14th May 2015

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Dr Mark Porter

In conversation with Roy Lilley - this is warming up to be a really good 'conversation'!

Chair of the BMA - just how relevant is the BMA; does anyone listen to them?

Health Chat at the King's Fund 18th June Details here.

News and Comment from Roy Lilley

If I had a penny for every time I have said 'we don't have enough nurses', well... I'd have a lot of pennies. If I had a pound for every time I've written; 'protect the front line, fund it properly and make it fun to work there'... I'd be able to buy a pound-shop.


No healthcare system in the world is better than its nurses. That is in no way to down-play all the other key-players in the delivery of healthcare. Everyone does their vital bit but nursing is the shop window, the pulse and the heartbeat.


The madness we call the CQC, spends millions, blundering around the healthcare system telling us quality is poor because there are not enough nurses. Sensible people would be doing something about it.


We are in the middle of a workforce crisis and no one, absolutely no one (with the exception of the King of Common-Sense, Peter Carter, boss of the RCN) gets near to recognising how serious it is.


We are up to our armpits in data that we ignore. Deaf to the siren voices, we turn our backs on reality. This issue is parked and left to fester in the 'too-difficult' tray.


The unwelcome and unwanted truth, there is a crisis in nursing; it is such bad news, so unwanted that it has become too dangerous to even acknowledge it is a fact. To do so would require some action and no one knows what to do. No one owns the problem. No one in charge.  The shortage of nurses has become toxic.


Here are some white-knuckle facts:

  • NICE say 400m is needed to get to safe staffing levels.
  • Ninety seven out of 157 acute trusts have more than half of their nurses worried about staffing levels.
  • The Centre for Workforce Intelligence says we will be 190,000 nurses short by next year.
  • We are training 13% fewer nurses than we did in in 2011
  • A third of nurses are at or near retirement age.
  • Four out of five Trusts miss their safe staffing targets.
  • At a time when we are shifting more care into the community and trying to deal with the needs of an aging population, district nurses are becoming rarer than a happy Labour supporter.
  • In 2013 there was a fall of 40% in the number of district nurses. In London only 5 new ones qualified and across the UK only 265. A quarter will retire by 2018.

Francis, NICE, the Flat-Earthers and anyone else who has had a finger in the safe staffing pie says the same; there are not enough nurses. Demand for healthcare is increasing at well over 4% a year but the workforce (not just nursing) is failing to either keep up or morph into something that might deal with the crunch.


So far the response has been for three quarters of English Trusts to bust their budgets and embark on expensive forays into austerity Europe; panic buying young nurses, in the hope they are robust enough to survive the exigencies of being up-rooted, language, food and homesickness.


As a result, there are about 6k overseas nurses working here compared with just over 1,000 in 2013.   In total, 91,470, of those now registered to work here, trained overseas.


Is nursing an unpopular career choice? No. Some training establishments will say, for every one candidate they take on, 4 perfectly well qualified applicants are turned away. 


Why?  Because no one has the money to pay for safe staffing and very few pay attention to the consequences if we don't.


It is true putative FTs, desperate to impress Monitor with balanced books, fudged the numbers of nurses they would employ and that skewed training numbers. It is also correct that post-Francis, safe staffing is at the top of the in-tray, but I get no sense that short of raids on Matrons from Mars we going to get near fixing this.


It's time for the DH to drive a national recruitment campaign and stop saying daft things like; 'it is up to Trusts to get staffing levels right'. They cannot do it alone. Through neglect this is now national imperative.


The other tough question is; what part of the broad nursing agenda can only be delivered by candidates with a sense of vocation and a degree and how much by candidates with a sense of vocation and training.  Is it impossible to fast-track an apprentice scheme, direct to the wards?


These are problems that need workforce redesign, ownership and urgent answers. Health Education England was born in 2012 to sort out nurse training.


It looks to me they are, like the rest of us, bystanders waiting for the crash.


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