Look who's talking

It would be difficult to write this week’s blog without commenting on the historic decision taken by many Royal College of Nursing (RCN) colleagues to take industrial action. It is something I’m slightly hesitant to do. Last time I blogged about colleagues taking industrial action, (12 years ago and not nurses) I was trolled unmercifully on social media. However, I will come back to the RCN outcome in due course. But first, let’s talk about a lady called Kelsay Irby. She is a nurse. In fact, she is a Charge Nurse working in a busy Emergency Department. On the 8th October this year, Kelsay was working an evening shift and there were over 50 patients in the ED Waiting area. Unfortunately, Kelsay only had half the staff she should have had, and the situation was quickly getting out of control.

Whilst the triage nurse on duty was doing a great job in prioritising patients by need, there was limited oversight of those patients in the waiting area whose conditions may well have started to deteriorate due to the long wait. It was a desperate, but perhaps, not too an unfamiliar situation. In desperation, Kelsay rang the emergency services for help and was connected to the local fire and rescue services who agreed to come out and help. Up came a fire tender with a crew trained in emergency first aid. They were able to re-take basic assessments and monitor the patients, allowing the ED staff to concentrate on those in most need. Eventually the ED returned to normal.

As you might imagine, Kelsay’s decision hit the news big time. But you may have missed the story as Kelsay works at the St Michael Medical Centre, Washington, in the US. Could something similar happen here in the UK? – I guess so. Last week, there were reports that the armed forces could be called in to fill the gaps if nurses take industrial action. Indeed, during the pandemic and last winter we had a small group or service men and women who worked in a variety of different roles in my hospital – and they did a great job! It’s an interesting situation.

Likewise, so is the possibility of industrial action. I would say right from the start that nurses deserve to be rewarded fairly for their work. Whilst many folk are attracted into nursing as a profession, I don’t subscribe to the notion that nursing is a vocation. It is a highly skilled profession. The education and training required are tough and expensive. And that is part of the problem. There aren’t enough nurses coming into the profession to replace those leaving, and this chronic shortage of nurses results in an unfair burden on those remaining within the profession. As Dean of a large university school of nursing I well remember my disbelief on hearing that from 2016 the bursaries student nurses received would be stopped, and that they would have to start paying for their university courses.

The decision saw student nurses applications fall dramatically. In the first and subsequent years, by nearly 40%. In 2020, the NHS Learning Support Fund was introduced. This was available to students starting their programmes in 2021. This package of support provides upwards of £8,000 a year as well as help with travel and accommodation costs while on clinical placement. The money does not have to be repaid. Students still have to pay the £9,250 a year course fee. Even with this most welcome support package, I think it will take some time before it provides the incentive necessary to significantly increase student numbers. Across the UK there was an 8% increase in student numbers in 2021. In England this meant an extra 20,930 students were recruited. In the same year just over 25,000 nurses left the profession. The students won’t join the qualified nurse workforce until 2024.

There aren’t many easy solutions. The pandemic exhausted many nurses. The cost of living crisis is hurting many more. However, the claim for a 17% increase in salaries (estimated to cost £9 billion a year) seems unlikely to be achievable. Something different in terms of an approach is required Removing the requirement to pay university fees would be a start. Likewise, writing off the education costs of students who started their training in 2016 but who will still be paying back their student loans today feels like a good idea. Symbolically, it would demonstrate the value of the nursing profession to society. Symbolically, clapping for carers doesn’t remotely have the same impact.

Of course, whilst nurses are important, they are part of a wider multi-professional health and social care team. Whatever eventually gets settled as a pay award, the impact will spread through this wider team like that famous lager that reached parts others couldn’t. Probably beyond too, certainly in the public sector. Currently, there are some 1 million other healthcare workers, from porters, radiographers, maintenance workers, doctors and so on, whose unions are all currently balloting their members over whether to take industrial action as well.

I do not blame them. All healthcare workers, whatever their profession, trade or background should be paid a fair salary for their contribution. Sadly, I don’t think calling for strikes and a large pay award will, on its own, be a sufficient basis to reach a settlement. It doesn’t have to be like this, all we need to do is keep talking*. I strongly suspect that money will not be the ‘silver bullet’ the RCN might consider it to be. Sooner or later there must be a conversation that takes a broader view of the issues other than the percentage size of any pay award. Over the coming weeks and months, it is going to be critical that all the parties keep talking. The future of our NHS, as we know and value it, is very much at stake.

*Inspired by our Pink Floyd concert last week, I thought their song ‘Keep Talking’ from their album The Division Bell seemed somehow appropriate.