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There are three work programmes to explore workforce retention and configuration in healthcare. The first programme will combine and align multiple large datasets from 20 NHS trusts across secondary care and mental health and 10 ambulance trusts. This will enable the analysis of multiple variables and their effect on workforce retention, and how these variables, in combination with workforce retention, subsequently impact patient outcomes. The second work programme will involve designing and testing an infrastructure for the routine extraction, combination and analysis of these large datasets. This will enable the adoption of these techniques across the NHS. The nursing element (NuRS) will start first, with the ambulance staff (AmReS) element following approximately six months later. A third programme will examine the effect of the COVID-19 pandemic on patient safety in terms of reporting behaviours, for example; and will explore how nursing and ambulance workforce configuration in response to a pandemic affects patient safety and quality of care. This project is a unique opportunity to unlock the key underlying drivers of nurse and ambulance retention and determine their impact on care quality, helping to tackle the challenge of supply in the NHS and ensure that high quality, sustainable care is available to all.

Key points Recurrent nurse workforce shortages are a global issue, also in high-income countries. Implementation of safe staffing policy measures largely varies across the world. Mandated patient-to-nurse ratios are the most straightforward policy to ensure staffing levels. Our overview of policies from various high-income countries may guide future decision-making.

Don’t rush. You should never have to write and submit a statement immediately. It’s fine for an employer to set a deadline, but you should still have reasonable time to prepare your statement and get it checked by the RCN. Know what you’re writing about. You should be given a clear instruction or question in writing. If you haven’t been given this, ask for it. Consider if you’re at risk. If your conduct or practice is being questioned by your employer or agency, then – provided you were a member at the time of the incident – use the RCN’s statement checking service accessed via RCN Direct on 0345 772 6100. If you’re being asked to provide a statement purely as a witness, and you don’t believe there is any risk to you, simply follow the RCN guidance (link below). Be clear. Your statement should explain events from start to finish as clearly and simply as possible. Explain when things happened, who was there, and what you did, saw and heard. Try to avoid offering an opinion not based on facts. Be relevant. Do your best to answer the question or allegation you have been set. If you can’t remember something, say so. Very few people can perfectly recall every event that’s ever happened to them. Be compliant. If you’re a registered nurse, follow the National Midwifery Council's Code of Conduct, particularly the ‘Promote professionalism and trust’ section. Ensure you follow your employer’s local policies and confidentiality guidelines too. List all documents referenced in your statement. If possible, state where to find them. Format your statement. Add page and paragraph numbers, double space your lines and ensure pages have clear wide margins at each side. Check it. Review each paragraph carefully, checking that your statement only communicates exactly what was asked for or required. Look at whether you can provide evidence for the facts stated. Check the facts you provide are clearly and objectively explained. Keep a copy. You may need to refer to it in the future. The RCN’s statement writing guidance covers these tips in more detail, has a statement writing template you can use, and provides guidance on what to do if you are asked for a statement in other contexts such as if a coroner or the police ask you for a statement. Follow the link below for more information.

When driving to work at the beginning of the pandemic, I felt a sense of worry and apprehension of what I would be faced with. As a critical care outreach nurse I never know what I may be faced with, but this has never bothered me. However, during the pandemic it did bother me. I worried how I could do my job; would I get sick and how would I navigate my way through the new ways of working? Seeing the brightly coloured rainbows in people’s windows gave me some hope. I knew that the public were thinking of us; they knew the risks we were putting ourselves at and our families. For a time, I felt special. It sounds pathetic, I know. For a time, I felt valued. Valued by the public, valued by the trust I work for and valued by politicians. As NHS staff we had priority shopping, we had discounts from big stores, we had free parking, we had donations of food every day while we were at work, we were donated hand creams and toiletries. School children drew us pictures to put on the walls of our staff room saying ”thank you”. What made me feel valued more than anything was staff wellbeing being at the forefront. Extra staff were redeployed to work on the ITU, we were made sure we had all our breaks and we were made to feel that each and every one of us counted. Relatives of patients wrote and expressed their gratitude, even if they were unable to visit their dying family – they were truly grateful to us. The ITU where I work received so many beautifully written letters and cards. We pinned every one onto the wall so we were reminded that we were shining bright despite the darkness. Then there was the Thursday clap. Personally, I thought this was an odd thing to do, but it seemed to bring people together and have a shared purpose – even if it was for a fleeting 5 minutes a week. When I think back at those months, it seems like a lifetime ago. Eve Mitchell’s recent blog on the hub highlighted that care homes are receiving complaint letters and some are even receiving threats of litigation. “Not enough PPE”, “lack of care given to my family member”, “my family member was neglected during the pandemic” – frustration and anger are palpable. Frustration and anger because families were unable to visit their relatives in their last days, frustration and anger that these precious moments have been denied from them. If it were my mum or dad would I feel the same? Of course I would. I would be the loudest voice there. Is it the fault of the care home? Should they be vilified for the protection of their residents? And now it’s the turn of the hospitals. We now have over a million people waiting on lists for operations, procedures, appointments. Some have already waited months before the pandemic started. Some have already died as a result of not having surgery at the right time. Patients have received surgery and treatment late and this has led to complications and a longer hospital stay – which then increases their mortality. At some point the gratitude from the public will turn to anger and frustration, as it has with the care homes. Would I be angry if my mum was waiting for an operation and died as a result of a prolonged wait? Yes I would. It is a natural response to blame the very people who should have helped – the NHS staff. I now drive to work and see faded rainbows in windows, I will be paying for parking again in the next few weeks, the donations of food have dried up, staff are back at ‘normal’ levels and I am back to having no breaks some days, not to mention that nurses were not included in the recent pay rise. I feel that we have served our purpose. ‘Thanks very much – now get back to normal, sort the waiting lists out and work harder to make sure it happens’. I don’t envy our senior leaders in acute Trusts. They are stuck in the middle of the Department of Health and Social Care and NHS England who are trying to fathom out a strategy to get the waiting lists down, and support frontline staff who are exhausted and a frustrated public that may erupt at any moment. Frontline workers have been through it the last few months. Navigating our way through complaints and litigation and an angry public who feel that they are not receiving the care that they expect in the coming months fills me with dread. We are not equipped. Faded rainbows – is this a representation of the fading support we are receiving in the NHS?