By JOHN LISTER 3 March 2016 for Open Democrqcy, Our NHS
The Beeb [BBC] claimed a scoop in investigative journalism this week – but its findings were no shock to most people.
This week the BBC led on its ‘scoop’ – obtained through Freedom Of Information requests – that two thirds of trusts and health boards across the UK have large numbers of vacancies, and are trying to fill them by recruiting abroad or facing inflated bills for temporary and agency staff.
23,000 – almost one in ten – NHS nursing posts are vacant overall, while trust board papers show that some face even more disastrous shortages.
In response to the findings, a grumpy John Humphrys asked a series of not terribly well informed questions of the head of Health Education England who was trying to make the best of things, and claiming everything would be okay by 2019.
“In other words we didn’t have enough nurses before to provide a high quality service? Ah!” said John Humphrys in shocked tones – as if this was a revelation the BBC’s flagship news programme had never heard before.
But the BBC failed to ask the key question – why were all the warning signs about nurse shortages, ignored?
After all, NHS chiefs and ministers had been warned clearly for years that there would be a shortage of nurses, as a result of David Cameron’s coalition government cutting training places for nurses and doctors from 2010 onwards. From 2010 through to 2013 the numbers of nursing places commissioned at universities in England were cut by 12.7% – resulting in 2500 fewer places. In 2012 experts warned that this would result in a “disaster” in two or three years. In all, the 2010 cutbacks (reversed only relatively recently) meant that around 8000 fewer nurses were coming into the system.
Other warning signs included the fact that among the nurses qualifying, more were beginning to choose to focus on work in the community, rather than more highly pressurised hospitals.
By the end of 2014 the Daily Mail was thundering that “up to 80,000 British students each year cannot find places on nursing courses even though the NHS is hiring thousands from abroad”. The article went on to point out (in predictably paranoid tones) that hospitals had recruited almost 6,000 overseas nurses – “a fourfold increase on the previous year”.
And of course the other warning sign was the over-reliance on agency staff – which the BBC could hardly have failed to notice, as the soaring agency staff bill (from £855 million in 2010 to over £3.3 billion last year) has been a factor mentioned in mitigation every time the sorry state of NHS finances has hit the news in the last couple of years.
Ministers have tried to tinker with the latter problem by seeking to impose a cap on the hourly fee NHS trusts should pay agencies for temporary staff – but with no answers on what they do if this means they can’t fill vital roles.
Of course the government and the Department of Health have continued to point to overall figures which appear to show that the nursing workforce has increased, although given the level of vacancies revealed by trust boards and the BBC’s latest survey, there are questions as to whether the figures on the HSCIC spreadsheets really translate into actual people straightening bedsheets on the wards.
By the spring of 2015 Nursing and Midwifery Council figures revealed that more than one in four (29%) British nurses had been recruited from abroad in the previous year, with inadequate numbers of ‘home grown’ nurses available.
And numbers of potential home-grown students will certainly not be increased by George Osborne’s latest wheeze to save an estimated £800 million by scrapping the bursaries for nursing students and for other student health professionals.
The prospect for the average nursing student, aged 29, of embarking on three exhausting years involving extensive time on what would be unpaid work placements on NHS wards, to be followed by a lifetime of paying back tens of thousands of pounds of student loans from less than generous NHS salaries seems certain to be a decisive turn-off.
Increased pressures and workload on front-line health staff mean that many qualified nurses, especially some of the more experienced ones, are opting for the less stressful and more flexible option of working for agencies, where they are often able to choose to work at times they find convenient, for the same or even more money, rather than tough it out in struggling trusts.
There are unresolved institutional issues of bullying and the use of staffing cuts to save money in NHS trusts – both of which were major factors in the shocking failures of care revealed in the 2013 Francis report on the failings of Mid Staffordshire Hospitals in the mid-2000s.
But even where this is not an issue, NHS management are frequently preoccupied with the need to balance the books while at the same time meeting a whole series of conflicting performance targets, and as a result do little to make the workplace environment and regime any more attractive for qualified nurses.
Seemingly indifferent to all these issues, ministers have insisted on effectively freezing budgets in real terms since 2010, and cash-cutting plans in the 2009 McKinsey Report proposing a theoretical £20 billion of savings by 2015 included a 10% cut in the headcount of the workforce.
However cost pressures on the NHS increase by up to 4% a year, and the population as a whole has increased by more than 3% since 2010. Numbers of more dependent people requiring NHS and social care have increased even more as budgets for NHS and local government have been more tightly squeezed.
A major part of the “cost savings” that have flowed from this budget freeze have been as a result of a three-year freeze on NHS pay, followed by a succession of below inflation pay increases which have slashed the real terms value of a qualified nurse’s pay by upwards of 16% since 2010..
That’s a much bigger plunge in living standards, than the average across the working population. And shows again that doors of nurse training courses are unlikely to be besieged by hordes of new applicants following George Osborne “lifting the cap on training places” by scrapping the bursaries.
Nurses, just like junior doctors, are faced with the prospect of mounting debts and then working in the face of cuts that could oblige them to work in ways that might put patients at risk. Little surprise that nurses, as well as doctors, have been looking to leave the NHS or leave the country.
Sadly the BBC failed to piece together more than a superficial fragment of the wider picture.
This left the Today programme as grumpily inadequate as ever, and once more allows Tory ministers and the Department of Health off the hook for the policies they brought in which have created today’s latest symptoms of crisis.
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