The UK’s National Health Service (NHS) is spending almost £1.5bn a year on temporary nursing staff to cope with shortages, The Guardian reports research has found. The NHS has a shortfall of 40,000 nurses in England, according to the Royal College of Nursing. A study from the Open University argues that the £1.46bn being spent on temporary staffing to plug the gaps could pay for 66,000 qualified registered nurses.
The report says the study found that NHS trusts paid for an additional 79m hours of registered nurses’ time at a premium rate in 2017, which is 61% above the hourly rate of a newly qualified registered nurse in full-time employment. If existing gaps were permanently filled, trusts could save as much as £560m a year.
“Relying on temporary nurses to plug gaps is just sticking a plaster over the problem, and costs considerably more than if vacancies were filled permanently,” said Jan Draper, professor of nursing at the Open University. “The sector is facing challenging times. We know that poor retention and low recruitment results in inefficiencies and ultimately puts patient care at risk, so it’s vital that we look to a more strategic and sustainable approach.”
Janet Davies, general secretary of the Royal College of Nursing, said the report exposed the “utter false economy” in NHS staffing. “Short-sightedness in recent years has left tens of thousands of unfilled nurse jobs, to the severe detriment of patient care,” she said.
“Workforce planning has been ineffective and dictated by the state of finances, not the needs of patients. It is further proof that cost-cutting plans saved no money at all and – instead – increased agency costs, recruitment fees and the sickness absence bill through rising stress.”
The report says retention of nursing staff has become a significant problem for the NHS. Seven in 10 newly qualified nurses quit their NHS trust within a year of qualification, with some moving to other trusts away from where they trained.
The study found 34% of registered nurses were unhappy in their role, with 35% thinking of leaving their job if things did not improve. Meanwhile, the number of applications to study nursing at university have fallen by about a third since the introduction of student loans for nursing degrees.
The report says the Brexit vote has also contributed to a growing recruitment crisis. Since the referendum there has been a 28% increase in the number of EU nurses leaving Britain, which could exacerbate the problem. Overseas applications for nursing roles has fallen by 87% in the past 12 months.
The study suggests that offering more flexible training, including distance learning, could help the problem, and urges a more consistent use of newly introduced degree apprenticeships.
Nursing staff are being forced to choose between finishing paperwork and treating patients, as the chronic staff shortages in the NHS continue to hamper the care staff can give, the RCN study has warned. It says the profession is “on the brink”, with the 43,000 vacant full-time nursing posts across the UK hampering their ability to do the job to the best of their ability.
The Independent reports that the shortage is a major source of public concern as well, with a YouGov poll of the public revealing 74% of people think there are not enough nurses to run the health service safely – and addressing this was their top priority for the NHS. “We warned this would happen, but were called scaremongers,” Davies says of the damage caused by Conservative government pay restraint policies. She has called for safe nurse staffing levels to be enforced by law in every part of the UK.
Wales, in 2016, became the first country in Europe to have a legal duty for health boards to employ enough nurses, record staffing levels and take action against breaches. The Scottish government has pledged similar measures but there are no such moves in England and Northern Ireland.
Some of the main concerns identified in the study were that a lack of time means fundamentals of personal and patient care are not carried out, with nurses unable to find time to wash patients or get them back in to bed. The burden of paperwork and auditing, a major part of this government’s drive to make the NHS the safest and most transparent health service in the world through data monitoring, is another burden. “Respondents described having to make difficult choices when there are shortages of registered nurses, between completing paperwork and providing care and treatment,” the study says. One anonymous respondent added: “I am not sure if I want to stay in nursing, I feel the care I give is compromised by trying to complete specific tasks which are more concerned with audit and performance rather than care of the patient.
“The paperwork is onerous, repetitive and does not facilitate care planning.” This issue was compounded by problems with IT systems which can make the process more onerous.
The report says nurses also raised concerns about the lack of time to discuss patients' care needs and next steps with love ones and relatives, and the shifting make-up of the workforce. There are many more healthcare assistants and junior nurses being recruited to plug an exodus of experienced staff, but this has meant many step straight into a high-pressure environment without adequate support and is contributing to high rates of staff turnover.
When these concerns are raised managers have no solutions or are too preoccupied with their own roles, the research found. “I constantly raise concerns each morning about staffing levels, risks to the clients,” another nurse is quoted in the report as saying. “It falls on deaf ears”
Davies said this was a “vicious circle” as the number one reason for nurses leaving – cited by 54% of their respondents – was staff shortages. “This situation could have been avoided. It was no accident – it was sadly inevitable. The reason we have so many vacancies is because of short-sighted cost-cutting in past years, and ineffective workforce planning driven by finance and not the needs of patients. This autumn, the College will launch a new campaign to demand, for every part of the UK, safe staffing levels and accountability set in law."
According to the report the Department of Health and Social Care has said it will train an extra 5,000 nurses a year from 2018 after scrapping training bursaries. A spokesperson said: “The NHS would collapse without our wonderful nurses – the fact that the NHS is ranked as the safest healthcare system in the world is a testament to them.
"From this year we will train 25% more nurses, are committed to helping them work more flexibly to improve their work/life balance and have awarded a pay rise of between 6.5% and 29% in a deal backed by the Royal College of Nursing themselves.”
Nurses have reported having to turn patients away from short-staffed sexual health clinics, leading to fears over a drop-in infection testing. Overstretched resources in the field mean that the public are being left unprotected, according to the study.
The Guardian reports that it found that the number of 18- to 24-year-olds being tested for chlamydia, the most common disease, has fallen by close to half a million in the five years since the government moved public health services into local authorities. Despite a 25% fall in tests, recent figures recorded a higher level of positive diagnoses, now at 128,000 cases a year.
The past five years coincided with what the RCN described as detrimental changes to commissioning of services, funding reductions and a “dangerous” recruitment freeze.
The study also found that while the introduction of the human papilloma virus (HPV) vaccine for teenage girls had contributed to a 74% reduction in genital warts in 15- to 17-year-old girls, access to cervical screening for HPV has been affected by confusion in commissioning and provision.
The report says the impact of sexually transmitted infections remains greatest in heterosexuals aged 15 to 24, black ethnic minorities and gay, bisexual and other men who have sex with men (MSM).
Helen Donovan, professional lead for public health at the RCN, said: “This is a worrying picture of understaffed services going to extreme lengths to try to cope, even turning people away – the last thing a health professional ever wants to do.
“If people are not able to access services then serious STIs could go undiagnosed and untreated – it is a major risk to public health.”
Olwen Williams, president of the British Association for Sexual Health and HIV, said that the findings provided more evidence that sexual health services had reached tipping point: “With the recent emergence of multidrug-resistant gonorrhoea and record levels of syphilis, these cuts have come at the worst possible time.”
The Department of Health said in the report: “This government has a strong track record on public health – teenage pregnancies are at an all-time low and sexually transmitted infections continue to fall overall. Local areas are best placed to understand their own needs, so over the current spending period, we will invest more than £16bn to help them deliver the right services for their communities.”
Nurses are, meanwhile, regularly forced to go hungry and thirsty at work because they have no time for a break. More than half go through shifts without being able to drink water because of “unmanageable” workloads that have left many suffering depression, The Independent reports that the study found. Three-quarters of the 1,905 nurses surveyed said they never had time for a break in their working day.
The report says the RCN described the findings as “shocking” and warned the health system was failing to meet the “basic human needs” of staff – 59% of nurses polled said they often went through shifts without drinking water, while 57% reported having no access to healthy or nutritious food at work.
Nurses also complained of understaffing, long shifts, a lack of work-life balance, bad management, and low morale. The report says one described having a “total meltdown, self-harming and suicidal thoughts” because of work pressures and many others said they were receiving treatment for depression or using alcohol to cope.
“I haven’t been coping,” wrote one survey respondent. “But I can’t afford to go off sick or be honest with how much I’m struggling because I don’t believe I’ll actually get support.” Another said they required treatment for kidney stones due to not being able to drink enough fluids.
Others described problems in accessing nutritious food. Some said they had no time to visit on-site cafes and canteens, while others complained hospital shops or vending machines did not offer healthy or cost-effective options. “I can’t leave the ward to go to the canteen, due to a lack of staff,” one nurse wrote. Another said: “The workload is unmanageable most days. They take 30 minutes break off of us every day, but we never get chance to have that break.”
RCN national officer Kim Sunley said in the report that the survey findings made “very hard reading” and suggested an inability to meet basic human needs had “now become the norm” in healthcare. These comments show the very personal impact that extremely pressurised working environments and lack of management support can have on nursing staff,” she said. “These are shocking findings and a very worrying snapshot of what is going on out there in the nursing workforce.”
Sunley said patient safety was at stake, as well as nurses’ own health, as dehydration could affect cognitive function. “Obviously in a crisis or emergency, absolutely, you wouldn’t go on your break, but when it becomes the norm that you don’t, that is unsustainable and leads to sick, exhausted and worn out nurses,” she added.
[link url="https://www.theguardian.com/society/2018/may/14/nhs-england-15bn-a-year-temporary-nursing-staff"]The Guardian report[/link]
[link url="http://www.open.ac.uk/business/apprenticeships/blog/tackling-the-nursing-shortage-May-2018"]Open University report[/link]
[link url="https://www.independent.co.uk/news/health/nurse-nhs-staff-patients-paperwork-bureaucracy-healthcare-funding-crisis-a8347611.html"]The Independent report[/link]
[link url="https://www.theguardian.com/society/2018/may/14/patients-being-turned-away-from-sexual-health-clinics-rcn-says"]The Guardian report[/link]
[link url="https://www.independent.co.uk/news/health/nurses-pressure-workload-hungry-breaks-royal-college-nursing-standard-department-health-a8347756.html"]The Independent report[/link]