One Day in January (2022)

I was sitting in a slightly uncomfortable high-backed chair watching what had been an extremely busy department tip over into a near chaotic one, and I couldn’t blame the nurses and clinicians in front of me for it. They were in an impossible position and no one was helping them.

 

It had been a struggle to get to the hospital that morning. I had spoken to my GP first thing in the morning and she advised me to attend hospital. She said that the aggravation of my asthma, which was stopping me from working and had left me barely able to climb the stairs, could no longer be managed at home and I needed to attend hospital. So at 9.30 that morning, I set off for hospital, arriving a little before 10.00. The short bus journey had left me very breathless and I had to use my reliever inhaler just to walk through the entrance. 

 

The triage nurse, after a quick assessment and a lot of coughing from me, called a doctor. The doctor wasn’t happy with the wheeze in my breathing and both of them agreed I needed admitting to the emergency department. But there was a problem; the emergency department was already full, at 10.30 on a weekday morning. The triage nurse said I could be a “chair patient”, did I mind?

 

I wanted to say, “I don’t mind, I just want my breathing to get better.” My asthma had other ideas and all I could say was, “I don’t … mind…” my coughing taking away the other words.

 

A “chair patient” was exactly that. Instead of sitting on a trolley I was sat on a chair, one of the high-backed, red vinyl-covered chairs that populate the hospital wards and NHS waiting rooms where I was treated. They had taken two beds out of a double side room and replaced them with six chairs. There the less critically ill patients, who still needed medical treatment, could sit and be treated. When I arrived, there were five patients being treated there; when I left, there were eleven.

 

In charge of this chair area was one nurse, he was being supported by a woman I took to be a healthcare assistant, an auxiliary nurse, but later I found out she was a ward housekeeper. She was doing her best, but above basic paperwork and putting ID bracelets on patients, there were not many clinical activities she could do, she couldn’t even check patients’ temperatures and blood pressure. Therefore, all the clinical work there fell onto one nurse. 

 

I was clinically unwell, but in that situation I should have been the most unwell person in that chair area, but I wasn’t. The emergency department was already full and yet more ambulances and more patients were arriving, ill patients needing treatment. People who were more ill than I was were sitting in that chair area—a woman with chest pains, a man with a suspected deep vein thrombosis, a woman needing admitting to hospital whenever a bed became available. The nurse there was rushing around with so many things to do.

 

At lunchtime, when a senior manager visited the chair area, I learnt that the emergency department was down six nurses due to illness (COVID-19) and the failure of the nursing agencies to provide extra staff. The nurse in the chair area asked the senior nurse for some help; there were already eight patients in there and another one was on the way. The senior nurse told him there were no extra nurses available. When he complained about the severe workload he was under, she replied, “You’ll just have to cope.”

 

I had been in his situation before, when I worked on hospital wards, and I had to bite my tongue when I heard her reply. I’d been told the same thing many times in the past and I knew how frustrating and unsupportive it was. A senior nurse telling me to cope, even when I was raising concerns to them.

 

I watched that nurse and the housekeeper with him trying to cope as the workload carried on increasing, but then, by mid-afternoon, I saw the worst thing happen. The nurse was so busy and so overworked that he stopped prioritising the work and clinical need and just started to deal with each task as it came along. An important task, such as monitoring a patient’s vital signs or giving them medication, would be pushed back in favour of a lesser task, like a doctor not being able to find something on the department’s computer system. 

 

I didn’t blame that nurse for what he was doing, he was so stressed and overworked that he could only deal with each task as it was thrown at him. I have been in the same situation as he was in. I know how stressful and overwhelming it is, the workload becomes too much and you can only survive by going from one task to another; you’re too stressed to step back and prioritise because in the time it takes to do that more tasks are thrown at you.

 

Unfortunately, this is when things get forgotten and clinical errors happen.

 

I do blame that senior nurse for not seeing what was happening, especially when the concern was raised to her, and not doing anything to help manage the incredibly high workload those nurses were under. She didn’t even offer to escalate the situation. It is senior management’s responsibility to manage situations like this, but there is so much pressure on hospital to “cope” and treat all the patients that are brought to them. However, there is a physical limit to how many patients can be treated.

 

In March 2022, 1 in 22 patients waited over 12 hours in an A&E department before they were admitted to hospital (1). That’s 33 times higher than March 2021 and 68 times higher than March 2019 (1). In February 2022, 7,200 patients waited over 60 minutes in an ambulance before they could be handed over to an emergency department; that’s 8.5% of all ambulance handovers that month. In January 2022, over 15,000 patients waited in ambulances for over 120 minutes, four times higher than in January 2021 (2). The NHS standard for this says that handovers from ambulance to emergency department should only take 15 minutes and shouldn’t exceed 30 minutes (3). 

 

In the three months leading up to January 2022, an average of 42,000 people visited A&E departments in England; this is 15% higher than it was in the same period in 2012. Of these patients, 37.7% waited longer than four hours to be seen in January 2022, which is an increase of 28.9% in January 2020 and an increase of 8.7% compared to January 2015 (4).

 

The data shows that A&E departments are under pressure, but why are patients waiting so long? The NHS simply does not have enough staff to manage this increase in demand.

 

The first week of January (2022) saw a 13% increase of staff off work, from 71,000 to 80,000; 44% of them had COVID-19 (5). But this only added to a large pre-existing shortage of NHS staff. The NHS has an uncomfortably high level of vacancies. 10.3% of NHS nursing posts, 5.8% doctors’ posts and 8.3% of all NHS posts are empty (6). This is a chronic situation and we have seen no change since 2018. 

 

We are also seeing a high degree of stress and burnout amongst the staff working for the NHS. In a recent survey, 57% of nursing staff said they were thinking of or actively planning to leave the NHS (7). Another survey found that a third of GPs are considering leaving their roles (8).

 

We are looking at a perfect storm, increasing demand on the NHS, continuing high vacancy rates within the NHS and higher numbers of staff considering leaving the NHS. But we know that poor staffing levels have a direct effect on patient care. A simple survey found that 53% of nurses surveyed found their recent shift unsafe because of lack of nurses on duty and 67% admitted that they observed basic nursing care, such as personal care and pressure area care, was missed as a trade-off due to lack of staff and pressure of workload (9). But poor staffing levels can have a severe effect on patient care.

The Shrewsbury and Telford Hospital maternity scandal saw over 300 babies die or be left brain-damaged between 2000 and 2019 (10). In her report, Donna Ockenden, an expert midwife who led the enquiry into this, found that one of the causes of this scandal was poor staffing levels (11). She called for national minimum staffing levels; these should reflect local demands and include allowances for sickness, training and annual leave, and if they were not achieved on a day-to-day basis it should be escalated to the service’s senior management, the service’s medical leads, the chief nurse, the medical director, and patient safety champion (11). She recommended this for maternity services but her recommendations should be rolled out right across the NHS; however, I doubt they will even be implemented nationally for maternity services.

“The true barrier to tackling this crisis is political unwillingness. The current situation is breaking the workforce and breaking our hearts,” said Dr Katherine Henderson, the president of the Royal College of Emergency Medicine (12).

The government wants to reduce the “COVID backlog” because the NHS was dedicated to the COVID-19 pandemic, but their plan does not address the problem at the heart of the NHS. In an oral statement to parliament, Sajid Javid, Health and Social Care Secretary, said there will be £2 billion of funding for new IT, £6 billion towards capital investment and £9 million for extra tests and procedures by 2025 (13). He did not announce one penny for workforce planning and recruitment. He promised a 30% increase in community diagnostic centres within the next three years (13). He also said, “No one will wait longer than two years [for treatment] by July this year,” and he also added, “Our aim is that we will get back to 95% [for patients receiving diagnostic tests] by March 2025.” Yet without any investment in staff, and trained clinical staff, will he be able to achieve any of this?

Pat Cullen, RCN General Secretary and Chief Executive, said, “Ministers say supporting the NHS to clear the COVID-19 backlog in England is one of their key priorities—but without the workforce to do it these are hollow words.” (14) And she is so right.

But Sajid Javid summed up the government’s lack of concern or priority over NHS staffing when he falsely claimed, “We now have more doctors and nurses working in the NHS than ever before.” (13) How can he claim this when there are 10.3% of nursing posts and 5.8% of doctors’ posts empty in the NHS (6)? The Nursing and Midwifery Council (NMC), the body that registers nurses and midwifes, reported that between 1^st April and 30^th September 2021, the number of registered nurses on their register only increased by 1.7% (15). How will this address the huge shortage of nurses in the NHS?

This government seems unconcerned about and unwilling to address this shortage of NHS staff. In April, the government rejected legislation that would have required them to publish an independent assessment of the health and social care workforce every two years. This was voted down by Conservative MPs (16). This amendment would not have required the government to do anything more than just assess the state of the workforce every two years; there wasn’t even a requirement to address any shortfall in staffing, just to look for it, but even this small step seems to be beneath this government. How committed are they to addressing the huge holes in NHS staffing when they won’t even look to see how big the holes are?

But how committed is this government to the NHS? When conservative MP Michael Fabricant falsely claimed nurses had drinks parties after work during the COVID lockdowns (17), no one in the government condemned him or even contradicted his claims. He later apologised for his appalling comments (18) but he has not received any censure from the Conversative party and no one in the government even criticised him for making the comments. If he’d made the same comments about police officers or army generals, would members of the government have remained so silent?

I wasn’t admitted into hospital that day in January, I finally left the emergency department at eight o’clock at night. The doctor had wanted to admit me, she wanted me observed and to receive regular nebulisers, but I could see that there were far more clinically unwell people there, people who needed to be admitted to hospital far more than I did. I managed to make a deal with the doctor. I am a nurse and so is my husband, he could keep a watch on me and bring me back if I deteriorated. If she prescribed me nebulisers then I would take them at home with the nebuliser I had there (the last part was slightly untrue, but by the next morning I had one, thank you Amazon next-day-delivery). I was able to return home, where I always feel happier.

There was no clinical incident in that chair area that day. No patient was harmed because of a missed intervention or observation, but it so easily could have been with the impossibly high workload that nurse was put under. And if there had been an incident then they would have blamed that nurse and only him. They wouldn’t have blamed the senior manager who offered no help. They wouldn’t have blamed the Trust’s chief executive for not raising concerns over the unsafe staffing levels and closed the emergency department to admissions to allow the staff to safely care for the high number of patients already there. They wouldn’t have blamed the chief executive of NHS England for not having a strategy to manage the chronic under-staffing in the NHS. They certainly wouldn’t have blamed the health and social care secretary and the prime minister for allowing the NHS to be so chronically under-staffed for so long and having done nothing to address it.

I know who I blame, and it will never be that overworked nurse.

 

Drew Payne

The Healthcare Professional Will See You in Four Hours Plus

Two years ago I had pneumonia. After three weeks of antibiotics and resting at home my symptoms had not improved. I staggered to see my GP, that Friday morning, and he advised me that I needed to be treated in hospital, there was no more he could do for me and I wasn’t getting any better. Reluctantly I agreed with him and my husband took me to your local A&E. We arrived at 12.00 noon, at 1 o’clock in the morning I received my first dose of antibiotics.

At the time I was so angry and demoralised to be treated like this, as if they didn’t really believe I was that ill, but later I came to realise what had happened, after talking to other people and checking some facts. The whole hospital, not just the A&E Department, were short staffed and having to cope with a large increase in demand. Is it any wonder that the system cracked?

On Monday 28th January, the Government took a step that will make my experience happen more often and to more patients, they announced that they will scrap the four-hour waiting target for A&E treatment (1). The Chief Executive of NHS England, Simon Stevens, announced it the Health and Social Care Committee meeting, on the 28th (2). Matt Hancock, Secretary of State for Health and Social Care, was also giving evidence to the committee at the same time. Simon Stevens said the four-hour target would be significantly altered, political language for scrapped (1).

This has certainly come as a surprise to everyone working in the NHS because no one had been consulting on this, neither the Royal College of Nursing (RCN) or the Royal College of Emergency Medicine (RCEM) were consulted about this (3), the Government just dropped it on us. This isn’t a new idea from this Government, in January 2018 Jeremy Hunted had hinted at this, in the face of the winter pressures on the NHS (4). It seems that the Government is using Brexit, and all the chaos we are facing because of it, to push through something they have been wanting to do for a while.

The four-hour A&E target has been a thorn in the side of this Government for so long. The target is that 95% of patients are treated within four hours in A&E, but in December only 86.4% of patients were treated within this target, and since July 2015 the target has not been met once (3). This has been a constant indicator of how poorly this Government is resourcing and managing the NHS.

The four-hour target was not reached by plucking a number out of the air, but is evidence based (5). It was introduced in 2004, following extensive consultation by the then Labour Government, as a response to overcrowded A&E Departments were patients were faced with long waits for treatment (5). Yet now, when we are again being faced with overcrowded A&E Departments and patients facing long waits, this Government plans to scrap the four-hour A&E target. What is the logic in this?

Targets, when evidence based, have proved very useful in measuring healthcare outcomes and help improve the quality of care. The RCEM, in a report supporting the four-hour target, have found extensive worldwide evidence that time-based targets help improve performance and were associated with reductions in morality (5). This target has also proved useful in highlighting places that are under pressure and strain, but now what it is doing is repeatedly showing how much strain the whole NHS is under, month after month, and embarrassing the Government, month after month.

A&E Departments are under stress for a lot of reasons, not just an increase in demand, but since 2011 there has been 8.8% raise in people attending A&E, this is 23.4million more A&E attendances, or 5,100 more patients a day (6). These increases in demand have not been matched with an increase in resources, which have stagnated since 2010, but there are also other factors putting huge strain on A&E Departments, such as:

- Staff shortages. 10.9% of nursing posts (7) and 7% of doctors’ posts (8) in the NHS are currently empty. These figures are for across the NHS, but this does mean there are far less nurses and doctors available to work A&E Departments. Shortage of staff has been directly linked to poor care. 45% of NHS staff, involved in patient care, have reported that they are too short staffed to deliver safe, dignified and compassionate care (9), and A&E Departments are not immune to this.

- Loss of hospital beds. In the last 30 years the NHS has lost half of its in-patient beds, right across the broad, including medical, surgical, maternity and mental health beds (10). Since 2016/2017, hospital bed occupancy has been running above 90% and regularly exceeds 95% during the winter months (10), which is far higher than the recommended safe limit of 85% (11). The less hospital beds available, the less availability there is to admit new patients, the harder it is to admit patients from A&E, therefore the longer patients have to wait in A&E to be admitted and the four hour target is routinely broken.

- Underfunding of social care. Since 2010 social care budgets have been cut by £7bn and between 2018-2019 they will be cut by a further £700 million, 5% of the whole budget (12). This directly affects patient’s ability to be discharged, because there is less money for home carers, less money for care home funding, less money to adapt patients’ homes and therefore less support for patients living in the community. When there isn’t the social care support then those patients cannot be discharged, becoming delayed transfer of care (DToC) patients, and DToC’s caused by social care problems have increased 130% since 2014 (13). And if hospital beds are being occupied by DToC patients, how can new patients be admitted from A&E?

- Not being able to get a GP appointment. Currently we are short of 15% of the GPs we need, 6,000 GPs (14), and there is a huge difference in the availability of GPs across the country (14). In some areas there is three times the number of patients for each GP (14), making getting a GP appointment far more difficult. The BBC found that only 40% of patients could get a same day appointment (15), 60% were not, while 27% of patients were able to get an appointment within that week. Not all of those who cannot get a same-day appointment will have urgent health needs, but many will, and where can they go when they cannot get a GP appointment? 40% of NHS Walk-In Centres have closed since 2010 (16).

There are a lot of factors that have caused the increase in A&E waiting times and there isn’t one, easy fix to it. Like so much else in healthcare, there are a lot of interconnected factors.

Different NHS Trusts and Social Care Providers around the country are introducing strategies and services to try and reduce A&E attendance. Doncaster has set up a multidisciplinary rapid response team to treat patients in their own homes (17); in Dorset an advanced nurse practitioner acts as a “gatekeeper” to A&E, redirect non-urgent A&E patients to other services where they can be seen (18); at the Chesterfield Royal Hospital nurses have been placed in charge of assessing patients at the children and young people’s assessment unit, therefore streamlining the service and reducing unnecessary admissions (19). But these are only local changes, none of them are national strategies, and it could be even argued that they are only tinkering around the edges. None of them are trying to tackle the reasons behind the increase in A&E demand.

What we need are national strategies to tackle this problem. We need more community services that people can access near to their home when they have an urgent care need (An infection, a wound, a sprain, etc…), which are not just open Monday to Friday, nine-to-five. We need services that enable people to stay in their homes when they are ill or have a long-term health condition, not just social care but much more healthcare being delivered in or near to patients’ homes. I am a Community Nurse, and many of my housebound patients still struggle to get to and from hospital outpatient appointments because there is no alternative. We need to move to a more community-based healthcare system. When I was a student nurse (nearly thirty years ago now) there was a lot of talk about moving us to a community-based healthcare system, and since then that is all there has been, talk. There are some local-based initiatives, but that has been no national policy or political will to achieve this.

In their new NHS Long Term Plan, the Government has promised, by 2023, an extra £20bn in NHS funding, but only £6.9bn will be spent in the community (17). How the are we expected to develop all these new services to reduce hospital admissions with only 34% of the funding? I would say this is a joke but it isn’t funny.

A&E Departments are not coping with the rise demand for their services, which is caused by a lot of factors, and yet this Government’s sole response has been the scrap the A&E treatment target, and therefore remove the one thing that has highlighted the problems in A&E Departments. Do they think that by hiding the problem it will somehow go away? Because this seems all they have done about it.

Managing Brexit is not the only thing this Government seems incapable of doing.

Drew Payne

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