Children's Workforce Guide to Qualifications and Training: Health

While the NHS remains the biggest employer of children's health professionals, many now work in multi-agency teams. In the children's sector, roles cover a wide range of areas including nursing, midwifery, health visiting, paediatrics, mental health, substance misuse and sexual health.

In October 2015, local authorities assumed responsibility for the commissioning of public health services for children aged five and under, adding to their existing responsibility for public health services for older children and young people. This has led to the development of more integrated 0-19 services, which could include early years, parenting support and support for children with disabilities.

Training is beginning to reflect this multi-agency trend. Health Education England (HEE) for example, is piloting multi-disciplinary training programmes for maternity services in 10 early adopter sites that will roll out across the country by 2017/18. There has been also some debate in the sector about the viability of a generic 0-19 nurse to replace the specialists who work with children, such as health visitors and school nurses.

"There is currently much discussion about the need to transform the children and young people's workforce, with a perceived need to increase the focus on mental health, learning disability and community," says Debbie Fallon, interim chair of Children and Young People's Nurse Academics UK.

The Shape of Caring review into the education and training of nurses and care assistants, published last year, highlighted the need for more flexible nursing roles. It recommended a new four-year structure for nursing degree courses involving two years of generic training, a year of specialising in, for example, children's nursing, and a work-based transition year in the student's chosen field of nursing. The Nursing & Midwifery Council (NMC) is reviewing its standards for education with a view to implementing new standards in 2018.

Currently, universities provide the number of nursing places requested by HEE, based on its workforce planning calculations, but due to nursing shortages universities will set their own admissions numbers from 2017. Students are required to complete 2,300 hours of practice and there are some concerns about whether enough placements will be available.

From August 2017 new nursing, midwifery and allied health students will no longer receive NHS bursaries, and will instead have to take out student loans. The government says this will result in 10,000 more students by 2020, but the London School of Economics predicts a six per cent downturn in applications.

The sector continues to explore new routes into nursing including a nursing associate role designed to bridge the roles of health assistant and registered nurse. Early test sites will recruit 1,000 students to start training for the new role in December 2016.

"There has never been a better time for student nurses," says Fallon. "The trusts are in recruitment mode, and are starting to focus on retaining band 5 and 6 nurses, with a lot more training available."

The previous government oversaw a workforce plan which boosted the number of health visitors by more than 4,000, but a recent survey by union Unite found 70 per cent of health visitors report "frequent" staff shortages over the last 12 months. "Progress made by the last government with the Health Visitor Implementation Plan could be jeopardised, with all the adverse impact this would have on families, children and the wider public health agenda," says Unite national officer for health Sarah Carpenter. Workforce figures show the number of health visitors in England has been falling since the start of 2016, with a significant drop of 433 posts between March and April.

The latest workforce survey from the Royal College of Paediatrics and Child Health revealed that 89 per cent of clinical directors are concerned about how their service will cope in the next six months, with more than half of paediatric units not meeting recommended staffing standards. "The paediatric workforce is at breaking point and children's healthcare is increasingly being compromised," says Dr Simon Clark, workforce officer at the college.

One area that is set to grow is mental health services, with plans for a significant expansion in access to high-quality mental health care for children and young people by 2020/21. Last year the government committed to an investment of £1.4bn over five years. This includes a £290m perinatal package that will be used to pay for new community perinatal teams and £1.5m to pilot joint training for designated leads in mental health in both schools and child and adolescent mental health services.

Nurses and midwives are required to re-register every three years to carry on practicing. A new revalidation process, which requires nurses and midwives to complete 40 hours of CPD rather than the 35 previously required, launched in April 2016. Under the new system nurses and midwives also have to reflect on feedback from colleagues and patients and discuss this with a fellow nurse or midwife.