Impact of nurse shortages on patients – experts discuss

So what can we do – are there any solutions to this nursing crisis and what is the impact for patients?

We’ve assembled a panel of health professionals here in Leeds to help us discuss this.

We were joined by:

Professor Nicola Ranger, the General Secretary of the Royal College of Nursing, Dr Billy Palmer, an NHS workforce analyst with the Nuffield Trust, Maxine Wade, a Nursing Associate and Professor Alison Leary, a healthcare workforce modeller.

Cathy Newman: Professor Nicola Ranger, I’m going to start with you first, just to get a response from you about the data that we’ve unearthed, and what you think about what you’ve heard.

Nicola Ranger: I was the chief nurse in a hospital when Mid-Staffs had just happened and the Robert Francis report, as you mentioned, where we committed, the government committed at the time, that we would never go back to that place again. But what we can see is years later, we’re still in a position where nurses aren’t in the right number, in all of those settings that you agreed.

Cathy Newman: So is that a betrayal by the last government and now we’re into a new government?

Nicola Ranger: I think it is. We were very clear at that time that this crisis in nursing has not happened overnight. This has taken several years to get into this position. And as has been highlighted on your report, rightly, nursing is a safety-critical profession. And actually, we want to be able to keep patients safe. And nurses in hospital settings are the constant 24-7 presence for patients and I find it extraordinary that in England, there’s a maximum number of dogs that you walk, but there’s no enforceable standards of a maximum number of patients that any registered nurse ever has to look after.

Cathy Newman: Is it, just briefly, there should be a mandatory minimum staffing level should there?

Nicola Ranger: I believe there should be if we are safety critical.

Cathy Newman: Maxine Wade. You’re a nursing associate. You feel this shortage daily do you. Just describe what that’s like?

Maxine Wade: It just makes your job a lot harder and it’s incredibly stressful that you’re not able to give the level of care that you want to give, and that your patients deserve, and you’re going from one task to the next and you don’t have enough time to spend and chat to your patients. And that makes what is already a very difficult job a lot more stressful, and it makes it much more easy to get burnt out with it.

Cathy Newman: Do you worry about the impact on your patients?

Maxine Wade: I worry, not me personally, I have been in that situation where I have worried about the impact. But I think any member of nursing staff that you speak to, these findings in this report, is not going to be surprised. We’ve all experienced working with short staffing. It’s almost become ubiquitous in working with the NHS having that short staffing and the impact that that has on patients and seeing that first hand and it’s a big reason as why we’re seeing the amount of nurses leaving the workforce that we are in.

“I think any member of nursing staff that you speak to, these findings in this report is not going to be surprised. We’ve all experienced working with short staffing.”

Maxine Wade, Nursing Associate

Cathy Newman: Well, Billy Palmer, let me bring you in here. How did we get here? Because we’ve just heard this is many years in the making. What is your assessment of how we ended up in this situation?

Billy Palmer: Well, it’s absolutely right. It is a situation that’s been many years coming. Since the inception of the NHS, nurse growth rate, the numbers of nurses, has increased about half the rate of that for doctors. So it’s a profession that we’ve not increased at the same rate as some other professions. And where that’s left us is in England, we have fewer nurses per head of population than other countries in the UK, than Wales and Scotland. And if we look further afield, We have fewer nurses as a proportion of our hospital workforce than countries like Germany and Ireland.

Cathy Newman: Having heard all of that, Professor Alison Leary, and you heard the former Health Secretary Jeremy Hunt saying that lives had been put at risk, lives have been lost because of this shortage of nurses. What is your thought on that? Is it true that lives have been put at risk, and worse?

Alison Leary: Yes, and we know there’s a great deal of scientific evidence, that not having enough registered nurses or compromising the amount of registered nurses that are available to patients, has an effect on survival and mortality. So we’ve seen that not only in scientific evidence, but we’ve seen that in 50 years worth of inquiries. Mid-Staffs was just one of them. Since the Ely inquiry in the 1960s, we’ve seen this repeating pattern of not having enough registered nurses and the consequences on survival.

“Since the Ely inquiry in the 1960s, we’ve seen this repeating pattern of not having enough registered nurses and the consequences on survival.”

Alison Leary, Healthcare workforce modeller

Cathy Newman: Professor Nicola Ranger, if the key problem here is a lack of qualified nurses, would you like the government to commit to bringing back the nursing bursary or write off the debts of those who have graduated? What are you calling for?

Nicola Ranger: We would really like to see our domestic recruitment increase. We want more numbers and greater numbers of people coming into the profession. We do hear directly from our student nurses that they have to pay for their degree, they have to, if they’re going on an assignment, they have to pay for their travel in advance and they’re living off 400 pounds a month which we know is very, very difficult.

Cathy Newman: So be blunt with the government. We had the Prime Minister on our programme tonight. You’ve seen our reports. What action do you want from them in response to what you’ve just seen?

Nicola Ranger: What we do want is proper recruitment of students and we want proper pay. We want to make this an attractive profession to come into.

Cathy Newman: But restoring the nursing bursary, would… ?

Nicola Ranger: We would. We would like to see loan forgiveness, where you come in, you get paid to do your training, but then potentially work for the NHS, community care or social care.

“We would like to see loan forgiveness, where you come in, you get paid to do your training, but then potentially work for the NHS, community care or social care.”

Nicola Ranger, RCN General Secretary

Cathy Newman: So write off the debt.

Nicola Ranger: And then write off the debt, because they’re not like other students. They can’t get a second job because they have to do clinical hours as well as their study.

Cathy Newman: Maxine Wade, how big a problem is pay in all of this?

Maxine Wade: I think it’s one of the biggest drivers of why we’re seeing the problems of retention. I think, you know, when I get paid at the end of the month, I don’t have a lot left after bills and sometimes I’ll be honest with you, Cathy, I wonder whether it’s worth staying in the job. But I do it because I love the patients, I love the people that I look after, but I get angry when I think, we live in a country where there’s so many billionaires and millionaires, and yet nursing staff like myself, struggle to make ends meet on a daily basis. And it’s why I’ve got friends personally who’ve gone and emigrated to go and nurse in Australia, places like that, where they have legal staffing ratios like we’ve spoken about and they’re paid a decent wage for the job that they’re doing. Ultimately, to me, it’s about respect. How can the government say the respect us when they pay us an absolute pittance for… I wish that Keir Starmer could just spend a day at work with me and see what we have to see and what we have to do.

Cathy Newman: You’re angry, you’re upset about it.

Maxine Wade: Yeah, I am.

Cathy Newman: So would that fuel you to go out on strike again?

Maxine Wade: 100% behind going on strike again. It’s not something that I like doing, and in an ideal world we wouldn’t have to do it, but I think that it’s the only way that we can get a pay rise that’s in line with inflation and to retract nurses and retain the staff that we’ve already got. You know, the BMA got 22% because they held and they were steadfast and they had a lot of resolve and they continued to strike to get the amount that they wanted, and they won.

Cathy Newman: Were you let down by your union?

Maxine Wade: There was a different leadership at the time.. but I think that we blinked and we settled too quickly. I think there was a lot of factors. I think there’s a lot of apathy between nursing members of the union who need to get involved and get on board. I think we’re not really a profession that stands up for ourselves and raises our voices in the way that perhaps other healthcare professions like doctors do, but if we don’t stand up and be counted, how are we going to see the increase that we need.

Cathy Newman: Nicola, you heard that loud and clear and you’ve got 2.8% on the table at the moment, pay rise from the government. Will you lead your union out on strike?

Nicola Ranger: What we want recognition for is exactly what you’ve described, that nursing is a safety critical profession. Let’s be really clear. If we called out every single nurse in every single specialty, for even one hour, patients would come to harm. We know that, the government knows that. That is an absolute last resort, but what we are asking for is recognition of the value of the safety critical brilliance of nursing. That’s what we’re asking for. I do believe this government understands that, but we need more than understanding. We need action. We’ve heard loud and clear from Keir Starmer that part of his motive with NHS England is to be able to put that money into frontline nurses.

Cathy Newman: Do you believe that?

Nicola Ranger: We, as the RCN, will absolutely be holding him to account on that. That has been said publicly.

Cathy Newman: And you’re not going to be settling like the last leadership did?

Nicola Ranger: Well, I think we want action. We want action. We want our value fully understood. Because I’m absolutely clear, the public understand the value of nursing. And we’ve heard a lot from this government about what they’re not going to invest in. What we need is, what are you going to invest in? And we would say nursing is money well spent.

Cathy Newman: Billy Palmer, is it possible to find a solution to this nursing shortage, without the government spending money that it doesn’t have?

Billy Palmer: Undoubtedly, pay is important. We can hear the case for it there. It’s not just about baseline pay. There’s pay progression. It’s clearly important to actually keep people in the service once they’ve joined. But there’s other things you can be doing as well. And we have to recognise this is not unique to the UK. What is unique is how little we’ve done to try to address it. So you look at other countries – in North America, they’ve actually used loans forgiveness style schemes. In other countries, they’ve used sort of tie-ins in response to actually paying for your training. In Ireland, they actually bridge between your university stage and then into your career in itself to help people through. So there’s things you can do from that. But then also in terms of, this is not new as well, and there’s lessons from history. We actually have had success in retaining nurses in the past. Let’s learn from those.

“It’s not just about baseline pay. There’s pay progression.”

Billy Palmer, NHS workforce analyst

Cathy Newman: Alison, let’s focus on some of the ways that hospitals are trying to make ends meet. They’re using health nursing associates like Maxine more than fully qualified nurses. Is that problematic for patient safety or not?

Alison Leary: It can be problematic. So what we’re seeing, it’s not that the use of nursing associates or support workers is the issue. The issue is they’re being substituted. So registered nurses, those posts are being disestablished and then replaced with nursing associates or support workers. And that brings down the available time that a registered nurse is available to those patients. And we know that is very much associated with worse mortality.

Cathy Newman: Maxine, do you accept that could be a problem?

Maxine Wade: I accept that that could be a problem and I think ultimately the government will take advantage of nursing associates because it’s easier for them and we are paid less but I think, you know, I can only speak for myself and other nursing associates that I know will work very hard but I think there’s a lot of concern about whether there’ll be progression within the role and ultimately that’s what I want to see to see the sustainability of it going forward.

“I think ultimately the government will take advantage of nursing associates because it’s easier for them and we are paid less.”

Maxine Wade, Nursing Associate

Cathy Newman: Nicola, we had a 10-month battle trying to unearth this data. How important is it that it is published, going back to what you were saying at the beginning about the Mid-Staffs?

Nicola Ranger: It is really important that this is open to the public. The reality is, anyone who’s been in hospital recently will see the real challenges. And the sad thing is, I don’t think many will be surprised. It’s absolutely right that we publish data, that it’s open, it’s transparent, because actually, that’s how people can see what the reality is.

Cathy Newman: Maxine, do you have any hope, under this government, that things will improve?

Maxine Wade: Not at all. I think we’ve seen already with the first, is it seven months of the Labour government that they’re quite keen to do a lot of cuts. And I don’t agree with getting rid of NHS England because they’ll get rid of a lot of tracking of the figures regarding this. This whole thing is about covering up the truth of what’s happening and I just will believe Keir Starmer when we see action over words, and empty soundbites.