Everything you need to stay up to date on patient safety and workforce, plus my take on the most important under-the-radar stories. From patient safety correspondent Shaun Lintern
Poor staffing levels drives out nurses
Let’s be clear: the government has made substantial savings off the backs of NHS staff for long enough. The calls to end pay restraint after seven years of austerity have merit and need to be heard.
But pay has dominated workforce debate since the election – taking oxygen away from other important issues that should be examined and debated in much greater detail.
Is pay the most important issue for nurses and is it driving them out of the profession? The only way to know is to ask some of those who have left the front line in recent years.
The Nursing and Midwifery Council have done just that in a survey of more than 4,500 former nurses. Of the 2,240 who left the profession for reasons other than retirement, the single biggest reason given – by 44 per cent of respondents – was working conditions such as staffing levels and workload.
Worryingly, disillusionment with the quality of care provided to patients was cited by 27 per cent.
Many of the reasons given have their root in poor staffing. Pay was a reason to leave for just 16 per cent of nurses.
These findings are entirely in line with what some nurses told me earlier this year. They are worried about their registration being at risk simply by showing up for work because wards were so short staffed. They described patients waiting for medication, left unwashed or vital observations being delayed and missed because of poor staffing.
This is what needs tackling if we are to stop the exodus of nurses from the NHS.
The Royal College of Nursing is doing what it, as a union, does best. It organised dozens of nurses to protest recently outside the Department of Health calling for an end to the pay cap. There were banners and megaphones. But when has any union marched on the DH or Parliament demanding safe staffing levels? Campaigning should be on that issue, with the pay cap as one factor in a longer list of demands. Only 18 per cent of RCN members took part in their recent ballot over pay. I’d be interested to see the response rate to a ballot on safe staffing.
All this noise about pay – as laudable as it is – means less focus and attention on the issue of staffing levels and plans for the future. The STPs published last year showed many were looking to save millions of pounds from reductions in qualified nursing staff.
Simon Stevens and other national officials have attempted to distance themselves from these plans. They must not be allowed to. Either Mr Stevens is leading the system and is overseeing what is being planned, or he is a figurehead unable to curtail local workforce plans unsupported by evidence and driven by financial concerns.
Jeremy Hunt similarly talks a good talk on safety but needs to engage on issues that are going under the radar.
Perhaps NHS England and STPs are simply doing what is necessary to placate the DH and Treasury? This harks back to the age of strategic health authorities when many areas planned for workforce reductions but rarely delivered them as demand soared. Short term planning until the political environment changes is understandable.
But here is the danger. As research by HSJ has shown this week, the tenure of senior NHS trust leaders is short. The shortest stints are associated with trusts rated inadequate by the Care Quality Commission. The quality of trust leadership varies and a board with inexperienced leaders or a poor culture and non-executives who fail to challenge their colleagues may pursue their STP with less caution than more experienced colleagues.
The patients at Mid Staffordshire Foundation Trust paid too high a price for such failings by that trust’s board in 2006. It only takes one trust for those mistakes to be repeated.
Brexit’s impact is happening now
One more mention for the NMC’s survey. Eighteen per cent of leaving nurses said they were departing the UK, and 32 per cent of nurses from EU countries told the NMC “Brexit had encouraged them to consider working outside the UK”.
These are staff who have worked here, made their homes in the UK and have been motivated to leave because of the referendum result. This will exacerbate workforce shortages and turn the NHS’s crisis into a disaster.