One of the striking omissions from NHS England’s Long Term Plan published last month was of course the lack of any workforce strategy as the number of unfilled vacant posts has risen above 100,000, and many key roles are finding it hard to recruit and retain the staff they need.
A major new report on staffing from the Health Foundation highlights some of the issues that NHS England and the government have to get to grips with if there is to be any serious effort to resolve a major and growing obstacle to maintaining viable services.
It notes a small scale overall (less than 2%) increase in staff numbers which is nowhere near enough to meet the needs for more nursing and professional staff. The highest rates of increase (rising by around 3%) were among ambulance staff, doctors in hospitals and community health services and allied health professionals.
There was less than a 1% increase in numbers of midwives and an even smaller (less than half a percent) increase in nurses and health visitors, although this masks an actual reduction in numbers of health visitors. Mental health nurse numbers have risen by less than 0.5% despite the government’s 2017 promises to recruit an extra 21,000 mental health staff.
Numbers of GPs have also fallen, again despite promises in the GP Forward View back in 2016 to recruit an extra 5,000 GPs by 2021. GP Online has now reported that a major international recruitment drive that aimed to recruit 2,000 GPs has actually managed to produce just 34 GP recruits in three years – and the chances of improving on this have of course been systematically undermined by Brexit and the government’s high profile “hostile environment” policy on immigration.
The Health Foundation report highlights the lack of any coherent government approach to the recruitment of professional staff from overseas, and in particular the need to include allied health professionals to the “shortage occupation list” since many of them earn less that the minimum £30,000 salary floor required to gain entry to the UK.
With a shortage of almost 41,000 nurses (almost 12% of the nursing workforce) crisis level staffing has become the norm across the NHS, according to a worrying new UNISON survey of over 16,000 staff. The snapshot was based on just one working day – Tuesday September 18 – before any winter pressures added to problems.
Almost two thirds (59%) of 2,345 staff responding who worked in acute inpatient services reported that staffing levels were insufficient. Almost half (45%) of mental health staff, 41% of primary care staff and more than a third (36%) of community health staff raised the same concerns.
Almost half of all the staff responding said that services relied on bank staff to fill nursing roles and work as healthcare assistants, admin and clerical and other jobs.
Almost one in six (15%) felt that patient safety was compromised by staff shortages on the day of the survey. 38% reported working longer than their scheduled hours, many of them unpaid, on the day of the survey.
Other responses help point to reasons for the problems recruiting and retaining vital staff. One in six (16%) of the staff in all posts reporting being subjected to violence, aggression or verbal abuse on the day of the survey, and more than a quarter (26%) reported high levels of stress.
UNISON is calling for legislation to ensure mandatory safe staffing levels in England and Northern Ireland, following on similar measures that have been implemented in Wales and broadly similar proposals being passed through the Scottish parliament.
The Royal College of Nursing is also pressing for a legal enforcement of safe staffing levels.
The RCN has also highlighted the long-term damage that has been inflicted by the government’s short-sighted effort to save money by axing NHS bursaries for the training of nurses and other professional staff is now beginning to show through.
It has revealed that nursing degree applications are down by a massive 30% since 2016 – the last year students received the bursary payments. 2018 was the second year in a row in which numbers of applications fell.
The largest decline in numbers is the 41% reduction in applications from mature students (aged 25 and over), who have consistently been the most likely students to stay the course and take on front line nursing jobs. Across the UK almost a quarter (24%) of students starting a nursing degree dropped out or failed to qualify within the expected time. The mature students, returning to learning after some years of employment, are most likely to complete the course, but also the most likely to require bursaries to help support families and compensate for loss of earnings.
Problems recruiting sufficient staff to deliver social care services are likely to increase sharply with Brexit according to the Association of Directors of Adult Social Services (ADASS). One sixth of the 1.3 million workforce in social care come from overseas, comprised of an estimated 100,000 EU nationals and another 100,000-plus non British workers.
Between 2011 and 2016 the number of European nationals employed in social care is thought to have increased by 68%.
Nonetheless the sector has 100,000 unfilled posts, and in a letter to London’s Evening Standard the ADASS point out that the proposed £30,000 minimum salary level for migrant workers to be allowed in to Britain would effectively block entry to new recruits and leave nursing homes and domiciliary care companies struggling to keep services running.
The problem is of course worsened by the absurdly low levels of pay prevalent in social care services, most of which are privately run, with some nursing home chains by large scale corporations but many smaller homes and home care services run by cheapskate small companies.