Trusts feel the strain as nursing numbers fail to meet demand
With people living longer and A&E departments becoming increasingly busy, the NHS is experiencing a staffing shortage that threatens its future. Alex Ross spoke to key figures about the need for nurses and what can be done to halt the decline
Students are no longer prepared to take on the level of debt... we are also seeing a drop in interest from men. The Government can’t take away support with one hand and then expect more nurses with the others. We are in a crisis.
SUSAN MASTERS, ROYAL COLLEGE OF NURSING
WHEN Aneurin Bevan sat down to draw up his vision for a free healthcare service for the nation 60 years ago, the health minister could never have dreamt how the NHS would evolve over the next half a century.
At the time of its birth, a leaflet was sent out to every house in the country with a simple message: “It will relieve your money worries in time of illness.”
Its aim was to deliver good healthcare for all, regardless of wealth.
But today, although still loved and respected in the UK and around the world, the organisation is proving to be a painful and costly problem for the Government.
In April, the body’s health trusts posted a combined £960 million deficit at the end of the 2017/18 financial year.
Today, people are living longer, requiring support and care for more complex needs, and then there is the continued rise in patients being admitted to busy A&E departments.
And although huge in size – 1.5 million employees – the NHS is facing a chronic shortage in nursing, one which is closing inpatient wards and extending waiting lists.
In the South, 12.3 per cent of all NHS nursing positions are unfilled, according to NHS Improvement.
Figures for the West Country show the Royal United Hospitals Bath NHS Foundation Trust has a shortage of 161 nurses (13 per cent), with the Royal Devon and Exeter NHS Foundation Trust 218 nurses down (12 per cent).
The Nursing and Midwifery Council last month said the number of registered nurses and midwives in the UK had risen over the past year, up almost 4,000 in a year.
But that increase is not enough to meet the demand from health trusts already showing cracks.
Somerset Partnership NHS had to close three community hospitals this year, Weston Area Health Trust was forced to shut its A&E overnight, while nursing staff across the South West find themselves moved from ward to ward to provide sufficient cover.
Performance is also under par across the South West in certain areas.
Waiting times for cancer treatment and diagnostic testing struggle are long.
And as bosses attempt to fill the growing gaps in nursing, more and more cash is being spent on agency staff to temporally solve the situation, further deepening debts.
Bringing in nurses from abroad is one solution – it has worked at Yeovil District Hospital NHS Foundation Trust, which thanks to an 18-month overseas recruitment campaign, has no vacancies.
However, employing from abroad brings its own issues.
Thousands of nurses may be identified from recruitment visits to the UAE, India and Pakistan.
But the sticking point is passing the International English Language Test System, based on guidelines from the NMC.
Weston Area Health Trust identified 22 overseas nurses – but all of them failed the exam.
Last month the NMC said it was to lower the requirement in writing so more potential NHS workers can pass the threshold, but expected standards in reading, listening and speaking will remain.
Looking at home-grown nurses, fewer people are applying to go on courses.
In the South West, universities in Plymouth, Bournemouth and Bristol offer courses. At UWE, in Bristol, the number of students graduating from its adult nursing course fell to 322 this year, from 404 the previous year.
A learning disabilities nursing course at the university almost folded this year – only to be saved by health trusts in the region seeking graduates.
South West regional director for the Royal College of Nursing Susan Masters partly blames the decline in interest on a Government decision to cut a living bursary for nursing students two years ago.
Mrs Masters said: “Students are no longer prepared to take on the level of debt which comes with the course without the living bursary.
“We are also seeing a drop in interest from men and applications for learning disability nursing courses.
“The Government can’t take away support with one hand and then expect more nurses with the others. “We are in a crisis.”
A spokesman for UWE said there had been a “substantial decline in applications for nursing courses”.
He added: “With a focus on educating students to provide outstand- ing patient care, the university is supporting many strategies to meet workforce demands.
“These include ‘return to nursing’ programmes, the upskilling and reskilling of qualified nurses, the development of flexible pathways toward nurse registration and the introduction of courses for new roles such as the nursing associate.”
The RCN has called on the Government to put £1 billion into nurses’ education. It predicts the number of national nursing vacancies will rise from 41,000 to 48,000 if nothing is done.
Department of Health and Social Care is to deliver a ‘long-term plan’ shortly.
Last night, a spokesman hinted there would be more support offered for student nurses.
He said: “There were more applications than available places this year and we’re working to ensure these places result in even more fulltime nurses on our wards.
“The long-term plan will also address how to open up the profession to people from all backgrounds,
and ensure they get the right support throughout their training.”
Bristol North West MP Darren Jones has raised the nursing crisis in the House of Commons.
He said: “The Government has repeatedly failed to acknowledge to the gaps in the NHS workforce.
“I have been wholly disappointed that nothing has been done to address the declining number of doctors, nurses, and other medical practitioners who may leave the workforce – this is even more of a risk given the botched Brexit process which has seen EU applications drop and many EU NHS staff considering their future in the UK.”
He added: “I fully support the reinstatement of bursaries and scrapping of the pay cap – that sees pay rises funded by government and not by reduced real-terms public service budgets – across our highlyvalued public services.”
But the struggle continues for health trusts in the region.
A look at trust reports on operational and workforce performance put before monthly board meetings reveals the challenges faced as bosses move staff and juggle rotas to provide adequate cover.
And then there is the financial reports with spending on agency staff often an issue flagged up as a problem.
Actions to be taken by the trusts include recruitment drives, both at home and abroad.
Somerset Partnership and Taunton and Somerset NHS Foundation Trusts has been picked to host a new nursing associate programme, aimed at moving health care assistants toward becoming registered nurses.
Chief nurse Hayley Peters said: “Like most of England, over the last few years we have experienced challenges in recruiting nursing staff, particularly at our 13 community hospitals and some mental health nursing posts.”
She added: “We work hard to recruit new staff and have been working with other trusts to fill shifts and find innovative ways to attract nurses to Somerset.”
At Weston Area Health Trust, which would not provide nurse vacancy rates, there was a 30 per cent vacancy rate for qualified Band 5 nurses in July.
Director of human resources, Alex Nestor, said: “Nurse recruitment is a challenge, especially within our emergency department.”
She said 43 nurses were joining over the next eight months.
At Royal United Hospitals Bath Foundation Trust, a number of nurses from the Philippines have just joined the group.
Chief operating officer Francesca Thompson said: “There is a national shortage of nurses and, like other trusts across the UK, we have vacancies in our workforce that we are working to address.
“We employ temporary and a small number of agency nurses when necessary, and can reassure patients that staffing levels are monitored regularly to ensure that we continue to maintain quality care and safety.
“We are actively recruiting registered nurses and health care assistants and have great opportunities available in a whole range of specialities.”
Salisbury NHS Foundation Trust said it was advertising in the media to attract more nurses.
University Hospitals Bristol NHS Foundation Trust, although facing a nursing shortage, has not yet had to recruit overseas. “Innovative advertising campaigns and a strong attraction to work” in Bristol had helped, said director of people, Matthew Joint.
He said: “Our vacancy rates remain below average and no services at the trust have closed as a result of staff shortages. However, recruiting nurses into specialist roles can be challenging and remains an important element in the trust’s recruitment plans.”
Given a reported emigration of EU nurses from the UK ahead of Brexit, and the recruitment drives by trusts, overseas, all health trusts were asked if there was “concern” following the withdrawal from the union.
However, none said they knew the impact of Brexit, and all said they waited further information on the implications.
Mrs Masters said: “Never has there been a more important time to invest in the future of our health service.”
Although it has 1.5 million employees,the NHS is facing a chronic shortage in nursing which is closing inpatient wards and extending waiting lists
From left: Royal United Hospitals Bath Foundation Trust chief operating officer Francesca Thompson, Bristol West MP Darren Jones and South West regional director for the Royal College of Nursing Susan Masters