The daily headlines of challenges facing the NHS are cause for concern and familiar to many (Kirk, 2015). Working within the confines of the NHS, nurses and midwives are central to these discussions and best placed to clarify any misconceptions the public may have; perhaps more importantly, nurses and midwives can be the voice of an overstretched service. For the first time, we have seen both junior doctors and midwives undertake industrial action to make public their concerns about the service, which has been met with differing opinion. While no one wishes to see the care of individuals being adversely affected, perhaps the time is right to take a stand against the continual cuts to resources.
Meanwhile, there are specific challenges in relation to specialist areas of maternity and neonatal service provision. One issue is that NHS Trusts have just been informed that continuing professional development (CPD) funding has been reduced—in some cases by 40%—and that all allocation should be based on clinical priority. This announcement has caused concern for both clinical managers and educators, who need to advocate lifelong learning to the workforce as part of the appraisal process. The Nursing and Midwifery Council has recently launched the revalidation process, which complements appraisals by encouraging clinicians to continue and give evidence of professional development. In an era of uncertainties, the reduction in CPD could undermine these processes.
Neonatal units are in a privileged position to have a National Service Specification for Neonatal Critical Care, alongside clear staffing guidance. The benefit of this is the transparent data which evolve to signify nursing workforce shortages and deviations from the recommended staffing numbers i.e. a 1:1 nurse-to-patient ratio for babies in intensive care, as recommended by the British Association of Perinatal Medicine (BAPM, 2010); in high dependency, the recommended ratio is 1:2 nurses, and 1:4 nurses for infants receiving special care. Neonatal units have additional directives relating to qualification—that 70% of the registered nursing workforce must have a qualification in neonatal speciality, which is only achieved through post-registration education (CPD). Higher education institutions offer courses based on need, with minimum numbers to make a programme financially viable. If fewer nurses are supported with CPD, could this provision cease?
A report from the charity Bliss (2015) highlighted a shortfall of neonatal nurses, not only in intensive care but across all remits of neonatal provision, which appears to be worsening. This has been emphasised by the numbers produced by neonatal operational delivery networks throughout the country. In the North West alone, based on the cot activity in neonatal units for 2014–15, 315 more whole-time equivalent registered nurses would be needed to meet the BAPM staffing guidance. This has been followed by some concerning evidence from Watson et al (2016), who reiterated the risks associated with decreasing nurse-to-patient ratios in neonatal intensive care. Although clinicians in many areas of maternity and neonatal care are familiar with this concern and strive to address workforce challenges, there remains a distinct shortfall of nurses qualified to work in neonatal care. Recruitment is a concern for many areas, with a number of Trusts looking to recruit from overseas. Why, then, was intensive care of the neonate absent from a recent list of CPD priorities?
The core challenges of the NHS, no matter what the discussion, continually revert back to recruitment and retention of registered nurses and midwives. Given this, why is the development of teams and support for staff education given so little emphasis? It has been recognised that if staff are made to feel supported and encouraged to develop, they will not only be faithful to the employing Trust but are also likely to remain in the profession (Good Governance Institute, 2015). The changes to student nursing and midwifery financial support are imminently close and we do not yet know how this will affect student numbers. Given that headlines and reports reiterate the shortage of nurses and midwives, many are struggling to understand the basis for some of the decisions that are made in relation to funding allocation. Reassurances are given that students will be better off financially; however, it has yet to be established whether some groups of applicants, such as those with families, will no longer feel able to undertake pre-registration training.
Each area of speciality continues to strive to improve services and ensure quality. There are many dedicated and highly skilled professionals working in neonatal and maternity care. Many of my colleagues already undertake mandatory training, in their personal time, to meet their employers' requirements. This could lead to a lack of motivation and burnout, especially if there are further expectations that CPD will not be offered. It is important that we do not lose sight of the fact that in order to keep this workforce in the profession, development must not be an oversight. Fire-fighting to keep a service afloat will undoubtedly end in the loss of core members of the team.