Recent figures show that NHS staff shortages have got worse but statistics don’t convey the dreadful reality of how this affects NHS staff and patient care. To understand the real impact we have to read the accounts of brave doctors, nurses and other health care staff describing the daily stresses of their work – stresses that are leading many to breaking point and to leave the NHS.
There are now more nurses leaving the profession than joining.
Those that remain struggle to provide safe effective care. In the recent NHS staff survey, 47% said current staffing levels were insufficient to allow them to do their job properly and 59% reported working unpaid overtime each week.
Staffing levels in some places are so poor that not only can quality care not be guaranteed, but safe and humane care is also at grave risk. Doctors and nurses are warning that this is creating another “Mid Staffs” across the country.
Recruitment from overseas to fill the gaps is now at risk too. Since the Brexit referendum applications from EU nurses have dropped 96%. This is having a serious impact on nursing numbers.
But the shortage of 30,000 nurses is not caused by the Brexit threat alone. The chronic shortage of nurses is the result of years of short-term planning, cuts to training places, underfunding of the NHS workforce and pay restraint – amounting to a real terms pay cut of 14% since 2010.
The government’s response is to try to minimise the scale of the staff shortages while announcing new initiatives that are inadequate to the problem.
For example Jeremy Hunt recently tweeted there were now 12,000 more nurses than in 2010.
But this is untrue. In May 2010 there were 280,950 nurses in England and in March 2017 (the most up to date stats we have from NHS Digital) there were 285,893. This is an increase of 4,943 or 1.6%. Yet over that period the population rose by 5% which means that there are now fewer nurses per person than in 2010. Key areas of nursing have suffered actual reductions in numbers: mental health being a prime example. See this excellent blog by David Munday for detailed analysis.
David Munday cites figures showing that between 2010 and 2017, the number of mental health nurses reduced by 4,942 (from 40,630 to 35,688) or 12.2%. It means a change from 1,296 people/mental health nurse to 1,549 people/mental health nurse.
This is scandalous given years of Government rhetoric about “parity of esteem” between mental and physical health.
There has also been a decline in numbers of community based nurses. One in seven district nursing posts were lost between 2014 and 2016. The government’s decision to hand over responsibility for children’s community nursing to local authorities while simultaneously cutting their funding has led to cuts in health visitor and school nurse numbers. Health visitors have declined from a peak of 10,309 in October 2015 to 9087 in March 2017.
The Government’s response to this is to say they will increase nurse training places. It has just announced some £16 million for 10,000 extra clinical placements for nurses, midwives and allied health professionals by 2020. It seems the government was only moved to act on funding because universities protested that they had been given no extra funding for the clinical placements. This is yet another example of a reactive decision to avoid bad headlines rather than sensible pro-active planning for the future – because extra nurse training places should have been funded years ago when people began warning about the impending crisis.
Latest data shows the number of nursing degree applications has fallen by 23 per cent this year compared with 2016. This is in large part due to the abolition of the NHS student bursary. Even though there are still more applicants than places there has been a reduction in applications from mature students with children – a group that has always been a key demographic for nurse recruitment, and more likely to stay on in nursing once trained.
But even if there is to be an increase in nurse training places, those new students will not qualify for several years, so will not help the current staff shortage. And increasing training places won’t help if high numbers of nurses still continue to leave the profession. The only way to ensure adequate staffing levels is to stem the flow of nurses and other health workers leaving the NHS and this means reversing the decline in pay and conditions. Pleas to the government to address this by nurses’ unions such as the Royal College of Nursing have fallen on deaf ears.
Nurses have reached their limit. In 2016 we saw unprecedented industrial action by junior doctors. Now it looks like the nurses are prepared to consider taking industrial action to defend their pay and conditions. The main nurses’ union, the Royal College of Nursing, recently surveyed its members to gain their views on industrial action and a majority indicated their support. As with the junior doctors this is not just about pay but about ensuring we have the necessary nursing workforce to provide safe high quality patient care.