Monday 22 January 2018

When You Just Don’t Understand the Situation

If you can keep your head, while all around you others are losing theirs, believe you me you don’t understand the situation.”

I don’t know who said it but I do like this quote, except when it comes true. Jane Cummings, NHS England’s chief nurse, has recently shown that she is a living example of this.

The crisis in nursing has further deepened, last week figures from NHS Digital were released that showed last year (2016 to 2017) more nurses left the NHS than joined it (1). Last year 33,500 nurses left the NHS (about 10% of the nursing workforce), 3,000 more than joined, and 20% higher than left in 2012-2013 (1). Some of these nurses have moved into the private sector, to work for nursing agencies and private companies and private hospitals, but an alarming number of nurses have left the profession altogether. Last year saw 1,678 more nurses leave the NMC register than joined it, 35,363 nurses left the register, 27% less nurses joined the register than left it (You have to be registered with the NMC to practice as a Registered Nurse, therefore if you leave it you cannot work as a Registered Nurse) (2).

A closer look at these statistics makes an even more uncomfortable read.

3,000 more nurses left the NHS than joined it (3). This is the biggest gap but not the first, for the last three years more nurses have left than joined the NHS, but last year saw the biggest gap. There’s no evidence that this trend isn’t going to carry on.

The largest percentage of those nurses leaving, 51%, were nurses under 40 (3). These are nurses at the beginning of their career. Traditionally, the largest percentage of nurses leaving had been over 55, nurses retiring. This has been a concern because of the drain of skills and experience from losing these nurses. Last year we saw the largest percentage of nurses leaving were ones at the beginning of their careers. Nursing is now so stressful and undervalued that it is driving away nurses at the beginning of their careers.

"We are haemorrhaging nurses at precisely the time when demand has never been higher,” Royal College of Nursing head Janet Davies said: "The government must lift the NHS out of this dangerous and downward spiral.” (3) She added that the government needs to address nurses’ poor pay and lack of support to start filling the huge number of empty nursing posts (3). She hit the nail on the head, unlike our Chief Nurse.

Jane Cummings told the BBC: "We do lose people that need to be encouraged. We're in the process of bringing in lots of nurse ambassadors that are going to be able to talk about what a great role it is, to be able to tell their story, so we can really encourage people to enter the profession and for those in the profession, to stay in it," (3).

She is the professional lead for nursing and midwifery in England (4) and yet she makes a comment as crass and patronising as this one. Nurses are the backbone of healthcare, we are the ones who actually carry out the vast majority of patient care, and the NHS is haemorrhaging nurses. Yet all Jane Cummings can say, in the face of this of all, is that she’s introducing “nurse ambassadors” who will tell everyone what a “great role” nursing is. She plainly ignores all the factors that are stripping the NHS of nurses, and instead she announces a pie-in-the-sky project. As if all we need are people to go around saying how great nursing is and nurses will stop leaving the NHS. What planet is this woman on?

If a “nurse ambassador” turned up at my workplace and told me it was great to be a nurse, I’d reply asking them what they were going to do about our ever increasing workload, all the empty posts in our team (let alone we need more nurses to manage our increasing workload) and what where they going to about the fact that my pay has decreased, in real terms, by 14% since 2010 (5)? If they answer nothing then I’ll demand to know what good are they? But let’s cut out the middle people, if this is all Jane Cummings can offer then I want to know what good is she?

According to NHS England, Jane Cummings was appointed National Lead for emergency care in 2004 and she had been working in management for many years before then (4). It is safe to say that it is many, many years since she worked on the clinical coalface of nursing, and it shows how her patronising response to this latest crisis is. Why is she in such an important role when she cannot offer the leadership needed?

In 2012, Jane Cummings’ salary was £165,000pa (6), and I am sure she has not seen her salary fall the way the clinical nurses have seen our salaries fall, in real terms.

How has Jeremy Hunt reacted to this latest nursing crisis? He is the Minister for Health and Social Care, he is the politician responsible for the NHS.

He has shown his typical complete lack of knowledge about the situation. In reply to the fall in the number of NHS nurses, Hunt said that he will increase student nurses places by 25%, training 5,000 Associate Nurses this year and 7,250 next year, make it easier for Associate Nurses to re-train as Registered Nurses and give nurses first refusal on any “affordable” housing built on former NHS land (7).

At first this may sound great but a quick glance at the figures shows how hollow they are. It takes three years to train a Registered Nurse and two years to train an Associate Nurse, so any extra training places will not give us more nurses now. In three years times how many more nurses will be leaving the NHS than joining it? There seems no evidence that the NHS will stop losing nurses. This Government has abolished bursaries for Student Nurse training, since then there has been a 23% fall in the number of people applying for nurse training (8). Will they be able to find enough appropriate people to fill these extra training posts? Associate Nurses are not a replacement for Registered Nurses, as yet there are no plans for Associate Nurses to be able to give IV drugs.

As for first “dibs” on “affordable” housing, well only on the ones built on former NHS land. You still need a mortgage for an “affordable” home, it’s not social housing, and with nurses’ pay falling in real terms who can we get a mortgage from? And how many “affordable” homes will be built this way? Certainly not enough to house all the nurses, and their families, who need them. This is another patronising and meaningless “bone” thrown at us by Hunt, which does nothing to ease all the problems faced by nurses.

Nursing is in crisis, we are haemorrhaging nurses from the NHS, yet this has been a problem for years and no one in leadership is doing anything meaningful about it. I want to scream “You’ll miss us when you’re gone, when there’s no nurses left you’ll be in trouble!” But with the leadership styles of Jane Cummings and Jeremy Hunt, I don’t think anyone will notice or will they even care, and that makes me so sad.

Drew Payne