The global crisis of medical staff shortages – particularly nurses – is worsening, with South Africa by no means the only country critically affected. And as major economies like the UK and Canada buckle under the pressure, they are turning to other countries – including South Africa – to address the problem.
Canada is haemorrhaging nurses and has a concerning lack of emergency staff – some services either closing totally or shortening working hours because of this – while Britain’s National Health Service (NHS) is to drastically cut the red tape necessary to recruit overseas nurses and dentists to help plug the gaps in those departments as it faces what may be its worst winter in history.
In South Africa, the impending retirement of thousands of nurses, and already crucial shortage of professional nursing staff, among other medical specialists, is collapsing the over-burdened public health system. The brain drain has left huge gaps in both the public as well as the private sector, and professional associations and others are warning of an even bigger crisis with the proposed National Health Insurance coming into effect.
The DA’s Shadow Minister of Health Michele Clarke said the NHI was “a recipe for disaster” and would accelerate the healthcare professional exodus and exacerbate the decline of the public health care system, reports PoliticsWeb.
Now, with British Ministers about to introduce legislation to tackle the NHS’ worsening staffing crisis by making it easier for overseas nurses and dentists to work in the UK, even greater numbers of South African medical professions are likely to flow out of the country seeking greener pastures.
The drive by UK Health Secretary Steve Barclay is intended to increase overseas recruitment to help plug workforce gaps in that country’s health and social care.
Barclay believes thousands of extra health professionals will apply, the new rules making it easier for medical regulators to register those who have qualified abroad. If the change proves successful it will help pave the way for more nurses and dentists coming to work in Britain from countries such as India, Sri Lanka, Kenya, the Philippines and Malaysia – and South Africa.
However, reports The Guardian, critics say this is a stop-gap that is no substitute for ramping up the supply of homegrown staff, and risks worsening the lack of health workers in other countries that are struggling with shortages of their own – Canada, South Africa, Zimbabwe, and most of the African continent, for instance, among them.
The initiative comes days after new figures showed that the number of unfilled posts in the NHS in England jumped by more than 25 000 in three months earlier this year to a record 132 139 – one in 10 of the entire workforce. That included 46 828 vacancies for nurses alone – 11.8% of the total.
Brexit has significantly reduced the number of nurses going to work in Britain from the EU.
Around one in 10 full-time equivalent posts in the NHS were vacant at the end of June, the highest proportion since current records began in 2018.
In London, around one in eight (12.5%) posts were vacant, with a record 30 506 vacancies across acute, ambulance, community, mental health and specialist services, reports The Independent.
The data come as the health services face what threatens to be the worst winter in its history, with the twin threat of a surge in COVID and flu cases.
It is feared that an early flu season – coupled with rising levels of the virus as people spend more time indoors during the colder months – could place further pressure on the NHS, which is already battling huge waiting lists and delays in ambulance services. Britain has not had a flu season since before the pandemic and immunity levels are low as a result, experts say.
The Department of Health and Social Care (DHSC) memo will lay a statutory instrument in the House of Commons intended to enable the bodies that regulate nurses and dentists to approve the arrival of more foreign-trained staff, with hopes that this will help the NHS cope with increasing demands.
However, the overseas recruitment push has generated controversy about the ethics involved, such as the decision to recruit 100 nurses from Nepal over 15 months to work in hospitals in Hampshire – NHS and nursing bosses are concerned at what they see as the over-reliance on luring staff from abroad.
The Royal College of Nursing has warned that “our health system is already over-reliant on international nursing staff and we must ensure recruitment is ethical”.
James Buchan, a senior fellow at the Health Foundation thinktank, said the acute shortage of nurses is likely to see already historically high levels of international recruitment of members of the profession go up further.
“While international recruitment (of nurses) can plug the gap short-term, it should not distract from the need to train and retain more nurses in the UK. To attract more homegrown people to the profession, nursing must be made an attractive career choice and that means improving pay, terms and conditions.”
The British Dental Association (BDA) said government action to enable a bigger supply of dental staff from overseas was welcome but the new push would not end the growing shortage of NHS dentists, which has left millions of patients facing serious difficulty accessing care.
“Action here is long overdue, but will not address the scale of the crisis facing this service,” said Eddie Crouch, the BDA’s chair.
“NHS dentistry is haemorrhaging talent by the day because of the dysfunctional system it’s built on. Ministers need to do more than try to fill a leaky bucket. They need to actually fix it.”
Meanwhile, in Canada, things aren’t much better, with emergency departments across the country, particularly at smaller, rural hospitals, slashing their services and hours.
In Nova Scotia, reports BBC, one hospital’s ER has been closed since June 2021 due to staffing shortages.
Canada is one of the richest countries in the world. Its universal publicly funded healthcare system has been touted by progressive politicians in the US, who see it as a needed alternative to an American system where millions remain uninsured.
But in recent months, Canada’s system has been described by workers and hospital executives as being in a state of “crisis”, which includes struggling emergency rooms.
Toronto ward physician Dr Raghu Venugopal has seen stretchers lining the hallways, occupied by patients suffering from ailments like a broken hip or abdominal pains. On some days, those patients may wait anywhere from two to four days to be admitted to hospital, all while a team of two nurses tends to a total of 50 to 60 patients on the unit.
Other patients are being examined in the waiting room because the lack of staff has forced parts of the ER to close, meaning there is limited space for doctors to see them privately.
In Saskatchewan, some paramedics spent their entire 12-hour shift waiting with a patient on a stretcher as no one was around to admit them for treatment.
In Ontario, a woman spent 19 hours in ER with severe backpain before she was admitted – and later diagnosed with cancer. In New Brunswick in July, a man died while waiting for care, and the hospital has launched a review.
The challenges brought on by COVID-19 bear part of the blame, in all of the affected countries, including Britain, SA and even the USA.
Many nurses in Canada, exhausted from the pandemic, plan to leave the profession due to burnout and limited support. Similar sentiments have been expressed by nurses in the US and in the UK, where a strike vote over wages is looming.
But experts say decades of bad policy, including the closure of hospitals and past austerity budgets, coupled with Canada's vast and complex geography, have exacerbated the pandemic pressure.
This has ignited a national debate on how to retain staff – primarily nurses – and how to save a public health system that is facing mounting pressure as it tries to care for an ageing population.
The modern version of Canada's universal healthcare system – under the Canada Health Act – has existed since 1984, though its roots were laid decades earlier in the province of Saskatchewan. Britain’s NHS, established in 1948, served as inspiration.
Canada’s system, however, ranks lower overall than the UK and others in international comparisons.
A 2021 report by the Commonwealth Fund listed it as second-last overall among a list of 11 rich countries – above only the US. The country specifically lags in equitable access and care outcomes.
Data over the past five years show people are waiting longer in the ER before they are either seen by a doctor or admitted to hospital.
Over the years, as Canada’s population grew in size and age, its healthcare capacity struggled to keep up. Rural hospitals – as in South Africa – have been most affected.
This is made worse by a vacuum of nursing talent that existed before the pandemic. There were 34 315 vacant nursing jobs in Canada at the end of 2021, a 133% increase from 2019.
It is estimated Canada will be short of 117 600 nurses by 2030. A third of the current workforce is close to retirement, and in a 2021 national survey, nearly 60% of early-career nurses say they are considering leaving their current job.
Some solutions to the crisis proposed by those in the sector include increasing wages for existing nurses, allowing internationally-educated nurses to practise in Canada, and increasing the capacity of nursing schools across the country, especially in rural areas.
Such measures mirror some of what is needed in South Africa, where the closure of nursing colleges, and the resistance to allow private institutions to widen their training of nurses, has exacerbated this country’s dire shortage of professional nurses.
In a Spotlight story run in MedicalBrief in 2021, it was reported that almost half of South Africa’s nurses were due to retire in the next 15 years and with only universities accredited to offer the professional nurse programme, there would be an almost 80% drop in new nurses in three years’.
The national spokesperson of the Democratic Nursing Organisation of South Africa (Denosa), Sibongiseni Delihlazo, had said this was “a ticking time-bomb just waiting to blow up in the face of South Africans”.
According to 2020 statistics from the SA Nursing Council (SANC), the current age demographics of registered nurses and midwives are heavily skewed towards older practitioners, with fewer than a third under 40. The statistics show 27% of registered nurses are in their 50s, 26% in their 40s, and only 21% in their 30s.
The set retirement age for nurses in the public sector is 65, although some extensions are allowed. This means, in short, that in 15 years, 47% of registered nurses will have retired. The same applies to about 26 to 30% of the enrolled nurses and nursing auxiliaries.
President of the Young Nurses Indaba (YNITU), Lerato Mthunzi, said working conditions added to the problem, making the nursing profession less attractive.
She said because of burnout and the “brain drain”, many have left the profession or the country for better working conditions, putting pressure on those who remain. General wards now have ratios of about one nurse and assistant to 20 or 30 patients, she said, compared with the norm of around five to one, shifting the focus from quality care to just managing.
The DA has continually highlighted the plight of medical professionals in South Africa and the overwhelming odds they face daily. Doctors and nurses lack support from the Department of Health (DoH) and the exodus of medical personnel from the country comes as no surprise, said MEC Clarke.
Various parliamentary questions from the DA revealed staggering shortages in the public health care system – a problem that compounds every year without necessary intervention from the DoH to address staffing shortages, training, registration, infrastructure maintenance and medicine and equipment shortages.
Politicsweb article – NHI will aggravate exodus of medical professionals (Open access)
.
BBC News article – Canada: Why ERs are struggling to stay open nationwide (Open access)
The Independent article – NHS staff vacancies at highest level since records began (Open access)
See more from MedicalBrief archives:
The obstacles stifling nurse training in SA
Retirement boom and training drought — SA’s looming nursing crisis
Changed qualification requirements will exacerbate nursing shortage