Nursing and midwifery taskforce minutes: April 2023

Attendees and apologies

Chair: Michael Matheson – Cabinet Secretary for NHS Recovery, Health and Social Care (Cab Sec)

Attendees

• Colin Poolman, RCN (CP)
• Eileen McKenna, RCN (EM)
• Jaki Lambert, RCM (JL)
• Gavin Fergie, Unite (GF)
• Matt McLaughlin, Unison (MM)
• Wilma Brown, Unison (WB)
• Jackie Mitchell, RCM  (JM)
• Professor Susan Dawkes, Robert Gordon University (SD)
• Professor Caroline Hollins-Martin, Edinburgh Napier University (CH)
• Professor Aisha Holloway, Chair of Nursing Studies (AH)
• Claire Pearce, ND NHS Tayside (CP)
• June Brown, ND Grampian (JB)
• Lesley Sharkey, MD NHS Tayside (LS)
• Jenny Pope, Deputy HRD (JP)
• Gillian McCannon, Chair of NHS Western Isles (GM)
• Karen Wilson, Depute Chief Executive and Executive Director of NMAHP (KW)
• Alex McMahon, Chief Nursing Officer (AM)
• Justine Craig, Chief Midwifery Officer (JC)
• Gillian Russell, Director of Health Finance (GR)
• Shiree Donnelly, Deputy Director of Health Finance (SD)
• Stephen Lea-Ross, Deputy Director of Health Workforce (SL)
• Isabella de Wit, Health Workforce Directorate (IDW)
• Daniel MacDonald, Health Workforce Directorate (DD)
• Nicola Gibb, Health Workforce Directorate (NG)
• Jennifer Callander, Health Workforce Directorate (JC)
• Rachael Dunk, Chief Nursing Officer Directorate (RD)
• Jess MacPherson, Chief Nursing Officer Directorate (JMc)

Apologies

• Serena Barnatt, HRD NHS Golden Jubilee 
• Jane Douglas, Transforming Workforce Lead – Nursing
• Richard McCallum, Director of Health Finance
• Angie Wood, Interim Director, Social Care Resilience and Improvement
• Fiona Davies, Chief Officer Argyll and Bute HSCP

Items and actions

Welcome – Cabinet Secretary for NHS Recovery, Health and Social Care

Cab Sec welcomed everyone to the first meeting of the Nursing and Midwifery Taskforce (NMT), advising although this was a commitment of the previous CabSec he recognises the importance of this work and wishes to progress at pace. 

The NMT will discuss building sustainable and skilled nursing and midwifery workforces and lead on co-producing tangible and realistic solution to key issues identified within professions, ensuring no duplication with the numerous work already underway. With the view of meeting quarterly with work undertaken via subgroups who will present to the NMT for agreement of recommended actions. 

Introductions - Cabinet Secretary for NHS Recovery, Health and Social Care

Background – Alex McMahon Chief Nursing Officer and Justine Craig Chief Midwifery Officer

AM provided an overview of the work currently going on in nursing and midwifery including: 

• the implementation of the Health and Social Care (Staffing) (Scotland) Act 2019, with and oversight board established and 11 boards agreeing to test out chapters prior to implementation from April 2024
• international recruitment – NHS have welcomed over 200 nurses in 2021/22 from overseas and well on track to recruit c.700 nurses and some midwifes in 2022/23. Also reviewing options for 2023 to 2024
• once for Scotland Retire and Return for all AfC staff agreed and signed off last Autumn, with NHS Greater Glasgow and Clyde reporting positive return
• the development of Band 2-4 framework signed off December and launched February 2023 with over 700 on call and strong appetite to progress within bands and pipeline for future nursing and midwifery undergraduates
• work ongoing within NES to scope out Band 4 consistency around education and training
• student nurse and midwifery numbers have been capped, with focus required on the attrition rate
• work is underway to review how we reduce the spend on supplementary staffing, last year the cost was £160m which is unsustainable long term. Principle we are working with is ‘stay local, work local, keep people safe’
• non-pay elements of recent negotiations to progress including, 36 hr week, protected learning time and review of the band 5 nurse job description

JC advised the work is relevant across midwifery as well and highlighted:

• the midwifery education review published in 2021 provided an overview of the work needed within the workforce, predicting that expected leavers from HEIs will not meet the expected demand until 2026
• reprioritisation has taken place to work on matters that will support the workforce as there has been a reduction in midwifery numbers, an increase in part-time and moving to other posts
• need to progress with international recruitment as can prove successful however only one board has utilised this
• work is underway to look at diversifying the workforce through apprenticeships, bands 2-4 and earn as you learn models
• midwifery heads have conducted reviews on the culture and retention elements. It is hoped that this will lead to better maternity cultures, higher retention and better patient safety

Discuss key themes and agree terms of reference (ToR)

Cab Sec opened up the discussion to focus on four key questions regarding the ToR:

Q. Is the aim, objective and scope for the taskforce correctly covered?
Q. Are there any programmes of work you would like to see included at Annex A of the ToR for context and to prevent any duplication?
Q. Does the indicative membership cover all interested parties?
Q. Are member content to agree the ToR?

JL highlighted the importance of data, and the lack of disaggregated data in the workspace. ToR is overarching and general enough to enable large volumes of work to be taken forward. More needs added regarding the reporting of the NMT and how work will be monitored going forward in terms of governance and transparency. Other stakeholders to be involved are the regulators.

AH noted whilst there is data, there are concerns over the quality with a lack of centralised framework. The data is stored in different areas and the engagement with the relevant stakeholders is challenging.

AH agrees ToR are dynamic which is what is needed for work going forward. Key stakeholders and communication within profession is needed and there needs to be reference regarding the reporting of work. Agreed that it would be valuable to have regulators along, there is existing work internationally that the NMT can utilise.

ToR are broad enough to enable work to be carried forward. There are quick wins now and aspirations for later. International recruitment is great but are we missing the opportunity of encouraging applicants from other UK nations.

CP ToR are open to allow them to be dynamic, work needs broken down into short, medium and long-term goals. The NMT should not just report but also engage with the workforce through a national conversation to ensure its work is not ‘doing to’ but ‘working with’. 

MM agreed ToR are broad in terms of scope and there is substantial need in making nursing and midwifery attractive again. However, must ensure we look for sharp, quick wins.

SD highlighted its harder to attract students now. Attrition is important to consider but where individuals fail can the service retain them in other capacities? Education sector requires representation here, and population health data is needed.

GM advised a clear governance and reporting framework is needed. Nursing education, particularly in remote areas, needs addressed as roles can be expanded which can link into different areas. Also population health needs and primary prevention needs to be wrapped around any curriculum. 

GF noted there is value in inviting regulators, and they can choose to attend. The NMT needs to be mindful that there isn’t just a focus on acute but also on community-based services, and that the NMT doesn’t continue for years.

JB is keen on evidence base being explored, particularly global evidence as subgroups move forward. 

SD stressed importance that actions and deliverables are initially focused on existing work and funding streams to minimise further spend.

AH noted Scotland has a lot to offer, the NMT should recognise and not overemphasise practice elsewhere in the world. WHO are currently developed a framework which can be utilised in this group. Highlighted that short term goals are great and a reason to raise finance, economy is slow, and finances are tight. Discussion is needed on how group can support CabSec in managing and negotiating with government for funds, as it is more than health's responsibility.

EM suggested more engagement with young people to understand why nursing is not being considered as a career. 

Action 1 - CabSec concluded the group is broadly content with ToR. Issues around regulators representation and reporting and accountability for the NMT can be taken away. SG officials to revise and finalise ToR, including additional reps and produce a proposition around reporting and governance. 

Meeting structures – Gillian Russell, Director of Health Workforce

GR proposed the NMT will meet quarterly, bringing discussion papers from subgroups. The subgroups with separate membership of will focus on the five key themes from the ToR:

• culture and leadership
• wellbeing
• attraction
• education and development
• retention 

The subgroups will work in parallel to the NMT, focusing on scoping work and present proposals of recommended actions at each NMT meeting. The SG will provide the secretariat function for each subgroup and outline current work in train, providing data and evidence across all themes with members providing specific issues on the ground for context. 

JC highlighted the two professions must be covered within the subgroups with tight workplans to progress work. 

SD also noted both professions must be covered with clear guidance for each subgroup and the need to avoid duplication. With consideration of how the subgroup leaders will be selected.

AH raised the point on commonalities between the professions and priority of the workforce to meet the population needs and mindful of gender and inequalities.

Action 2 – Cab Sec advised workplans and the schedule of subgroups are key for NMT to proceed and should be operational as quickly as possible. SG officials to take forward.

National conversation

GR proposed subgroups are set up on the basis of key themes as per ToR. These are identified as leadership and culture, wellbeing, attraction, education and development and retention. To ensure engagement with current and future workforce, a Nursing and Midwifery Conversation is proposed which would include  regional and in person/hybrid events  and could be facilitated with the aid of trade unions, . 

Engagement sessions could mirror the themes of subgroups and SG will support these. Consideration is required on how these events will be reported and ensure the correct audience is captured i.e. views from existing workforce, students/school level. 

CP noted if national conversations are held these need to be ongoing to enable movement, there needs to be quick wins also as twelve weeks is a long time between meetings.

WB emphasised the conversations need to be with the right audience and all unions should be involved.

LS echoes WB, engagement sessions are welcome, but consideration is needed on how to portray conversations to people. The public also need to be able to express their views on workforce and service.

JL considered it helpful if sessions were held with nurses and midwives separately.

Cab Sec clear expectation is required to understand what is to be achieved from these events and should be structured to cover the voice appropriately of each profession. These would be a NMT events and regardless which TU is supporting facilitation, this should be done on a shared basis. Important to create a tone and structure that supports and encourages attendees to speak and feel their contribution is valued, otherwise it will appear that the NMT isn’t listening to workforce and no value would be gained. Furthermore, momentum should not be lost, especially with the external world and the Nursing and Midwifery Conversation should help identify quick wins.

Action 3 – SG officials to consider how the NMT shape the national conversation and options on how these are structured and managed.

Closing remarks

Cab Sec thanked everyone for attending and highlighted action points to be taken away.

Summary of actions:

• revise and finalise ToR, including additional reps and produce a proposition around reporting and governance - Nicola Gibb - by next meeting
• set up a workplan and schedule for subgroups, including how chairs and leads are selected - Alex McMahon/Justine Craig/Gillian Russell - by May 2023
• how can the NMT shape the national conversation and options on how these are structured and managed - Alex McMahon/Justine Craig/Gillian Russell - by next meeting