Friday, 11 May 2018

Coming to Britain

The Windrush scandal (1) is certainly shocking. When I first heard it I was both sickened and angry, was this the way to treat people who had given their lives working for this country, many of them in not very well paying public service jobs. It was disgusting. But as the scandal progressed I got a horrible sinking feeling. The Windrush scandal was replaying the British attitude to immigrants, we will let them come here to do the jobs we cannot get anyone else to do but we will not fully welcome them into our country and don’t want to give them full citizen rights.

Fortunately there was a loud public outcry against the Windrush scandal, many members of public saw the injustice of deporting Windrush people now that they were elderly, no longer wanted after giving Britain a life of service. The outcry was so loud that the Government finally had to act. The Home Secretary resigned (2), though it was over misleading parliament and not actually the Windrush scandal. Sajid Javid replaced her as our first black and Muslim Home Secretary (3), though Javid voted against releasing all the government papers relating to the Windrush scandal (3), so no open government there.

At the time all this broke there was another immigration scandal that slipped under the radar. Last month 100 doctors from Indian had their visas refused and were turned away from entering the country (4). Those doctors already had jobs, they were part of a scheme to place doctors with North-West NHS Trusts (5), and NHS Employers have said that since December there have been 400 other cases (5).

The Home Offices has monthly quotas for the numbers of visas it issues for skilled non-EU workers wanting to enter the country (6). Two-thirds of these are skilled medical professionals coming to work for the NHS (6). Yet last month that quota was reached for the third month in a row (6) and anyone else who wanted to come and work here was automatically denied a visa, even if they were desperately needed medical professionals coming to work in the NHS. A whistle blower, in December. Claimed that the Home Office prioritises visa applications by how much money they will earn the department, i.e. which visas carry the highest fees (7). The fees for student visas and spousal visas are much higher than the fees for a working visa (7).

The NHS is short of 100,000 staff (8), which is 1 in 12 posts or 8.3% of all NHS posts are
empty. Of those 100,000 empty posts, 35,835 are empty nursing posts, or 10.3% of all NHS nursing posts, and 9,676 of the empty posts are medical posts, 7.9% of all NHS doctors’ posts are empty (9). This is a shocking state to be in, between 8% and 10% of the main roles of an organisation are empty. If between 8% and 10% of all MP’s posts were empty then both main political parties would not shut up about it, yet they are happy for the NHS to carry on with this skill deficit.

Traditionally the NHS has recruited from aboard, especially from Europe and the Commonwealth, when it has been short of staff. Many of the women in the Windrush migration were nurses and midwives coming to work in the NHS. When I started my nurse training, nearly 28 years ago, 4 out of the 30 members of my intake were non-British, that was 13% of us. The most recent figures I can find show that 9% of NHS doctors are from the EU and 16% are from the rest of the world, while 7% of NHS nurses are from the EU and 8% are from the rest of the world (10). With the current state of empty posts in the NHS we cannot afford to lose any more staff. If the number of empty nursing post rose to 20% it would create an unsafe and toxic working environment, seriously putting patient care at risk. But that is the risk we are facing.

Since the referendum vote we have seen a shocking fall in the number of EU nurses coming to work here, and a rise in them leaving, shown by the Nursing and Midwifery Council (NMC) numbers. Between April 2017 and March 2018 29% more EU nurses left Britain than the year before (11), and that was three times higher than in 2013-2014 (12), the first time the NMC recorded these figures. The numbers of EU nurses coming to Britain, between April 2017 and March 2018, was 87% less than the previous year (11). We have been haemorrhaging EU nurses since the Brexit vote. Janet Davies, the chief executive of the Royal College of Nursing, has blamed this exodus on the badly organised nature of Brexit (12). She said that the Government’s refusal to state what the rights of the three million EU citizens living here will have when we leave the EU is causing so many EU nurses to leave ahead of it all (12). And I have to agree with her, since the referendum, Brexit has created a toxic environment for EU citizens living here and our Government seems intent on doing nothing about it.

We are seeing many attempts to recruitment nurses from outside the EU. Oxford University Hospitals NHS Foundation Trust (13), North West London University Healthcare NHS Trust (14), the Heart of England NHS Foundation Trust (15), Whittington Heath NHS Trust (16) and Barts Health NHS Trust (17) have all been recruiting nurses from India and the Philippines, and these are only the ones I found on a simple Google search. I am certain there are many, many more Trusts also trying to recruit nurses from non-EU countries. Even the Department for Health and Social Care is getting in on the act. Through Health Education England, a scheme was announced last year to recruit 5,500 overseas nurses, from India and the Philippines (18). The scheme was expanded to include Jamaica (19). But there is an uncomfortable fly in the ointment here. Oxford University Hospitals NHS Foundation Trust (13) reported that 40% of overseas nurses offered jobs would not unlimitedly take up those offers due to the immigration processes and language checks. This is a very high and very expensive drop-out rate, back in 2015 it cost £3,000 to recruit a non-British nurse (20) – I wasn’t able to find anymore up-to-date figures than these, it’s as if Trusts no longer want it known how much they are now paying to recruit overseas nurses. Oxford University Hospitals didn’t say how many recruited nurses dropped because of difficulties with getting a visa and how many were rejected for visas, but a 40% drop-out rate is shockingly high.

There is another issue to consider with all this overseas recruitment, Britain isn’t the only country with a shortage of nurses. The World Health Organization (WHO) estimates there will be a global shortage of 12.9 million healthcare workers by 2035 (21). The International Council of Nurses (ICN) interim chief executive Thomas Kearns warned Western countries not to “drain” developing countries of their nurses, but to focus on their “homegrown” nurses (21). As British Trusts actively recruit nurses from India, the Philippines and Jamaica, what affect will this have on their own healthcare systems. We have 40,000 empty nursing posts and the NHS is not coping with this burden, how will a developing country cope with this shortage of nurses, they certainly cannot recruit from over countries the way we can, the shear expensive of doing so. Britain isn’t the only country recruiting nurses from developing countries. Do we have the right to just see these countries as a mere stockpile of nurses to be recruited from, and “drain” them of their own resource, their nurses.

For as long as I have been a nurse, the NHS has recruited nurses from abroad, mainly from EU but also from non-EU countries too, long before Brexit, but we need to develop an ethical approach to this. The Department for Health and Social Care scheme to recruit nurses from India, the Philippines and Jamaica is being painted as “ethical” recruitment (19). Nurses will be recruited from these countries for a fixed term, and while here they would work and learn new skills, skills that they will then take home. How affective this will be is still unproven. The nurses will work here for three years. How many employers will want to invest in sending these nurses on specialist training when they will work for the Trust for only three years? Their skills training may boil down to “on the job training”, just working as a nurse in Britain, which also sounds rather patronising.

The Government needs to take seriously the skill shortage in the NHS and make the process user friendly. All nursing posts are on the Shortage Occupation List (22), the list of occupations the Home Office gives priority to when considering issuing working visas, doctors are considered by the specialist skills they have. There are 150 different Standard Occupational Classification (SOC) codes on the list, the different jobs and occupations that the Home Office gives priority to when issuing working visas (22) (I physically counted them and there maybe occupations on the list that I missed, it wasn’t an easy list to count). Actors, dancers and musicians are also on this list. The Government web page about Shortage Occupation List (22) does not state that any occupation is given priority, so when the monthly quota is met people are flatly denied visas, no matter what their profession is or how despair we are for people with their specific skills (doctors and nurses).

But Theresa May does not seem to be taking this issue seriously. At the end of April, she overruled calls from members of her own cabinet to relax visa quotas for doctors coming to work in the NHS (23). She was lobbied by the Health Secretary, the then Home Secretary Amber Rudd, and the Business Secretary, but May ignored them all and refused any visa quota relaxation for doctors, what hope is there she’d consider nurses as a priority? Neither has Theresa May and her government clearly stated what rights EU citizens, living in the UK, will have after Brexit (24). In some statements EU citizens will have less rights and in other statements EU citizens will have the same rights as they do now (24). There are so many contradictions coming out of this government that no wonder EU citizens living here fear for their rights post Brexit (25), especially now post the Windrush scandal (25). If the government can treat Windrush people in the way they have done, what is there stopping them treating EU citizens in the same way post Brexit? No wonder we are seeing an exit of EU citizens, especially nurses who are in demand in other EU countries (26).

This government certainly does not seem interested supporting “homegrown” nurses as Thomas Kearns warned (21). After eight years of pay austerity the government’s pay offer to nurses, this year, takes away more than it offers (27), and could see nurses losing more pay in real terms. The government’s reaction to the 40,000 empty nursing posts has been pitiful. They abolished the bursary for nurse training (28) and since then 14% fewer people have applied for the September 2018 intake than did last year, and last year saw a 30% reduction on 2016 (29). The government has done NOTHING to encourage nurses to stay working for the NHS, many Registered Nurses are leaving because of the high workload, poor working conditions and stagnating pay. 

Nursing and the NHS are in crisis (30) and still this government does NOTHING about it. Is Brexit taking up all the government’s ability, time and resources? If so then this is the worst government on record. A government should be able to multitask, that is the nature of government, governing requires being able to do many different things all at the same time, and hopefully all of them well. This government is blindly ignoring the crisis in nursing and therefor ignoring the terrible cost this is taking on patient care. But why they doing this? Was Theresa May treated harshly by a nurse when she was a child and this is her revenge? Or is it more likely that they are ignoring it all because they are too incompetent to actually tackle the problem head-on? Whichever way patients will suffer until they do something… But I do not hear any action coming from this government any time soon.

Drew Payne

Sunday, 8 April 2018

Read The Small Print Before Signing

Back in October Jeremy Hunt announced that the 1% pay cap (forced on NHS staff) was finally going to be scraped (1). Six months later we have got news of what that pay deal will be (2). At first the offer seems to be going some way to redress the loss of pay, in real terms, we have suffered with this government’s pay freeze and then pay cap. Since 2010 nurses’ pay has fallen in real terms by 14% plus (3).

At the beginning of March, it was leaked in the Guardian newspaper that the government had drawn a “red line” that this pay offer would come with the condition that we had to give up a day’s annual leave (4). Never has a single MP’s pay rise come with this condition. Naturally there was an outcry against this. NHS staff have worked hard enough over the previous years, especially during last winter, the sheer arrogance of this demand was breath-taking. Strangely, when the pay offer was official announced, at the end of March, gone was the requirement (2). Had this been a crude example of political spin, to make us swallow this pay offer without too many questions?

This pay rise might seem generous at first sight, a pay rise of 6.5%, but a closer look quickly shows that this simply isn’t the case.

Firstly, this pay raise is over three years. We will get 3% this year, 1.7% next year and 1.6% in 2020 (5). The inflation rate was 2.5% in February this year (6) which would mean our pay would rise 0.5% above inflation, not much. But inflation is predicted to be 2.2% in 2019 and 2% in 2020 (7). This would again see our pay increase less than inflation, again a cut in real terms. One pay rise just above inflation in ten years, would MPs tolerate this?

The pay points, on the Agenda for Change (AfC) pay scale, are to be “re-structured” (5). We are told that this is to remove the overlap in Bands (5). If you are on the top pay point of Band 5 you will be earning more than someone who is on the bottom pay point of Band 6 (Though the Band 6 person’s pay will increase yearly pay increments). The pay bands will be reduced to three for Bands 5 to 9, with only two pay points for Bands 2 to 4, and they will not be awarded yearly (5). Ultimately this will see a reduction in yearly pay rises, people will reach the top pay point for their Band quickly, even with pay points not being awarded yearly, and then face the only increase on their pay being a yearly pay rise, which since 2010 has been repeatedly below inflation. Gone will be the yearly pay increases from AfC.

To move onto the next pay point we will have to had completed the following:
  •  We completed our yearly appraisal
  •  Have no live disciplinary actions on our record
  •  Have completed all our mandatory/statutory training
  •  And if you’re a line-manager you must have completed all your staff’s appraisals too (5)
And it looks like that these requirements maybe enforced more (5). So if your unit is so busy that you can’t get to your mandatory training, if your manager is too busy to arrange your appraisal, or you are that manager who is too busy to arrange your staffs’ appraisals then you won’t move to the next pay point. So if our workload is too heavy our pay could actually suffer.

There has been much made of that some people will receive a 29% pay rise but in reality most of this 29% isn’t a pay rise but part of the re-structuring of the AfC pay points. Newly qualified nurses will see the biggest pay rises as the lowest pay points on Band 5 will be abolished, making a Band 5 starting salary £24,907, but that is only a 12.5% increase (8), not 29%. Only 1% of NHS staff will see the 29% pay rise through re-structuring of AfC, most of whom are unlikely to be nurses, with 50% of staff only receiving the 3% basic pay rise (9). Many nurses like myself, who are at the top pay point of our Band will only get a pay rise of 0.5% above inflation.

When Hunt announced the scaping of the pay cap, last year, he did say that any pay rise would be linked to productivity (1). We now see what this is. There will be a “focus” on reducing rates of sickness (2) and staff will be “encouraged” to work Bank shifts on top of their contracted hours. I cannot find how the sickness rates will be “reduced”, but I fear that it will entail punishing staff for being ill, i.e. more disciplinary procedures and Official Warnings for staff with raised Bradford Scores (The method used to monitor staff sickness in the NHS [10]). How will staff be “encouraged” to work Bank shifts, again I can’t find anything about this. But how is getting an already overloaded workforce to work on their days off helping with staff retention and nurses work/life balance? How will “encouraging” already overworked staff to work even more hours help reduce sickness rates?

Nursing is facing a recruitment and retention crisis. Last year saw 33,000 nurses leave the NHS, that’s a 20% raise on the number who left in 2012-2013 (11). Last May the RCN found that there were 40,000 empty nurses posts in the NHS, just under 10% of the nursing workforce (12), and since then the government has done nothing to recruitment more nurses. There are even less people applying for nurse training since this government abolished student nurse bursaries. Only published this month, UCAS announced that 14% fewer people have applied for the September 2018 intake of student nurses than did last year, and last year saw a 30% reduction on 2016 (13). Last year, for the first time, more nurses left the NMC (Nursing and Midwifery Council) register of nurses then joined it (14). 1,678 more nurses left the register than joined it, in total 35,363 left the NMC’s register. You have to be registered with the NMC to work as a Registered Nurse, so those 35,363 nurses were lost to the professional, with all their experience.

How much will this pay rise help with the recruitment and retention crisis? Pay isn’t the only reason nurses are leaving the NHS. A report to the House of Commons Select Committee on Health, in January, found that nurses were leaving because of the poor pay, but also because of the high workloads, restricted access to continuing education and feeling undervalued, especially by this government (15). How will a 0.5% above inflation pay rise for half of nurses, and then another two years of below inflation pay rises for all nurses, encourage people to stay in the NHS? It does not address our spiralling workloads, working shifts without a break because we are so busy and poor access to education, it certainly doesn’t show us we are valued by this government. Yes, newly qualified nurses will be paid more but is this enough of an incentive to encourage people to apply for training? Without the bursary, qualified nurses are now looking at £35,000 to £40,000 of student load debt, and more if they train in London (16). Though, if you earn more than £21,000 a year you have to pay back more of your student loan (16), so how much of this increase in newly qualified nurses’ salary be eaten up by student loan repayments?

Most of our unions have already backed this pay deal (2). Janet Davies, RCN chief executive, called this deal, “A significant shift in government policy that has been forced by nurses themselves. That is why we are recommending that you accept this deal.” (17) Sara Gorton, lead negotiator for the health unions, said: "It will go a long way towards making dedicated health staff feel more valued, lift flagging morale and help turn the tide on staffing problems." (2) Danny Mortimer, chief executive of NHS Employers, said this deal will make the NHS a "desirable" employer again (2). Only GMB national officer Kevin Brandstatter called the deal "jam tomorrow", saying "Long-serving, dedicated health service workers have had thousands of pounds swiped from their pay packets since 2010 by the government's cruel and unnecessary pay cap." (2)

Will I vote to accept this pay deal? What choice do I have? If we turn down this deal what is the alternative? The doctors strike in 2016 was bitter and won little concessions, but at least the doctors had us to cover for them. If we strike who will cover for us? No one and patient care will suffer. Also, if we reject this pay deal the government will not offer us the deal we want, they will not restore the pay they have taken from us since 2010, instead they will claim there is no money for any other deal, I am certain. I am so demoralised by my treatment from this government that I am willing to accept as bad a pay deal as this one because I am desperate for any type of pay deal that isn’t another wage cap.

I was right to mistrust this government when they announced they had “scrapped” the pay cap (18), what they are offering in its place is barely any better but what can I do?

"The agreement [this pay deal] reflects public appreciation for just how much they [NHS staff] have done and continue to do," Jeremy Hunt (2), but he has always repeatedly shown his hypocritical attitude NHS staff, he certainly doesn’t value us.

If you want to know how much your pay will or will not increase then check here, at the NHS Pay Calculator.

Drew Payne