Everything you need to stay up to date on patient safety and workforce, plus my take on the most important under the radar stories. Contact me in confidence. Shaun Lintern, patient safety senior correspondent.
Seeing the bigger picture
It is extremely encouraging to see organisations like the Health Foundation, Nuffield Trust and King’s Fund focusing their big brains on the issues affecting the NHS workforce.
NHS Providers will be joining the party soon with a new report, and its chief executive Chris Hopson has already done a laudable amount of drum banging over what is now widely regarded as the biggest pressure facing the service and the one keeping managers up at night.
The Commons health committee is also joining the fray with an inquiry into the nursing workforce. Such an investigation is welcome but long overdue given that warnings of a national nursing workforce disaster go back to 2012.
The workforce is essential to the delivery of healthcare – the right staff with the necessary level of education, training and competence is vital. A service as complex as the NHS needs robust, accurate data about how the 1.3 million workforce is broken down, where people are working and what they are doing.
There is a great deal of data produced by NHS Digital but its presentation can mislead and has contributed to a lack of visibility.
NHS Digital’s overall workforce data includes nurses and health visitors as an overall category with midwives as a separate one. This has led to the combined figure being used to describe the situation for nurses only.
But to get nurse only data you need to look at a separate dataset where nursing is broken down into areas such as acute, community and mental health, and where it is possible to subtract health visitors.
Interpretations of this data have led to some erroneous conclusions, such as the claim that the number of nurses working in hospitals is falling year on year. In reality, when health visitor numbers are taken out, the acute sector continues to have record levels of employed full time equivalent nurses with 900 more in post in July 2017 compared to July 2016.
The sector has been the focus of the “Francis effect”, which has driven recruitment of nurses since 2013.
Other areas such as in mental health and community services show dramatic falls and health visitors on their own are now declining by more than 900 posts year on year. This all contributes to an overall fall in nursing and health visitor roles of 1,345 in July 2017 compared to July 2016 – but not a fall in nurses in the NHS, as some have been tempted to say.
But even this is not an accurate picture because it excludes nurses working in GP practices, mental health and community staff who have been transferred to non-NHS providers (an increasingly common activity) and any staff employed by local authorities, a destination for many health visitors.
Has the NHS really lost that many staff or have they transferred to new employers? We can’t be sure which statement is true. We also don’t have a clear picture of UK healthcare workforce generally.
If the NHS is going to have a multiplicity of providers and if integration across organisations means staff changing employers then we need to have integration of the data.
It must be made easier to know how many registered nurses are providing NHS funded care and who employs them; to be able to count separate workforce groups who have separate roles such as health visitors and midwives; and to see clearly what the workforce levels are for sectors such as mental health regardless of employer.
Only then can we start to have sensible discussions about what the data is showing us and what needs to be done for the country’s healthcare.
The Brexodus is happening
There have been many warning signs over the state of the nursing workforce in recent years but one of the most reliable is data from the Nursing and Midwifery Council on the number of nurses leaving the profession, and in some cases the country.
According to the latest data, in the last 12 months the number of UK graduates leaving the profession has increased by 9 per cent. The number of nurses and midwives from Europe leaving the NMC register has increased by 67 per cent, while the number joining dropped from 10,178 last year to 1,107 this year – a decrease of 89 per cent.
In short, these are signs that nursing as a profession, regardless of sector, is becoming less attractive and EU staff are leaving the country.
Welcome government announcements on increasing training places by 25 per cent may help, but not for several years. Efforts on retention need to be stepped up and if the Treasury does allow a pay rise for NHS staff, the government must resist the temptation to deliver it with cuts elsewhere.
Overseas recruitment should also kick on and it is time ministers engaged in a national drive for more healthcare staff rather than leaving it to ad hoc local attempts. Immigration rules based on salary levels must either reflect special exemptions for healthcare staff or be changed completely. The much feared Brexodus is happening.