Written evidence submitted by Dementia UK (RTR0074)

About Dementia UK 

We are Dementia UK – the specialist dementia nurse charity. 

Dementia is a huge and growing health crisis. There is no cure for dementia. But there is care. And care can change lives. 

That’s why Dementia UK is here. Our nurses, called Admiral Nurses, who we continually support and develop, provide life-changing care for families 

affected by all forms of dementia – including Alzheimer’s disease. For families affected by dementia, they can be a lifeline. 

What is an Admiral Nurse?   

As dementia specialists, Admiral Nurses help families manage complex needs and help people living with dementia stay independent for longer – and support the people caring for them. This takes the pressure off the NHS and social care services. Admiral Nurses also provide these services with specialist advice and best practice guidance.  

We currently have over 300 Admiral Nurses in NHS hospitals, GP practices and local community services. But by 2025, the number of people with dementia in the UK is projected to exceed one million. We need to drastically increase the number of Admiral Nurses to meet this demand, to support every family needing a specialist dementia nurse.  

Dementia UK’s submission 

Dementia UK is submitting evidence because of our clinical nursing experience supporting families affected by dementia. Our clinical leadership team are expert practitioners who have experience of dementia care across all care settings; this includes insights into workforce issues including recruitment, training and retention.

A note on our submission: we have not responded to all questions, eg, questions on a reduction on the training period for doctors/ cap on medical places, as we have focused on questions within our areas of expertise. 

What are the main steps that must be taken to recruit the extra staff that are needed across the health and social care sectors in the short, medium and long-term?

Strategic steps are needed to recruit and retain staff with the skills set and expertise to meet the needs of patients and their families – this includes ensuring compassionate and person-centred care for an ageing population living with long term conditions such as dementia and the complexities that this can bring for the whole family.

Specialist roles such as Admiral Nurses are pivotal in providing compassionate and person-centred dementia care. Dementia cases are rising, and more Admiral Nurses and other skilled health and care professionals are essential to meet the complex needs of the person with dementia and their family carers. This requires a greater focus on recruiting – and retaining - workforces to meet current and future care needs across all settings to ensure people with dementia and their families receive the same quality of care and support as people living with other health conditions.  

Recruitment

Dementia UK has introduced steps to raise awareness of Admiral Nursing and encourage more registered nurses into this specialist career. Similar awareness raising measures may be beneficial to boost recruitment across other health and care disciplines.

Steps include:

• an open access pre-Admiral Nursing e-learning module[1] for all health and social care professionals to learn more about Admiral Nursing and working with families affected by dementia
• delivering a virtual open access Summer School through the Admiral Nurse Academy to highlight the role of Admiral Nurses in specialist dementia care[2] – with future open access events planned
• trialling new ways of recruitment, including using social media to reach a wider professional audience, and targeted awareness/open days to share the work of Admiral Nursing
• providing talks about Admiral Nursing on pre-registration nursing courses
• providing candidates with clear information about the benefits of a career in Admiral Nursing and career progression opportunities in recruitment material and job descriptions, and as part of their induction into their Admiral Nurse role

Higher education

Dementia nursing requires a unique set of clinical and therapeutic skills, but dementia is not always seen as a specialist area in its own right.

Dementia UK recommends that universities raise the profile of specialist nursing roles, including within dementia care, by providing an earlier curriculum focus in undergraduate degrees. More placements in dementia care settings, such as within care homes, are also needed so students can gain a greater understanding of dementia, complexity of need and the skilled interventions required. This will also require investment grants for further workforce developments in dementia nursing.

This greater focus on dementia nursing needs to start now as there will be a ‘time lag’ until we see new graduates ready to start their careers. In the long term, this could lead to an increase in people interested in a career in dementia care, which is urgently needed to replace a workforce approaching retirement[3].

Similarly, universities should better promote social care nursing as a career choice. This workforce totals more than the NHS nursing workforce[4] and already faces staff shortfalls and a constant stream of nursing staff leaving the sector. Social care nursing is urgently required to meet current and future needs of an ageing population who require complex and ongoing care.

Retention and training

Explore ways to retain staff approaching retirement, as their skills, knowledge and expertise are important while new recruits are developed. This can include promoting more flexible work patterns or opportunities. For example, retired Admiral Nurses can work flexible hours on our Admiral Nurse Dementia Helpline to continue supporting families facing dementia. They also share their experience and knowledge with other Admiral Nurses through our Admiral Nurse Academy.

‘Nurturing’ the workforce of the future is key, which includes providing a clear and rewarding career pathway. Dementia UK will shortly launch our Admiral Nurse Accelerator programme to upskill and develop Admiral Nurse Clinical Leads. This new programme aims to develop new Admiral Nurses so that they acquire the knowledge, skills and competencies to enter new hosted roles that we will invest in over the next two years.[5] 

Other steps Dementia UK has taken to develop and retain Admiral Nurses include:

•          access to the Admiral Nurse Academy which gives CPD opportunities and support to learn and develop (eg, our Dementia UK Leadership programme and access to the Florence Nightingale Leadership programme)

•          the Academy also includes access to Communities of Practice, Special Interest Groups, webinars, induction programmes and access to an academic Competency Framework module. The Competency Framework facilitates professional development, identifies gaps in knowledge and articulates the specific and unique skills Admiral Nurses need

•          access to regular Practice Action Learning sets (PALs) to provide quality clinical supervision. Nurses value peer learning and support and PALs groups provide a safe and reflective space to explore clinical practice in a facilitated group

•          our Consultant Admiral Nurse team provides Admiral Nurse teams with clinical consultation and support with specialisms

What is the best way to ensure that current plans for recruitment, training and retention are able to adapt as models for providing future care change?

By 2025, it is predicted that over one million people in the UK will be living with dementia. Dementia is a complex long-term condition that requires specialist support across health and social care. Dementia nursing and the dementia care pathway will need greater prioritisation in health and social care workforce development plans to meet the growing needs of those affected by dementia and their family carers. 

Local workforce plans should meet population needs and projected care needs going forward. This includes planning for the ongoing and long term impact of Covid on unmet patient needs. For example, the pandemic has led to a backlog in dementia diagnosis, which means people are then unable to access post-diagnostic support. More staff are needed to support timely diagnosis and to ensure there is enough post-diagnostic support available to families throughout the dementia care pathway.

Quality and compassionate person-centred care should be built into any future care changes. This will ensure workforces can provide the right care at the right time and in the patient’s preferred care setting, ie, as people live for longer, we should support them to live independently for as long as possible.

Workforce models need to be integrated across and between health and social care to provide better co-ordinated care and information sharing. A multidisciplinary model can also lead to better sharing of best practice, reduce workloads and the risk of patients falling between the health and care gap.

This also calls for better systems for data capturing to strengthen workforce planning and projections as well as to ensure changing demographics are considered.

Other recommendations include:

• Equality, Diversity and Inclusion (EDI) - improve recruitment and representation across all communities in the health and social care workforce
• focus resources on health inequalities and long term conditions such as dementia
• more focus on developing multidisciplinary teams and a tiered approach, with the ability to scale up or down in terms of interventions needed
• high quality leadership and modelling best practice
• ensure workforce plans are embedded in all key Government strategies and plans

• improve staff resource for hospital discharge in order to facilitate safer discharge and avoidable readmissions

What is the correct balance between domestic and international recruitment of health and social care workers in the short, medium and long term?

There may be the need to rely on international recruitment in the short term, particularly to help address the current NHS backlog. However, international workers need to meet quality standards to work in the UK. This includes having relevant knowledge and skills in dementia care to support people with dementia who are in hospital (sometimes for long periods of time) and residential care.

However, focus must remain on promoting health and social care as valuable careers to domestic workers to ensure we have a more sustainable work stream into the future.

What can the Government do to make it easier for staff to be recruited from countries from which it is ethically acceptable to recruit, with trusted training programmes?

Leaving the EU has been a challenge in terms of general nurse recruitment. Some EU countries provide good nurse education and training, similar to nurse training in the UK. Are there opportunities to focus nurse recruitment efforts in these countries?

Other recommendations:

• visa support and help with settling into the UK for international staff and their families
• support recruits with ongoing training and development opportunities including increasing their understanding and awareness of person-centred and quality dementia care

What changes could be made to the initial and ongoing training of staff in the health and social care sectors in order to help increase the number of staff working in these sectors? In particular:

There needs to be more focus on training and development opportunities – particularly within social care, which currently doesn’t provide a clear career structure. This should include clear career pathways and leadership opportunities.

Encourage staff in their professional development by investing in time for training, so staff can explore their interests and what benefit they can bring to the care setting.

To what extent is there an adequate system for determining how many doctors, nurses and allied health professionals should be trained to meet long-term need?

The workforce planning in dementia care has historically been poor and only focused on health and not social care. Data on the number of social care nurses has not been adequately calculated and, unless this improves, we risk not being able to calculate numbers required to meet long-term need. This is a critical issue, as the increasing numbers of people living with dementia will need more specialist nursing support.

Do the curriculums for training doctors, nurses, and allied health professionals need updating to ensure that staff have the right mix of skills?

Rates of dementia are increasing and Dementia UK recommends a greater focus on dementia care as part of curriculums for all health and care professionals. Dementia is a progressive, disabling condition that requires increasing levels of support over time from a wide range of professionals, including GPs and nurses working in acute and community services. People with dementia and their families require access to quality care and support across all health and care settings. This calls for a focus in curriculums for increased clinical understanding of dementia, the range of skilled interventions needed, and improved communication skills to address the needs of the person and their family.

What are the principal factors driving staff to leave the health and social care sectors and what could be done to address them?

Workforce shortfalls are a long term issue in the NHS and social care, which has now become critical. It is well documented that the pandemic has led to burnout amongst health and care professionals with many staff working, or being re-deployed, for sustained periods in highly stressful situations with limited support. This had led to increasing numbers leaving their profession, particularly in social care.

Social care nursing should have parity with nursing within the NHS. Their specialist interventions can reduce a person’s need for clinical interventions in health settings such as hospitals. Social care requires more long term workforce planning and a focus on greater retention of staff by providing clearer career pathways and progression opportunities.

The challenges of acute care being in a constant state of emergency means there is limited scope to think and plan long term. However, better planning and implementation is urgently needed to support patients and the workforce now, and into the future.

Health and care professionals may be carers themselves needing support. This could be in the form of time off for appointments and working flexible hours. Without support, many feel they have no choice but to stop work. This risks losing more skill and expertise at a time when it is needed the most.

Rebuilding workforce resilience, including improved wellbeing and financial support (pay and reward), and flexible working is required to support burnout and allow staff to better balance work and life commitments.

Are there specific roles, and/or geographical locations, where recruitment and retention are a particular problem and what could be done to address this?

Places with a high cost of living, such as London and Bristol, can be challenging to recruit to. Better metropolitan salary weighting may be required to attract and retain staff.

Rural areas need better workforce planning as rural locations can reduce the pool of skilled people applying for roles. Resettlement support could help with initial recruitment and attracting more staff. Access to ongoing wider peer and learning support, which Dementia UK offers to Admiral Nurses across all geographical locations, can help people feel less isolated and part of a wider community.

What should be in the next iteration of the NHS People Plan, and a people plan for the social care sector, to address the recruitment, training and retention of staff?

Workforce plans need to be integrated and streamlined. Non-NHS workforce planning needs the same value afforded to NHS planning with parity across the workforces.

Greater value needs to be placed on the complexity of social care work and with this, better pay for the workforce. The sector also needs a clearer career structure and progression opportunities with appropriate development and retention plans.

What is the role of integrated care systems in ensuring that local health and care organisations attract and retain staff with the right mix of skills?

Integrated care systems (ICS) will need to improve working across health and social care – not only would this provide patients with better co-ordinated care and information-sharing, staff would also benefit from working collaboratively, potentially leading to a reduction in workloads and improved job satisfaction.

Local Integrated Care Boards (ICB) will need to work with NHS England and Improvements to ensure local population needs can be met by current and future workforce plans. This includes an ageing population that is living for longer with multi-morbidities and complex needs that require timely and skilled interventions across settings and services. Dementia care should not be an ‘afterthought’ and should be fully integrated in local plans. This includes ensuring there are dementia specialists to support families affected by dementia in all health and care settings.

Jan 2022