government’s plans to expand the NHS mental-health workforce.
Thin on the ground
There are numerous reasons why nurses, and mental health nurses in particular, are so thin on the ground. A common complaint is that the withdrawal of the bursary scheme for nursing students is behind the significant drop in applications to undergraduate nursing courses across England: down by 23% in 2017/18 compared with 2016/17.
This means prospective nurses now have take out a student loan or rely on existing employers embracing alternative routes such as nursing-associate training or nurse-degree apprenticeships. Tuition fees for universities in England now cost £9,250 a year. Once maintenance loans are factored in, the average debt at graduation is estimated at £50,000 or £56,000 for students from less well-off backgrounds.
Bursaries are not the whole story, though. As the Commons Health Committee pointed out, the number of nurse training places was capped under the bursary scheme, while the number of applications for university courses exceeded the number of places available by two to one.
There are further complications, such as limited capacity for clinical placements on degree courses, the UK’s decision to leave the European Union alongside more stringent requirements for language training, or lower numbers of mature students pursuing a university degree in nursing.
A tough job
A more fundamental problem, and one with particular relevance to mental healthcare, is that nursing is a tough job requiring considerable physical, emotional and psychological resilience.
Healthcare services are under constant pressure from escalating demand and limited funding, while patients and their conditions become ever more complex, especially in specialised services. In a culture more oriented to self-absorption and personal gain, the traditional notions of public service that have sustained professions such as nursing are in retreat.
Once again, the shortfall is particularly marked in mental health. According to the Health Committee report, some universities that offer undergraduate courses in mental health and learning disability nursing are struggling to recruit enough students.
Grow our own nurses scheme
There are no easy or quick solutions to these problems. However, a number of provider organisations, both within and outside the NHS, are grasping the nettle by launching ‘Grow your own nurses’ programmes to nurture their own talent.
One crucial barrier to graduate entry in mental health or other forms of nursing is the prospect of running up significant debts while effectively putting earnings on hold. With The Huntercombe Group’s (THG) Grow your own nurses scheme, participants can continue working while training as nurses all the way up to graduate level.
THG started taking a closer look at its nurse recruitment and retention needs around two-and-a-half years ago. The resulting Grow your own programme starts with a 12-month Open University course called the Higher Education Certificate in Healthcare Practice.
This is the equivalent of taking the first year of a BSc (hons) degree in Adult or Mental Health Nursing. Staff members who successfully complete the 12-month course are then invited to apply for the second stage of this programme which will, if successfully completed, deliver a Nursing Degree.
The partnership with the Open University gives participants a good deal of flexibility in balancing their commitments. Huntercombe staff usually spend 50% of their time as students and the other 50% at work.
One obstacle we encountered, though, was finding our staff practice placements in NHS Trusts for their second year: a Nursing Degree requires experience in all areas of the profession. These places are usually reserved for students coming to work in the NHS.
We have resolved this issue by seconding participants out to study at local universities, which then organise the necessary practice placements. THG continues to pay their salary while funding their education, and course participants work shifts whenever they can. They are guaranteed a nurse’s role at THG once qualified.
Cohort of trainee nurses
At the moment we have three staff at our Cedar House facility still working with the Open University, while four staff at Eldertree Lodge are on the local university pathway.
We also have another cohort looking for placements from September this year. Moreover, Cedar House is piloting a nurse-associate programme with the local university in Kent, where five students will start training.
Support workers and healthcare assistants
The aim is to have a fresh cohort of THG trainees every year and a pipeline of qualified nurses coming through the business.
Support workers are at the heart of this process. In the past we have benefited from highly capable support workers at Huntercombe who nonetheless could not afford to train as nurses.
By funding participation in the Grow your own nurses scheme, we are not only opening up a new career path for support workers but cultivating engaged, informed and loyal employees who understand the complexities and challenges of mental health. Graduate nurses from universities often need substantial in-house training to adapt to the very specific demands of our services.
Support workers or healthcare assistants can be a severely undervalued part of the mental health equation, too often overlooked in policymaking or perceived as unregulated and poorly trained.
Yet they are intrinsic to helping patients manage their life on a daily basis, providing anything from physical care and support at mealtimes through to one-to-one conversation and interaction or encouragement to engage with therapy.
Flexible programme to qualify as a mental health nurse
The flexibility of the Grow your own nurses scheme means staff can take a break from their educational commitments if necessary and pick up the course when they have more time. Moreover, the scheme provides an inclusive entry route; staff who at the start of their career were not able to consider nurse training or other staff who may have difficulty with academic requirements for university nursing courses now have an opportunity to develop the career they aspire to (or something like that). With its mixture of formal learning in a university environment and on-the-job experience in THG facilities, Grow your own nurses is building on the best of ground-level skills, such as compassion and behavioural insights, to produce a new generation of nursing staff.
These qualified professionals will not only fill critical recruitment gaps in mental health but will bring a more rounded and rooted perspective to an always challenging but rewarding occupation.