Sunday, May 26News For London

NHS’ lack of registered nurses threatens UK’s health system

Chelsea & Westminster Hospital | Photograph by Filippo Rossi

Nurses’ shortage is forcing the NHS into hiring nursing assistants to fill the gaps, according to the Health Foundation report.

The NHS is currently facing a considerable deficit of nurses, a situation which is expected to worsen as a result of poor workforce planning.

Alarmingly, the demands on nurses are disproportioned to the existing nursing workforce. Therefore, it is considered one of the lowest in the clinical workforce. 

It is estimated that the number of doctors employed in hospitals and other healthcare institutions has increased by ten percent in the last five years as opposed to nurses who have only registered an increase of three percent.

As demands on qualified nurses and midwives increase, the NHS is under considerable pressure to address the issue because of its impact on the overall quality of care that patients receive.

Mariana Eufrasio, a Portuguese nurse from Stoke Mandeville Hospital in Aylesbury, said to Westminster World: “If you feel that there is no support from your team, and good numbers to work, you can’t do things properly. Lack of staff is a problem.”

Eufrasio, who has only been in the UK for a year, added: “I work more with people that are from abroad than from here, the [UK] healthcare system depends on us.”

Figures from the NHS show that there has been a rise in the number of vacancies advertised for nursing and midwives posts since 2015. However, there has also been a sharp decline in the number of applications for these positions.

Royal College of Nursing in London| Photograph by Elza Lopes

In addition to this, statistics show that the shortage of registered nurses is because they are living the workforce. For instance, 27 thousand (8.5 percent), of nurses left the workforce in 2010/11, compared to 33 thousand (10.2 percent) in 2018/19.

The recruitment and retention of skilled nursing workforce, are also among the causes of the shortage, which has been blamed on low pay and unsatisfactory working conditions.

A nurse from the London Royal Hospital, who asked for anonymity, said: “It is difficult to recruit staff nurses, it is easier to recruit support workers. It is not only difficult to recruit but more staff nurses are actually quitting.”

This approach of hiring overseas nurses has been reflected in the past decade with a mix skills nurses and clinical support staff. In contrast to the workforce in 2009/10, where numbers of registered nurses and healthcare support workers were argued to have been at the same level.

Annisa Annaw, a former nurse from the University College of London (UCL) hospital, believes that the problem of shortage goes way back from 2005/6 at the time of the recession, where a lot of nurses were argued to have lost their jobs. 

Annaw, said: “The government never did enough to return them [nurses] to the profession. Now they [the government] are thinking of employing nurses from outside when we have a lot of nurses inside.”

Annaw, added: “We need highly qualified nurses, we need courses to be funded for the nurses, we need not to be working over hours, we need to have free courses, it’s better than having nurses coming from overseas.”

A Consultant Anaesthetist, from one of the major teaching hospitals in London, who also chose to be anonymous, said: “There are people working on a temporary basis to cover the gaps, and sometimes we have to cancel operations because there is no available staff because of the shortage. Shortage of staff can be a concern, and have an impact on the cost and revenue for the Trust and also on patient’s safety.”

The Consultant Anaesthetist, added: “[The nurses coming from non-European countries and Europe] They are an enrichment for the NHS. Care could not be provided by UK nurses only. 

Having a diverse workforce can only benefit the whole organisation. The NHS would not exist without the immigrant workforce.”

Nursing Associates have fast become an important component in the NHS landscape in the past 4 years since their introduction by the Shape of caring review in 2015. The review aimed at providing high quality education and technical skills to nurses and midwives throughout their careers. Thus, guaranteeing a high-quality healthcare system.

The role was created by the government to fill in the gaps within the healthcare system as demands for skilled and qualified workforce increased. It is a crossover between the registered nurse who undertakes a 3-years degree course and need to be registered with the nursing council and the healthcare assistant who are not registered and have no degree qualification and act as a support staff only.

In the current climate, due to Brexit, nursing associates are being employed to fill in the gaps left by nurses from European countries. This has also led the NHS to increase the outsourcing of workforce from non-European countries, such as India and the Philippines.

Marian Johnson, a nurse from UCL hospital, had two contrasting views in regards to the role of nursing associates. Johnson, said: “using more nursing associates is a risk because most of them are not trained to administer medication like we normally do. Again, it is a benefit for the NHS, because it takes the load of the nurses, which means nurses can do a lot more of the medication, but that can be a shared responsibility to the nursing associates.”

A report by Nursing in Practice highlights this issue, by stating that the lack of qualified nurses has a significant impact in the way patients are cared for, it has increased waiting times as well as posing risks to patients’ safety and experience.

Public awareness of the current state of the healthcare system has also grown. 

Taxpayers are left to wonder what concrete measures the government has in place in terms of legislation to solve the 44,000 nurses’ vacancies. 

Ellie Chizen, a Pastry Chef from London said: ”Lack of money, nurses and funding isn’t there to support them [the staff]. I feel the hospitals are not like they used to be 10 years ago, because of lack of nurses.”

Eugenie Ng, an International Business student from Westminster University, said: “The government should put more money into training and educating young people to become nurses. The government has to make sure that there is enough money to provide better healthcare.”

The UK General Election: parties’ promises on nurses’ shortage 

The current government’s attempts to attract an additional workforce, has been justified by proposing a reduction by 50 percent of the cost in visas in order to attract overseas workers.

However, government’s-imposed surcharges on health to foreign workers are expected to increase under its current plans.

Brexit also means that EU workers who are currently exempt from extra costs on health, may be forced to pay fees.

The Conservatives, pledge to help retain the existing workforce, which has been one of the NHS’ biggest challenges by implementing policies to ensure they remain.

In a bid to tackle this issue the NHS has already introduced a series of measures that entails attracting back the workforce who have left the system. These measures are: reducing working hours, provide further training as well as professional development as an incentive.

 Labour’s and Liberal Democrats plans to reinstate bursaries for nurses and midwives and allied professionals, may be welcomed to professionals working in the health service. As Molly Lavender Rose, a medical school staff said: “We definitely need more registered nurses. The first thing is to reinstate the bursary, that was cut by the Conservative government. If you reinstate the bursary, more people will want to become nurses. It’s just common sense.”

The NHS’ institutions and healthcare professionals seem to share the same sentiment that the government has used the NHS organisation for political gain rather than addressing its longstanding problems.

Across the healthcare system, shortage of registered nurses is affecting existing staff who complain being overworked and underpaid. 

Government’s current policies on the NHS, has been seen with criticism by not only professionals in the field but also the public who are the most affected. It is argued that government’s policies are pushing registered nurses, midwives and allied professions such as paramedics, out of the profession due to lack of funding.

 Ahead of the General Election, the next government is asked to fulfill its promises on funding nurses’ training, promote nursing career development and most importantly reinstate bursaries abolished in 2017 under the current government.

Furthermore, professionals across the board acknowledge the importance of skills mix within the NHS workforce. For instance, the role of the nursing associates and healthcare assistants in the overall management and functioning of the healthcare system. However, it is widely rejected that healthcare support staff as in the particular case of nurses associates, should be substitutes to registered nurses because they lack the skills only qualified nurses have to perform more complex tasks. 

Researches by the Health Foundation have shown that having nursing associates perform tasks only registered nurses are qualified for, may be posing considerable risks to patient’s safety, and in some cases lead to death.

The current state of the shortage of registered nurses and its impact in the healthcare system is best described by Daniel Sutherland, a press officer, from the Royal College of Nurses, who said: “We recently surveyed our membership, and we found that 6 in 10 nurses, said they cannot provide the quality care patients need. 

That’s the real consequence of staff shortage. The patients are the ones’ who suffer.” 


Words: Elza Lopes | Video: Qinxin Lu, Li Yan and Filippo Rossi  | Video editor: Francis Peña | Audio: Filippo Rossi | Still Images: Elza Lopes and Filippo Rossi