The richer areas of the country, with good schools, are the areas most doctors want to work in. Now the bill for locums will be much higher in the unpopular areas than the popular (wealthy) ones. So a perverse outcome of the mismanagement of manpower, people, and politics, is that those areas which need the most have to spend more of their emergency budgets on locums. Jenni Russell needs to be reminded that there is no NHS, and that devolution has failed.
ike many others, I’ve had a recent and alarming encounter with the NHS’s critical shortage of nurses. A relation came out of hospital with a serious condition which required constant monitoring by the hospital team.
Inside, their care had been exemplary. Once outside, and with worrying symptoms, it was as if a steel door had been slammed. No amount of hammering on it made any difference. Every number given for nursing or follow-up advice rang out. Nobody responded to the voice messages we were told to leave. The switchboard said it wasn’t their responsibility to find an actual human being, and put us through to more machines.
It took 11 days of calling, and the intervention of the chief executive’s office, before anyone rang back to advise. In between, quite apart from the absence of a nurse to offer guidance, everything had indeed fallen into a hole, with none of the critical tests or appointments listed on the discharge letter scheduled. “We don’t have time to listen to the messages. Phones ring out on the wards all over this hospital,” one staff member told me, apologetically. Efficiency can’t be assumed in an overloaded system. England’s nursing crisis, with 42,000 unfilled posts, hospitals desperate for staff, and hundreds of millions being spent on expensive agency nurses instead, is neither unpredictable nor an accident. It is entirely the government’s fault.
Beyond Brexit, three key decisions over the past nine years have worsened the current and future shortfalls. The most recent, misguided and blithely foolish of these was the decision by Jeremy Hunt and George Osborne in 2015 to remove bursaries and free tuition for nursing students and replace them with loans from 2017.
They were widely warned not to do anything so stupid. The NHS pay review board, the Royal College of Nursing, and the Labour Party were all aghast, pointing out that forcing low-paid nurses into about £50,000 of student debt would be a huge disincentive. Far from it, the government insisted. The £1 billion saved by the Treasury would fund more training, and produce more nurses.
Two years in and the proof is there: the critics were right and the government wrong. Applications for nursing have fallen off a cliff, down a third since 2016. The fall is steepest among mature students, traditionally the majority of new nurses; women with families or life experience who want a new career. Those are down 40 per cent.
The numbers accepted on nursing courses have also gone into reverse, spinning down from a peak of 22,000 to just over 20,000 in 2018. It means the shortage will only worsen in the future. The government’s strategy has been a disaster.
Whatever the arguments for fees and loans in principle, it makes no sense to apply these to nurses. University students have short terms and predictable schedules, allowing them part-time jobs. Nursing students work for 45 weeks, and spend half their course contributing to the NHS by working in hospitals or the community, often in long, unsocial shifts. They can’t cut their debt by working on the side. Nor do they have the earning potential of other graduates. For the vast majority, nursing will be a steady job but not a lucrative one.
This makes the debt both a real burden to nurses and an illusory saving to the Treasury. Official figures show that eventually 45 per cent of nurses’ loans will be written off. Almost half the claimed savings from the change are in fact a pretence.
Bursary abolition compounded two other major errors. In 2010 one of the first coalition decisions was to cut university nurse training places by 12 per cent within two years. Had they retained Labour’s quota, thousands more nurses would be available now. In 2013 they cut the potential supply further by deciding nursing should be graduate-only. That has eliminated swathes of caring people who are less academic. The belated attempts to make up for that by creating nursing apprenticeships and associates have been pitiful and little-noticed; last year, fewer than a thousand were taken on.
This is a crisis that will hit every one of us when we or our families need care. The sticking-plaster solution, increasing our raids on other nations’ nurses by another 5,000 a year, will only meet part of the shortage, and raises the question of how we can defend making other countries pay for the training we refuse to fund ourselves.
The government has to change tack. Its new NHS long-term plan relies on nurses it doesn’t have. A third are due to retire within five years. Meanwhile, staff gaps are creating a vicious circle where exhausted nurses quit the NHS, forcing hospitals to fill rotas with agency staff. These are inevitably less efficient, and less committed, as they aren’t familiar with the computers, systems or patients. The cost is another ludicrous burden. Last year the Open University reported that replacing agency nurses with full-time ones would save £560 million a year.
The Royal College of Nursing has a practical solution to increase numbers sharply, with the government either paying nurses’ fees and giving means-tested grants, or writing off loans in return for ten years’ work in the NHS. Either gives a net saving of almost £1 billion per year group once the cost of agency nursing and existing loan write-offs are added in. Without action, the staffing gap will be 48,000 by 2023. The government must listen, learn and reverse its policy, now.