While efforts on widening participation to education and careers have been relatively successful in nursing and, perhaps to a slightly lesser extent, midwifery in recent years, Scotland nevertheless faces challenges in recruiting to the professions.
Applications for nursing and midwifery courses have been falling, albeit only in some areas and fields of nursing. Numbers of men expressing interest in careers in the professions have reduced, and the public image of nursing and midwifery needs to be updated to ensure that candidates coming forward for careers in the professions have a better understanding of what their experiences will actually encompass.
In nursing, initiatives launched elsewhere in the UK and internationally and societal changes here in Scotland are questioning what a nurse will look like in the years to come. This is being addressed through the Nursing 2030 Vision initiative,  which sets the direction of travel nursing needs to follow.
The care home and wider care sector, which provides such a vital service to Scotland's communities, is also facing recruitment challenges. The sector is seeking solutions by trying to find ways to encourage more registered practitioners to commit to, for example, care home nursing to help the service develop and improve.
These factors, and others, signalled that action is required to ensure a sustainable nursing and midwifery workforce for now and the future to ensure the right numbers of people with the requisite qualities and competencies enter nursing and midwifery education, complete their courses then enjoy long and satisfying careers as registered practitioners in the NHS and/or social care sector (particularly in care homes) in Scotland.
The Chief Nursing Officer's ( CNO's) ambition is to maximise opportunities to access nursing and midwifery education and careers through offering appropriate support, widening participation strategies and providing flexible pathways, with the aim of meeting projected needs for nurses and midwives as outlined in the National Health and Social Care Workforce Plan Part 1  (see Section 3.1.1).
For the purposes of the Commission, 'widening participation' is defined as: widening opportunities for people not only to access education in nursing and midwifery, but also to engage in careers in, or associated with, the professions. Widening participation to nursing and midwifery therefore relates to a wide range of people with diverse social characteristics and from a variety of backgrounds. This includes young people, higher tariff-point students, mature students, men, people from disadvantaged communities, people with disabilities and people from ethnic minority communities. It also takes into account people who wish to learn on a part-time or distance basis and those already engaged in, or about to embark upon, a vocational route.
To achieve the ambition, CNO commissioned Professor Paul Martin, CBE, Depute Principal, University of the West of Scotland ( UWS), to chair a review process and submit a report that sets out:
- a shared understanding of the routes to accessing nursing and midwifery education, the barriers that may exist and the opportunities for their removal
- recommendations on actions and targets to improve access to nursing and midwifery education and careers and strengthen a culture of partnership among schools, colleges, universities, employers, NHS Education for Scotland ( NES), the CNO Directorate and the wider Scottish Government, with each recognising the role it can play in improving access to nursing and midwifery careers and working in partnership to achieve this.
This final report is set out in three main chapters.
1. The Commission, describing the Commission's aims, strategic drivers and processes.
2. Evidence and findings, setting out the data that underpins the Commission's observations and recommendations. The chapter looks at the nursing and midwifery workforce, pre-registration nursing and midwifery education, access routes (both to general and nursing and midwifery education), and funding and support (again, for education generally and nursing and midwifery education specifically). It also includes a rapid review of the international literature, the results of a survey carried out on the Commission's behalf of students and registered nurses, and examples of emerging approaches in Scotland.
3. Observations and recommendations, presenting the Commission's observations and recommendations across three key areas:
- Celebrating the impact and opportunities of nursing and midwifery education and careers
- Flexible access to nursing and midwifery education and careers: making it happen
- Positive commissioning.
The National Health and Social Care Workforce Plan Part 1 signalled challenges across the NHS and social care workforce. While the Commission's work focused on nursing and midwifery, it is hoped that some of its outputs may be generalised across the entire health and social care workforce.