Nursing has been woefully managed. No wonder there’s a crisis.
From ditched bursaries to poor pay, the policies behind the NHS recruitment and retention crisis have been laid bare in a new report
Article in the Guardian by Richard Vize
The health select committee’s report on the nursing workforce is an excoriating critique of the multiple errors in policy and practice that have created a recruitment and retention crisis. According to them, it is difficult to identify a single aspect of nursing workforce management that is not being mishandled.
The UK has relatively few nurses compared with many EU countries – yet there are still 36,000 NHS nursing vacancies in England. Around 33,000 of these are filled with bank and agency staff, which ramps up costs.
While the headlines focus on shortages in hospitals, the rush by acute trusts to recruit nurses in the light of the Mid Staffordshire inquiry has fuelled shortages in other parts of the NHS.
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The result is that since 2010, the number of nurses in general, elderly, adult, children’s and midwifery services has grown by between 7% and 11% – while the numbers working in community services have dropped by a tenth, district nurses have fallen by almost a half, learning disabilities have lost almost 40% and mental health has lost 13%.
So despite the rhetoric about “parity of esteem” for mental health, and commitments to move services into the community, in the desperate scramble for staff, the needs of acute hospitals are warping the entire system.
Trying to identify the impact of different policies on recruitment and retention is all but impossible because there is so much simultaneous upheaval. Recent changes include the removal of student bursaries, the arrival of nursing associates and nursing apprenticeships, changes to the language test for overseas recruits and (last but not least) Brexit.
The bursary cuts have been followed by a significant fall in applications for nursing degrees with a sharp drop in the number of mature students. As the health select committee notes in its report, mature students bring valuable life experience to the workplace. Meanwhile, the expansion in nursing places that was supposed to follow the funding changes has been delayed.
Quality and safety is being compromised. The Care Quality Commission provided shocking evidence of the consequences of too few staff, including inconsistent identification and management of life-threatening conditions such as sepsis; poor audits of key safety priorities and quality improvement projects; poor infection control; failures to provide essential safety training such as safeguarding; poor information sharing; and treatments being delayed or repeated unnecessarily.
The MPs heard consistently that nurses feel undervalued. While pay is an issue, there is palpable anger among staff at cuts to their continuing professional development. In just two years, this has been slashed from £205m to £84m at a time when the government is calling for higher nurse productivity.
NHS Employers spelled out why this is a “fundamental priority for national action”, as it is undermining the quality of everything from community practice to intensive care nursing.
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Local employers aren’t even getting the basics right. Nurses complained about the lack of facilities, such as kettles and fridges. A failure to use e-rostering hampers flexible working. Bureaucratic barriers inhibit nurses from applying for vacancies in their own organisation, and there are difficulties in having skills recognised when moving between employers.
As recruitment of nurses from the EU slumps, Health Education England is ramping up national-level recruitment from overseas. But this is being hampered by poor professional development and the lack of clear career structures. With a global shortage of healthcare staff, the UK is in a highly competitive market.
Health Education England is consulting on its draft workforce strategy, published in December. The initial proposals require substantial development if they are to meet the multiple challenges spelled out by the health select committee. It needs to raise the ambition for recruiting and retaining nurses, confront the problems of pay and professional development, be honest about the shortcomings in the education system, and push employers to get the basics right.
Everything in the NHS is tough at the moment, but the nursing crisis is being exacerbated by unforced errors.