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

Western Daily Press (Saturday) - - The Long Read -

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.”

Peter Byrne/PA

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

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