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.
No comments:
Post a Comment