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.
There were 50,341 registered children's nurses in the UK in March 2017, but while children and young people make up approximately a quarter of the population, only five per cent of registered nurses have a children's nursing qualification, according to Children and Young People's Nurse Academics UK. Recruitment onto children's nursing programmes is healthy, with many university courses oversubscribed. However, children's nurse educators are under increasing pressure to justify specialist child nursing qualifications when a generic nursing qualification may be cheaper to deliver.
Training in nursing and midwifery is set to undergo some changes following a consultation issued by regulatory body the Nursing and Midwifery Council (NMC) to review standards students have to meet before working as registered nurses, as well as standards for training providers. Proposals include allowing students to spend significantly more time in simulated activities, which could cut the amount of time they spend in placements, and allowing student nurses to be supervised by any registered medical or social care professional rather than a registered nurse. Training providers will be able to set their own literacy and numeracy entry criteria.
The sector continues to explore new routes into nursing including a nursing associate role designed to bridge the roles of healthcare assistant and registered nurse. One thousand nursing associates started training in December 2016, and another 1,000 started in April 2017. "The high level of interest means we have been able to select even more sites to take forward the training, and further underlines the real appetite for helping deliver this new role," says Professor Lisa Bayliss-Pratt, director of nursing and deputy director of education and quality at Health Education England.
In March 2017, the chief nursing officer for England announced another new route into nursing. The postgraduate Nurse First programme will run along similar lines to education's Teach First, and aims to fast-track graduates from other sectors into registered nursing positions. The first trainees will start in September 2017, and will be given the opportunity to progress to leadership roles within five to seven years.
Since August 2017, new nursing, midwifery and allied health students no longer receive NHS bursaries, and instead have to take out student loans. Applications to study nursing in 2017/18 slumped by 23 per cent compared with the year before.
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 help for children with disabilities. Training is beginning to reflect this multi-disciplinary trend. Health Education England's Maternity Safety Training Fund programme, for example, has distributed more than £8m across all NHS trusts with maternity services in England to implement packages of multi-disciplinary training. Training programmes are due to be completed by March 2018.
With commissioning responsibility now in the hands of local authorities and budget cuts continuing to bite, there are growing concerns that health visitor and school nurse roles are under threat. "What we fear is that overall workforce planning for health visiting and school nursing will fall between the NHS and local authorities," says Unite lead professional officer Obi Amadi. Research from the Labour Party published in July 2017 found 10 per cent of school nurses, 11 per cent of health visitors and 12 per cent of district nurses have been lost to the NHS in the past two years.
Some areas have cut back on the Family Nurse Partnership (FNP) programme which provides holistic support to young families. In Cumbria, for example, nurses delivering the FNP programme will move into wider roles within multi-agency "strengthening families" teams that would aim to work with the 3,500 most vulnerable children in the county. In other areas the FNP programme is still being used, and a scheme called FNP Next Steps is looking into giving nurses more training to help them deliver adaptations to the programme.
In some areas, redesigned services may mean enhanced roles for health practitioners, but in other places, staff numbers are being reduced. Unions claim specialist staff such as midwives are being required to work outside their remit, threatening their ability to access the professional support and development they need to maintain their registration. Unite is campaigning for ringfenced funding for health visitor and school nursing services.
Research from the Royal College of Paediatrics and Child Health (RCPCH) published in July this year found that almost one in five paediatric trainee positions for doctors are currently vacant. This figure jumps to nearly one in four in more senior trainee positions. "Health Education England is responsible for training, but has insufficient funding; NHS employers have insufficient funding; yet this problem is here and now," says Dr Simon Clark, RCPCH officer for workforce planning.
The RCPCH is calling for the government to identify a responsible body for integrated national and regional workforce planning. It wants the government to fund an increase in the number of paediatric trainee places to 465 in each training year for the next five years, and says paediatricians should be immediately placed on the government's shortage occupation list, removing some of the barriers from recruiting from outside the EU.
In the children's mental health sector, new opportunities are opening up with the establishment of 20 community perinatal mental health teams, part of a five-year transformation programme backed by £365m in government funding. The NHS has also set out plans to recruit 2,000 more staff to work in child and adolescent mental health services by 2020/21. Two new HEE training routes include psychological wellbeing practitioner, a new role to deliver "low intensity" mental health interventions to children and young people, while Recruit to Train requires service providers to create an appropriate new post to train and deliver psychological therapies to children and young people. HEE covers salary and training costs in the first year of employment for both new routes.
At the beginning of 2017, the Department of Health published a new education and training framework for the mental health workforce, including sections on the core skills and knowledge needed to support children and young people with mental health problems, and those who have learning disabilities.
Read more from CYP Now's Children's Workforce Guide to Qualifications and Training
