NHS IN CRISIS: Health service must not rely on '˜nursing on the cheap'

The NHS must not be forced to rely on '˜nursing on the cheap' as vacancies of fully-qualified staff mount and trainees on cheaper and quicker courses are brought in, the Royal College of Nursing has warned.

The number of people applying to be nurses has fallen by 23 per cent this year after the Government controversially axed a bursary scheme to support students through education in a bid to save £800m, while new figures have revealed a 90 per cent reduction in the number of EU nationals applying to work as nurses in British hospitals following the Brexit vote.

Just 101 nurses and midwives from other European nations joined the register to work here in December - a drop from 1,304 in July, the month immediately after the EU referendum.

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RCN figures show there are already 24,000 unfilled nursing vacancies across the country.

Tom Sandford, director of the Royal College of Nursing in England, says he is concerned that the shortfalls will lead to a greater reliance on new ‘nursing associates’ being brought into the NHS in support roles for fully-qualified nurses.

The Department of Health is introducing 1,000 trainee nursing associates this year at 11 test sites, with a further 1,000 to follow later this year.

The RCN has warned the new staff ‘must not be used as substitutes for registered nurses’ and are monitoring their use at the test sites in places including London, Leeds and Manchester.

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Mr Sandford said: “We are very worried they are going to be a nursing workforce on the cheap. We want to understand more about the training.

“It is endemic in the public sector.

“It is not just in nursing, in almost every area of public service they are looking for substitution cheaper labour.”

Mr Sandford said the RCN are now pushing for more details from health bosses on the intended use of nursing associates in the next few years as the NHS looks to plug a £22bn funding gap through the development of Sustainability and Transformation Plans (STPs).

Despite the concerns, NHS England say they are ‘confident’ they will be more NHS nurses in future.

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A spokesman for NHS England said: “Reviewing all STP returns shows that the number of qualified nurses in hospitals, community services and primary care will in fact go up by 2020/21.

“It is wrong to expect they would reduce, and we are confident that a growing NHS will see more qualified nurses employed across England.”

But Mr Sandford said he is concerned whether the STP plans will be achievable without enough nurses and is calling on the Government to reinstate the bursary programme, as well as reassuring EU workers they are welcome to keep working in Britain.

“We need to know we have got enough nurses. In nursing we have a very significant problem.

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“Applications are down 23 per cent for nursing training. We believe that is entirely down to the removal of bursaries.”

Mr Sandford said the lack of detail in many STPs, combined with the way they have been drawn up ‘has given the appearance of secrecy and a lack of transparency and openness’.

He added the Brexit process is also contributing to the uncertainty.

“We are massively down on EU nurses at the moment, There are just under 60,000 staff with an EU nationality working in the NHS at the moment, 22,000 or 23,000 are nurses. In some emergency departments, you will find an almost completely Portuguese workforce.

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“But in December only 101 nurses applied to be registered in Britain.

“EU staff have just turned off from coming here. I’m very, very concerned that the Government sends a positive message that despite Brexit you are going to continue to work here if you want to work here.

“There needs to be a very reassuring statement from the Government about the future eligibility of EU staff.

“Everybody working in the NHS is doing an amazing job at the minute. If you look at the demands on the service, staff are flat out keeping the service going as best they can.”

“I’m concerned about the workforce plans at the minute.

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“You can see nursing numbers falling off a cliff in relation to the EU and training.”

Mr Sandford said the RCN have been doing a huge amount of work trying to understand what the STPs will mean in practice.

He said the organisation welcomes the idea of planning for the future in principle, as well as the inclusion of local councils who are responsible for social care in the development of the proposals.

“The implications for local authorities are massive. The absence of social care is still the reason we have acute beds blocked in hospitals. Most local authorities have lost 40 per cent of their budgets in the last few years. We have a major problem in that area.”

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But is concerned whether the principles behind them of improving the health service while cutting costs can actually become a reality.

“I think things could be achievable but it needs a lot more political will than we have at the moment.

“A lot of the plans are about creating healthier communities and that is laudable. But we are seeing health visitor posts disappear, school nurse posts disappearing.

“How are you going to create healthier communities who get the best take on the health of our children are going?

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“The good bit is we are planning for five years time. That is really, really important to take a long-term view.

“But I can’t pretend I don’t have anxieties. Post-Brexit, how can anybody not have anxieties? We are putting our economy in a much more precarious position than it has been for several years.”

Guy Collis, health policy officer at Unison, has also raised concerns about the use of nursing associates and the use of non-clinical staff without training.

“If there are ways of expanding what they’re doing and taking on other roles, providing there was appropriate training, potentially depending on the way it was done, there might be something positive to be said.

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“Our concern is that with some of those it’s going to be care on the cheap.

“We’ve seen this in particular with nursing staff, there’s suggestions they will be trying to use nursing associates.

“If they’re being used in place of registered nurses there’s a concern there it’s being driven by cost cutting, rather than any desire to improve the quality of services.”

Mr Collis said staffing in the NHS was close to crisis.

“We’ve already got, if not a staffing crisis, then certainly a shortage in a number of areas,’ he said.

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“It’s discouraging students form taking on not just nursing but others because of the extra money they’re expected to be paying out.

“There’s still massive uncertainty from Brexit, there’s still the uncertainty from the right to remain for healthcare workers here already, let alone the migration the NHS depends on.”

He added: “There’s a big clampdown in the last couple of years trying to cut back on agency costs.

“There’s nothing wrong with that but we can’t blame hospitals for trying to fill gaps.

“The answer is proper staffing levels so they don’t they need to.”