Sunday, 5 November 2017

It’s not just the chattering classes that should be concerned about the NHS – it’s all our problem.

I very much enjoyed taking part in last week’s #WeNurses twitterchat. Next year sees the 70th anniversary of the creation of the NHS. See here for a brief public information broadcast celebrating the birth of the NHS, which was made at the time. Given this focus, the overall question explored in the twitterchat was: The NHS, What would you do? During the 60 minutes of tweet conversations, contributors considered what makes the NHS special; why we might need to be concerned about the future of the NHS; what they would do if they were Secretary of State for Health; and what the NHS might look like in another 70 years’ time. It was a lively chat, and you can read the twitterchat summary here.

Not surprisingly, there was a lot of high expressed emotion during the chat with health service managers and politicians responsible for funding, coming off worse. I say not surprisingly for a number of reasons. Both groups are easy targets, and there is a grain of truth in the claims that we have too many managers and there is not enough money. Last week the independent charity, the Kings Fund reported that 51% of all NHS Trust Finance Directors thought the patient care in their area had got worse over the last 12 months. Less than 45% felt they would meet their financial targets this year. As the Kings Fund pointed out, the NHS is in a precarious position heading into the winter, with all the problems that is likely to bring.

Already many Trusts are not meeting the four hour A&E target. There are now 4.1 million people waiting for treatment and emergency admissions are 3% higher than this time last year. Likewise what was noted in many of the twitterchat tweets, workforce issues are also adding to the problems and challenges facing the NHS. It’s getting harder to recruit nurses in many parts of the UK and some medical specialisms are becoming very difficult to recruit into. The days of recruiting nurses from overseas particularly Europe are long gone. Normally up to 10,000 nurses a year come to work in the UK from other European countries, this year that number has fallen by 90% to just 1000 nurses. Likewise many of those nurses recruited over the last few years have started to return to their home countries. The NMC reported that 67% of those nurses recruited have now left the UK.

Sadly many UK nurses are also leaving the profession. Some 29,000 left the NMC register in the year to September 2017, which is an increase of nearly 10% on the figures for the same period in 2016. I am not seeking to revalidate my registration next year. This is not because I am experiencing, directly, the pressures of being on the front line of practice, I am simply retiring. And I am not alone. It has long been recognised that nursing and midwifery is an ageing profession, with significant numbers of nurses on the register now reaching retirement age. Age UK reported in July this year that there are now 15.3 million people in the UK over the age of 60. This number is expected to pass the 20 million mark by 2030. Nearly one in five people currently in the UK will live to see their 100th birthday, and this figure includes 29% of people born in 2011.

Perhaps what is not so readily recognised is that there is also a significant increase in those nurses on the register who are choosing to leave before they reach retirement age. The NMC reported earlier in the year, that when those nurses who retire aged 60 are excluded from the numbers of those that are leaving the profession, the average age of all others leaving the register is now 51 years. The numbers for those under the age of 40 who are choosing to leave the profession is particularly noticeable. 

Last week also saw the emergence of another significant element in this workforce and funding perfect storm. The Health Service Journal reported on yet another hospital trust replacing qualified and registered nurses with Nurse Associates. I have no doubt others will follow. There is plenty of good evidence that reducing the nursing skill mix by adding nursing associates and other groups of assistive nursing staff contributes to preventable deaths; has a negative impact on the quality and safety of patient care; and ironically contributes to hospital nurses shortages – see some of this research here. Back in 2016, Health Education England’s Director of Nursing, Lisa Bayliss-Pratt assured the nursing profession that this wouldn’t happen. Secretary of State for Health, Jeremy Hunt announced in Oct that another 5000 nurses associates would be trained in 2018, and a further 7500 in 2019. 

As my friend and former Dean at Oxford Brooks University, Professor June Girvin noted last week, ‘Nursing has sleep walked into the dismantling of the profession. Without blinking an eye’. And sadly I don’t think there are any easy or quick solutions to the situation we find ourselves in – over time the workforce issues will get better, but services will need to continue to change and become more integrated, and people will need to take greater responsibility for the maintenance of their own health and wellbeing.