Staffing is the issue keeping NHS leaders awake at night — and which consumes two-thirds of trusts’ spending. The fortnightly The Ward Round newsletter, by HSJ workforce correspondent Annabelle Collins, will make sure you are tuned in to the daily pressures on staff, and the wider trends and policies shaping the workforce. Contact me in confidence.
Over the weekend, which already feels a very long time ago, Matt Hancock revealed the government was asking British manufacturers like Rolls Royce and JCB to start making ventilators in preparation for a surge in coronavirus patients.
The health secretary also told the BBC’s Andrew Marr show: “We’ve got the number of doctors that we have, we want to bring people who are recently retired back into service and, for instance, release doctors from some other duties and get them back into the health service.”
The comments made nice political soundbites, but nursing leaders were far from impressed and swiftly raised fundamental concerns about the credibility of the plans. Mr Hancock’s failure to mention ITU nurses, of which there is a shortage, was also a glaring emission.
“[Mr] Hancock has suggested we can open an extra 5,000 intensive care beds,” said Nicki Credland, chair of the British Association of Critical Care Nurses and senior lecturer at the University of Hull. “But this is simply not feasible, and we simply cannot do it based on the staffing ratios we have.”
Ms Credland explained that for patients to be fully ventilated on an intensive care unit, a one-to-one patient to specialist nurse staffing ratio is needed.
“Intensive care is a very technical and complicated role,” Ms Credland said. “You cannot just move staff around to work in ICU.”
It takes a year to 18-months for an intensive care nurse to qualify, after their three-year nursing degree, while working on an intensive care unit and gradually building up the specialist skills and knowledge required.
“You simply cannot upskill someone to be an ICU nurse in this length of time,” Ms Credland warned.
In response to Mr Hancock’s call to build more ventilators, the British Association of Critical Care Nurses, the UK Critical Care Nursing Alliance and the Critical Care Networks National Nurse Leads have been working on a strategy, which sets out how to manage intensive care patients, while ensuring they receive high quality and safe care.
“We are talking about redeployment of staff,” Ms Credland explained. “Staff in hospitals may have some critical care skills, for example theatre nurses, and they could be given extra training to support intensive care nurses.”
“As we escalate we are going to have to draw on professions that don’t routinely work with patients like that, for example, nurses who work in outpatients or health care assistants who we simply need as pairs of hands to support us,” she said.
Alison Leary, professor of healthcare modelling at Southbank University, also stressed the key issue is the workforce.
“There seems to be an assumption that all they need are ventilators — a critical care patient needs much more than a ventilator,” Professor Leary said. “You need the highest skilled people looking after them.”
She echoed the possibility of asking nurses in other areas to support ICU nurses.
“It is going to increase risk, but that is a given now,” she said. “The question now is how to we minimise risk and get the best outcome for the most people. What are we willing as a society to accept?”
Protecting staff and patients
Maintaining standards and protecting staff and patients, while boosting the workforce is a crucial point and something the government, when announcing emergency measures, needs to recognise.
Jane Ball, deputy head of school for health sciences at the University of Southampton, has called for the Nursing and Midwifery Council to use its emergency powers to reduce the total number of clinical hours required to achieve registration.
But she has stressed all those who achieve registration must have passed academic and skills assessments.
“Reducing total clinical hours required for registration will reduce burden for student supervision on NHS and keep the nursing workforce supply pipeline functional, easing flow through it,” Professor Ball said.
However, she said if students become part of the workforce, as suggested by Sir Simon Stevens last week, a set of principles must apply — such as being outside their role as students and they must have paid employment and rights.
The suggestion to bring in third year nursing students — like many other measures — also needs to be properly thought through, or instead of helping the covid-19 effort, such measures will be a hinderance.