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I want you back for good

October 1, 2014

We’ll be together, this time is forever! In the first of two staffing stories from the past week, Health Education England (HEE) announced their plan to lure lapsed registrants back to nursing with easier-access Return to Practice (RTP) courses. Goodbye to paying up to £1500 to complete the course and having to organise your placement yourself – which apparently used to be a feature of some RTP schemes. Hello (at least for a trial period) to free tuition, bursaries to help with expenses and guaranteed placements. In a country experiencing severe nursing shortages, this has got to be a good idea – it’s cost-effective and in fact such a no-brainer that it makes you wonder why HEE took so long to think it up.

How successful is it likely to be though? Research commissioned by HEE and reported earlier this year focussed mostly on the variable quality of RTP courses in terms of content and user experience. Speaking to the Nursing Times last month, campaign leader and managing director of Health Education West Midlands, Professor Janice Stevens, said that HEE had now agreed a standardised schedule of what RTP should offer and a ‘checklist for anybody wanting to commission an RTP course that says it must include these elements’.

She also gaily admitted that she had no idea what the demand for re-vamped RTP would be: ‘The only stat we’ve got is how many people’s registration has lapsed, and it is thousands and thousands’. (For her information: the Nursing Standard has reported that ‘in England, 748 people applied for 712 places on courses in 2012/13’). What was conspicuously lacking was any curiosity about the reasons why pre-retirement age nurses allow their registration to lapse, what has stopped them from renewing before now, and what would make nursing seem like an attractive option to those who had previously ruled out coming back.

So while it’s one thing to find (as reported in an earlier Nursing Times article) that ‘support for former nurses wishing to return to the profession is patchy, with many struggling to access courses and some forced to organise their own work experience’, the much bigger question is: what about all those people who’ve never even considered returning to the profession? What would it take to bring them back to the fold?

With a couple of caveats, some answers can be found in the comments made on articles on the subject. Firstly it’s impossible to know how representative they are; and secondly. to have found their way to in the first place, you’ve got to assume that even the ones who proclaim that wild horses wouldn’t drag them back to nursing still retain a residual interest, even if all they want to do is gloat that they don’t have to put up with its indignities any longer. Common complaints are that the unlovely things that drove people out in the first place – stress, low pay, unsympathetic management culture – would prevent a return. Others say they have put their transferable skills to use in jobs outside nursing or have stayed in but transplanted to more congenial working environments beyond these shores.

What is evident is that nursing has image problems even within the ranks of those who once held it dear. Comments like ‘Clinicians needed to be treated with respect rather than being bullied and harassed’ and ‘A good support system and a fair wage might tempt me back…many aspects that I miss’ suggest that even the undoubted satisfactions of the job are outweighed in many people’s minds by the drawbacks. The point is that lapsed nurses could be a mine of information – but it’s a mine the profession as a whole seems to have turned its back on.

In this context, two of the most interesting comments came from a couple of nurses who had completed the RTP course and were keen to start work – but not in the NHS. One because ‘all the jobs on local wards require internal rotation [and] I am unable to do this as my daughter is only 14 and it is illegal to leave [her] on [her] own overnight’ and the other because ‘most NHS Trusts have adopted the 12/13 hour shift pattern with night and day duty in the same week. These are very long and tiring shifts that do not fit in with family life’.

So the picture we’re getting here is that no one knows how many people will be attracted by the new RTP courses – so no one knows what the demand will be for teaching, for placements and for good, encouraging mentors – and no one knows how many of those who successfully complete will go on to be employed in the NHS. Or, presumably, their reasons for not choosing the NHS if they go elsewhere. But getting answers to these questions is crucially important, and will only become more so in future.

At last week’s Labour Party Conference, party leader Ed Miliband pledged that if elected next May, a Labour government would introduce a £2.5bn ‘Time to Care’ fund that would pay for 20,000 extra nurses and 5,000 extra health care support workers by 2020. The reaction of many commentators was ‘Great! But where are they all going to come from?’. Broken down over a five-year parliament, it means filling 4,000 new posts a year – that is, on top of natural wastage from pre-existing posts.

Although it sounds a tall order, it could be achievable. Recently published figures confirm that since August last year, more than twice that number – 8700 nurses – have joined NHS in England and Health Education England (HEE)-commissioned university places have jumped by 9% to 13,228 2014-15. But these figures mask some possibly more worrying trends. Most of the gains have been in the acute sector, and even here, increases have tailed off recently. Mental health and the community, for example, have benefited much less. Universities are still locked in a dispute with HEE about funding for undergraduate nursing courses – if this can’t be resolved, the threat of course closure may follow.

But the biggest problem is, numbers joining are dwarfed by numbers leaving. In May this year the Nursing Standard reported that ‘More than 90,000 nurses have dropped off the Nursing and Midwifery Council register in the past five years’ (this would relate to UK-registered nurses working anywhere in the world, rather than England alone). Many of these departures will have been practitioners heading off to well-earned retirements, but many will have been working-age people who simply couldn’t take any more.

Retention of staff must be the easiest and most cost-effective way of staffing the service, but also seems to be the one that attracts the least interest. It’s telling that during this party conference season, neither of the main parties has made any commitments to raise public sector pay; in fact the Tories have made a virtue out of their determination to hold it down. Whenever I’m wrong just tell me the song and I’ll sing it? Sorry Gaz, you had your chance.


For recent figures on nursing numbers for the NHS in England (excluding GP practices), see:

For information on the Return to Practice scheme, see: and

For the Nursing Standard article, see:

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