Figures from the NHS’ health and social care information centre indicate that the number of specialist mental health nurses in the UK has plummeted by more than 10% in just five years.
This recession of mental health staff is particularly serious considering the fact that it has occurred mainly in hospitals and mental health units treating some of the sickest patients.
And this fact has been confirmed by official NHS data.
The number of qualified nurses working in psychiatry slid from 41,320 in 2010 to 36,870 in 2015.
Luciana Berger, Labour’s shadow minister for mental health, expressed concern about the figures and the treatment of mental health in the NHS.
“These shocking figures raise serious concerns about the future of our mental health services. At a time when there is growing demand and staff are being asked to do more for less, cuts to the number of nurses working in mental health are completely unacceptable.”
And diminishing number of qualified mental health employees comes at the worst possible time.
Official figures indicate that the number of people in contact with NHS mental health services increased by more than 40% over the same period.
It seems certain that the economic climate in the UK is massively contributing to this, and thus critics of the Conservative government are provided with a double-pronged weapon to attack it.
At a time when the funding of the NHS is clearly a major issue, there must now be a question mark over the ability of the NHS to meet mental health demands in both the present and future.
Needless to say, the Royal College of Nursing expressed extreme concern about the situation.
“There are serious questions about how mental health services can be delivered when the number of mental health nurses is still declining,” said Howard Catton, head of policy at the Royal College of Nursing. “These nurses are the quiet heroes of mental health services, helping people in crisis and keeping people as well as possible.”
It is not only in mental health where staffing issues are apparent. Recent data has indicated that doctors are rapidly dropping out of the NHS, while shortages of nurses have also been reported in recent weeks.
The arguments over junior doctors’ contracts and nurses’ bursaries are expected to create further fallout as well.
Nurses’ bursaries are being abolished as part of the Department of Health’s (DH) plan to boost NHS England’s budget by £8bn by 2020-21.
Increasingly, it looks as if the government will have to rethink many of its existing policies, or face the consequences.
New regulations will ensure that Eurozone nurses and midwives travelling to Britain will need to prove that they are fluent in the English language.
Previously such checks have only been applicable to nurses from countries outside of the European Union.
This new initiative means that any nurses who are unable to show that they possess sufficient language skills will need to have an English language assessment.
The decision has been made by the Nursing and Midwifery Council, and is intended to ensure that the nursing profession runs parallel with that of doctors.
Although language problems can frequently be a difficulty in the NHS, the issue related to doctors was particularly highlighted by a lethal mistake made in 2008.
At that time, Dr Daniel Ubani, a German doctor carrying out an out-of-hours shift, gave a lethal dose of a painkiller to patient David Gray.
Because Ubani was a German citizen, he was able to register as a doctor and practice medicine in the UK without passing a formal language test at that time.
Commenting on the new regulations, Nursing and Midwifery Council Chief Executive Jackie Smith was adamant that the decision made to protect the nursing profession was a sound one.
“From now on all nurses and midwives applying to join the register from outside the UK, including the EU, will have to demonstrate they can communicate effectively to a high standard of English. The ability to communicate effectively with patients is fundamental to patient safety and a principle that is central to our code.”
The council has announced that the new test will assess listening, reading, writing and speaking fluency, in order to ensure that every practising nurse and midwife possesses a full palette of language skills.
And if an allegation is made that a nurse or midwife already working in the UK does not possess the necessary English language skills, they could be investigated under fitness to practise rules.
To put this issue into perspective, the Nursing and Midwifery Council Currently has in the region of 700,000 registered nurses and midwives on its books.
With the Department of Health having noted that there is a shortage of nurses available in the NHS, it is expected that the health service will increasingly have to recruit from abroad.
It must also be said that this issue is being heightened and exacerbated by the government’s recent decision to scrap bursaries for nurses.
The financial reality for many young persons wishing to enter the nursing and midwifery professions is that the financial sums may no longer add up.
Katherine Murphy of The Patients Association also welcomed the move.
“Nurses from other countries make an extremely important contribution to healthcare in the UK. However, we hear from patients on our National Helpline that there can be real issues with some overseas health professionals; including problems with communication and a lack of understanding of processes and procedures. The Patients Association calls on all Trusts to ensure that their staff meet these new requirements, and that all overseas nurses have the necessary support and training to be able to offer patients safe and effective care.”
The Royal College of Nursing has published data which suggests that thousands of nurses were denied permission to work in England during 2015.
This is despite the fact that hospitals across the country face staff shortages.
In particular, important hospitals in Cambridge, Newcastle and Manchester were central to this process.
A Freedom of Information request to the Migration Advisory Committee found that there were in the region of 2,350 refusals in total.
In response, the government indicated that the committee is currently reviewing its refusal policy.
This will be a particularly embarrassing situation for both the government and the Department of Health, as the argument regarding nurses’ Bursaries remains in stasis.
Analysts and experts have suggested that the government policy makes little sense in this area, with recruitment from overseas increasingly required in order to account for a lack of native nurses.
Yet blocks are apparently being placed on recruiting overseas nurses, according to several people resident within the existing NHS system.
The Royal College of Nurses investigated that the number of applications to allow overseas nurses to work in England between April and November 25, and found that some NHS trusts had refused 100 per cent of applications.
Janet Davies, chief executive of the RCN, suggested that the issue was indicative of a general neglect towards nursing.
“These figures show that when nursing is not on the list, many trusts are unable to recruit enough nurses, which could have an impact on patient care.”
While Catherine Morgan, director of nursing at The Queen Elizabeth Hospital in King’s Lynn, confirmed that she had been scuppered in her desire to recruit more nurses for the organisation from overseas.
“It is frustrating because we are running a hospital and do want it to be safe, and we had the opportunity to recruit from India and the Philippines and we had nurses keen to come over but haven’t been able to bring them over.”
The Department of Health was adamant in a statement that the situation is being addressed appropriately.
“The Migration Advisory Committee is currently reviewing the shortage occupation list. Staffing is a priority and there are already more than 8,500 more nurses on our wards since 2010 and 50,000 more nurses in training. We want more home-grown staff in the NHS and our recent changes to student funding will create up to 10,000 more nursing, midwifery and allied health professional training places by 2020.”
But those who were acquainted with the nursing situation in the NHS will increasingly suggest that staffing levels are being neglected.
Considering the huge amount of pressure that is placed on nurses working within the National Health Service, it is clear that recruitment, education, training and salary issues must be addressed in the immediate future and coming years.
Marches of midwives and nurses have taken place in London today as NHS workers oppose plans to scrap the bursary for students.
The decision was announced during the spending review in November.
As a result of the decision announced by George Osborne, bursaries for nursing students and other healthcare undergraduate professions will be replaced with loans.
It is a generally considered that this will lead to financial hardship for many students entering the nursing profession.
Additionally, there is already evidence that the NHS is hugely reliant on migrant labour in this area, so it can ultimately be viewed as essentially false economy.
The march started at midday on Saturday from St Thomas’s hospital at Westminster Bridge and finished at Downing Street, where a rally took place with a series of guest speakers.
With broad support across the NHS for the marches, members of both the Royal College of Nursing (RCN) and the Royal College of Midwives (RCM) joined forces.
Commenting on the issue, the RCN chief executive and general secretary, Janet Davies, stated: “RCN students have today shown just how worried they are about this move and its potential effects. Student nurses and midwives are the profession’s future and their voices and concerns must, and should, be listened to.”
Davies also pointed out that the RCN has a rich history of supporting education in what is a critical area of the National Health Service.
“Over our 100-year history, the RCN has a long track record in the education of nurses and the government should listen to our knowledge and expertise as it consults on these ill thought out plans. The future of nursing must be protected. Our patients deserve nothing less.”
The RCM’s head of education and learning, Carmel Lloyd, was united with Davies in her view of the issue.
“These government plans are appalling and will undoubtedly deter many committed and talented people from considering a career in midwifery. The RCM is extremely disappointed that the government did not seek advice or consult with us prior to making this decision.”
Lloyd pulled no punches regarding the seriousness of the financial decisions that have been taken by the Chancellor of the Exchequer.
“This is a change that has huge implications for both our student midwife members and an already understaffed maternity service. Currently, we have a diverse body of students who come from all walks of life. Many are mature, not school leavers, who already have substantial caring and financial commitments. They will be particularly hit hard.”
The public feelings supporting the position of nurses and midwives is underlined by the fact that an online petition calling for the government to retain the bursary has received 150,000 signatories.
Parliament is thus forced to debate the petition on 11th January.
Trainee nurses and midwives are planning a major campaign against government plans to make them pay for their own training with student loans.
The industrial action comes in the context of learning that their earnings will be cut by nearly £1,000 annually.
Chancellor of the Exchequer George Osborne has announced this measure in the Autumn Statement, and after consultation with union representatives, trainee nurses are ready to take action.
Osborne had announced that NHS bursaries, which are paid to student nurses to cover their living costs while studying, will be converted into formal student loans that will have to be repaid, depending on future earnings.
This will make it extremely difficult for people of modest means to enter the nursing profession.
And it contributes to an overall impression that studying at university is becoming prohibitively expensive, as well as something that incurs a huge amount of debt for most students.
Under the controversial reform, nurses will also have to pay £9,000-a-year student tuition fees for the first time.
This means that student nurses are expected to begin their careers in the NHS at least £50,000 in debt, with an immediate demand from the student loans company to begin paying off this amount.
The current starting salary for a nurse is £21,692 – rising to £22,799 by 2020, Meaning that the level of debt will be effectively 250 per cent of the average starting salary.
With the government plans causing a lot of anger among students, it has now been indicated that nurses will indeed protest strongly against these plans.
This is just the latest problem that the Conservative government has experienced with regard to NHS contracts, after similar industrial action was proposed by junior doctors.
Having encountered difficulties with both junior doctors and nurses, there is the overwhelming impression that the Conservative government is out of touch with the requirements and opinions of NHS rank and file.
The organiser of the nurses’ campaign is Danielle Tiplady, 29, who is in the final year of her nursing degree at King’s College London.
Tiplady outlined the financial situation for many people entering the nursing profession.
“People who have had children have told me they cannot afford to become nurses now – they cannot face that much money going out of their wage. It’s daunting having that much debt as well. We really contribute to patient care. It doesn’t just affect students, it affects the whole country because if you don’t have nurses, then who is going to look after people?”
Considering the plans of the Conservative government to switch to a seven-day NHS culture, it is clear that there is a real rift between reality and expectation.
An email exchange between the chief executive of the health watchdog the National Institute of Health and Care Excellence (NICE) and the Health Secretary Jeremy Hunt has reportedly delayed reports on staff nursing levels in the NHS.
NICE had been ready to make this research public, but this process of revelation will now apparently been delayed.
The report is, in fact, already late, even before this latest intervention.
Experts at NICE had been due to publish their work on the safe levels of staffing in NHS A&E departments at the end of July this year.
But the decision to make their efforts public was reversed following an email exchange between Sir Andrew Dillon, NICE’s chief executive and the Health Secretary’s principal private secretary Kristen McLeod.
The precise content of this exchange has not been made public despite Freedom of Information requests, but it is known that the subject of this discussion was ensuring that the information related to the report should be held back until a later date.
The parliamentary Labour Party has already been critical of the Conservative party for intervening in Monitor reports, stating that the Government had prioritised its own party conference over critical information related to the NHS.
Work in this NHS England review had already been rolled into a wider report, but the country’s biggest nursing union raised concerns at the time that the move had been driven by “affordability”.
The reporting question is considered particularly important considering the current staffing levels in the existing health service.
Low staffing levels have been cited as an issue by inspectors at two-thirds of NHS hospitals.
Yet despite this apparently alarming picture, the NHS remains in the midst of a major cash crisis, with a £2 billion deficit in the hospital organisation projected by the end of the fiscal year.
The aforementioned Ms McLeod had emailed Sir Andrew stating: “I thought it would be helpful to confirm in writing our conversation. We agreed that it could be confusing for staff and the public if NICE were to release one piece of work on safe staffing now without any context and in isolation of any final guidance on safe staffing levels. However, we both agreed that this work should be put in the public domain as soon as is practically possible.”
Two minutes later Sir Andrew emailed senior members of staff at NICE confirming that the information would not be published as planned on 30th July.
At the time of writing, the Department of Health has declined to comment on the email exchange.
Hunt has stated that NICE will have the opportunity to review the final staffing guidance, currently being prepared by NHS England.
Labour’s Shadow Health Secretary, Heidi Alexander, was predictably critical of the government’s conduct, and suggested that the full correspondence should be released into the public domain.
“If there has been any attempt by ministers or the Department of Health to influence NICE against the publication of this work then that is extremely worrying. If Jeremy Hunt really believes in transparency, he should now order the release of all this correspondence in full so that people can judge for themselves whether any inappropriate pressure was put on NICE.”
A NICE spokesperson said: “We do not believe the emails show an inappropriate attempt to influence NICE and Andrew Dillon against publishing the safe staffing evidence. The Department of Health expressed its views and these were taken into consideration.”
NHS trusts in the south west of England face continuing uncertainty regarding their procurement of agency nurses.
With a deadline looming for the health service, regulators have still yet to approve plans for the region.
From 19th October, there will be a barring on the usage of agencies that are not approved as part of new framework agreements.
Trusts will still be able to obtain specific approval in order to circumnavigate this regulation, but this could be a litigious, bureaucratic and complex process.
As the deadline approaches, four frameworks have been approved within the English health service.
However, numerous agencies that operate in Cornwall, Devon, Somerset and Dorset are not part of these overarching national schemes.
Trusts based in the south west region continue to collaborate with Peninsula Purchasing and Supply Alliance in an attempt to hammer out an interim agreement.
It is hoped that this can be achieved by the end of the week
Peninsula Purchasing and Supply Alliance is a procurement body representing 14 providers in the Southwest region. These 14 providers in question are as follows:
Cornwall Partnership Foundation Trust
Devon Partnership Trust
Dorset County Hospital FT
Northern Devon Healthcare Trust
Peninsula Community Health
Plymouth Community Healthcare
Plymouth Hospitals Trust
Royal Cornwall Hospitals Trust
Royal Devon and Exeter FT
Somerset Partnership FT
Torbay and South Devon FT
Taunton and Somerset FT
Yeovil District Hospital FT
It is notable that Salisbury FT has stated that it has a contract with a different provider, whose framework for agency nursing has already been approved.
The healthcare regulator Monitor has already stated that it is working closely with the Peninsula Purchasing and Supply Alliance in order to resolve the issue.
In a short statement, Monitor confirmed that it would be possible for trusts wishing to use an unapproved framework agreement or off-framework arrangement to apply to either the regulator or the NHS Trust Development Authority for approval.
Whether this would turn out to be a convenient process for trusts based in the south west region is highly debatable.
It would be necessary for any such trust to demonstrate “how their arrangements provide superior quality and value for money over existing approved framework agreements” if they are to gain approval.
Commenting on the subject, Mark Gronow, director of procurement for the alliance, said its “agency relationship agreements” were set up last year due to “significant use of non-framework agencies within the South West”.
“Given the increased challenges concerning the use of agency staff in light of the agency rules, the PPSA are working with Monitor to ensure that the agreements receive their approval.
“In doing so, the need for individual trusts to apply for approval of arrangements that fall outside approved frameworks will be alleviated. “This is the first step in developing a collective South West agency solution which will secure improved quality, governance and financial savings for the NHS.”
Another new element of the rules involves individual ceilings were set among trusts for the proportion of nursing expenditure to be spent on temporary staffing agencies.
This came into force on 1st October.
Media reports today indicate that the system of checks related to nurses and midwives is about to be significantly changed.
The new plans have been instigated in the context of the so-called mid-Staffordshire scandal.
An estimated 400-1,200 patients died as a result of poor care over the 50 months between January 2005 and March 2009 at Stafford hospital.
As a result of the fallout from this case, nurses and midwives will now undergo checks every three years.
NHS watchdogs indicated that the reforms, which will be officially announced on Thursday 8th October, will constitute the biggest change in the history of the regulation of nurses.
The new regulations were considered essential in order to ensure that poor standards were not replicated on a wider scale in the NHS.
As a result of the new system of checks, nurses will be required to provide evidence demonstrating that they are both skilled and compassionate.
This can include feedback from patients, managers and fellow members of staff.
The new regulations are a first for the nursing profession, as it had previously been standard practice for workers in this sector to declare themselves fit for work without third-party evidence as support.
But recommendations from the public enquiry into the Staffordshire scandal have led to this new system of checks and balances.
The new system will be implemented by the Nursing and Midwifery Council, and will further require nurses to prove to regulators is that their professional skills are adequate, and that regular training has been undertaken in order to ensure complicity with contemporary practices.
Nearly 700,000 registered nurses and midwives in the UK will be subjected to the checks.
It has been pointed out with regard to the decision that it would generally not be expected for an individual to be present on a professional register for several decades without significant checks on their ability to conduct their duties.
Yet this was precisely the situation for nurses ahead of this new regulation and legislative measure.
In particular, nurses will be tested against the code of conduct of the Nursing and Midwifery Council.
And the hierarchy of the council has already placed a particular emphasis on the importance of patient feedback.
It is clear that this measure is intended to restore public confidence in the health service, and also to ensure that nurses and midwives engage more readily with the general public.
Sir Robert Francis QC called for the system of “revalidation” two and a half years ago, in his public inquiry into the scandal at Mid Staffordshire NHS Foundation trust.
And it seems that the radical overhaul recommended by Francis is now ready to be implemented.
The head of NHS England has thrown his hat into the immigration debate, encouraging the government to reconsider its policy toward nurses.
New proposals from the government will see lower paid nurses from outside the EU deported.
But Simon Stevens acknowledged the rather well-publicised fact that the nursing profession faces a shortage of qualified employees at present.
Naturally nursing is absolutely critical to the everyday functioning of the NHS, and leaving the health service short of nurses is tantamount to handcuffing it.
Stevens is merely the latest high profile source to offer a negative opinion of government policy.
The deportation approach has already been criticised by employers’ groups and the nurses’ union, both of which consider it to be a disastrous piece of legislation.
It is already projected by some experts that the policy could ultimately cost millions in recruitment, in addition to the staffing difficulties that it could create.
Both of these groups have already urged the Home Office to add nurses to the list of shortage occupations, effectively exempting them from the new legislation.
Additionally, it has been suggested that the £35,000 salary threshold is far too low, and that this should be reconsidered for the nursing profession.
Under existing rules, workers from outside the European Economic Area who are earning less than £35,000 after six years in the UK will be deported.
Most experts seemingly agree that this will lead to organisational difficulties, if not outright chaos.
Meanwhile, speaking at the Institute of Directors annual convention in London, the NHS England chief executive became the most prominent healthcare figure in the UK to offer a forthright opinion on the subject.
“Understandably we’re having a national discussion about how to get immigration right. My responsibility is to point out that, at time when the need for nurses is growing, when publicly funded UK nurse training places will take several years to expand, and when agency staff costs are driving hospital overspends right now, we need to better join up the dots on immigration policy and the NHS,” Stevens stated.
The Chief Executive also compared nursing to ballet dancing, calling into question the logic and rationality of the existing legislation.
“Most nurses I speak to struggle to understand why our immigration rules define ballet dancers as a shortage occupation but not nursing. However, most nurses I speak to struggle to understand why our immigration rules define ballet dancers as a shortage occupation but not nursing. And most hospitals tell me the idea that we would seriously consider deporting some of our most experienced and committed nurses solely because they’re not earning £35,000 clearly needs a rethink,” Stevens commented.
Stevens is just the latest individual to criticise the government policy.
The Royal College of Nursing has already estimated that in the region of 3,500 nurses could be affected by the legislation.
This could effectively cost the NHS over £20 million in recruitment alone, with the ultimate financial and organisational cost considerably higher.
And the union claims that the figure will rise to in the region of 30,000 nurses by the end of the decade, should workforce pressures lead to increased international recruitment.
This mammoth number would require in the region of £180 million to recruit replacements alone.
Student nurses and midwives could be forced to fund their own education under a scheme currently being considered by the government.
The new Treasury plans would see these critical NHS workers being forced to pay their tuition fees and living costs, if proposals currently being assessed by the government come to fruition.
This will be a particularly worrying precedent for many concerned about the state of the health service, considering the fact that there is already a shortage of nurses in the NHS.
Indeed, it is often argued that the health service is one of the biggest beneficiaries of migrant labour of any organisation in the United Kingdom.
This certainly applies to doctors, physicians and surgeons, but also to nursing staff as well.
Due to the relatively small numbers of qualified nurses among the UK population, hospitals have frequently resorted to paying up to £2,200 per shift for locum staff, with thousands more being recruited from abroad.
And many people applying to train as nurses in the UK are currently turned away, with three times as many applicants as funded places, figures indicate.
Nonetheless, the government is apparently pressing on with the assessment of plans to compel student nurses and midwives to pay tuition fees and living costs.
The Councils of Deans of Health and Universities UK have already submitted plans to the government’s spending review.
This critical document is due to be published next month, and seemingly seeks to axe the existing system of free education completely.
All bursaries will be scrapped completely, replaced by a loan system. Tuition fees would also be introduced, and these would have to be funded by student applicants.
Many people will be extremely critical of the government scheme, viewing it as merely another opportunity for the financial sector and private equity to gain a valuable source of revenue.
Considering the importance of nurses within the NHS, and the obvious gulf between the required number and existing qualified individuals, putting such a significant barrier in the way of qualification will surely exacerbate the problem.
Critics will suggest that this scheme rather grates with the rhetoric that has issued forth from the government in recent weeks and months about the importance of the NHS in general.
Already nursing and midwifery unions have spoken out about the proposed changes.
The complaints of the largest nursing unions in the country indeed seem rather plausible, and are focused on the suggestion that many potential entrants will be deterred, particularly those from financially disadvantaged backgrounds.
With nursing already attracting a relatively meagre starting salary, the prospect of large debts will doubtless be viewed as a millstone by many potential applicants.
Tom Sandford, director of nursing at the Royal College of Nursing raised concerns that such changes could put potential nurses off entering training completely.
“Financial hardship is the top reason nursing students drop out, and the full time demands of the course make it very difficult for nursing students to earn extra money while they are training,” Sandford said.
Meanwhile, the Royal College of Midwives claimed that the plans risked worsening a shortage of 2,600 midwives.
NHS Employers has expressed concern about recruitment policies in the NHS related to the European Union.
According to figures provided by NHS Employers, around 1000 nurses from outside of the European Union have been rejected to date by the Home Office due to immigration rules.
The organisation was keen to emphasise that legislation is compromising patient safety, with a shortage of nurses potentially crippling the NHS.
It is believed that the reluctance to recruit NHS nurses will be particularly damaging to the NHS in winter, as demand for care increases.
Although there are plans afoot to train more nurses within the UK, this policy may not reap any serious reward until 2017.
Commissioning and delivering internal training within the NHS takes in the region of four years, so there will naturally be a delay with the arrival of the next raft of Britain-based nurses.
In the intervening period, NHS Employers believes that the NHS must prioritise delivering sufficient staffing in order to ensure quality patient care.
With NHS Employers concerned about the extent to which migrant doctors are being valued, the organisation has taken the initiative to take direct action.
NHS Employers has written a letter to the Home Secretary Theresa May to outline concerns that the organisation has regarding recruitment policies.
The letter is signed and supported by many trusts across England and co-signatories include Sir Robert Naylor (UCLH), Sir Len Fenwick (Newcastle) and Sir Andrew Cash (Sheffield).
Speaking about the issue, Danny Mortimer, Chief Executive of NHS Employers, expressed his concern.
“Hospitals strive constantly to deliver the same high standard of care to patients amid rising demands. Even with Government commitment to additional training places for nurses and a focus on retention, we need to employ staff from outside the EU to meet current demand for staff.”
Mortimer also outlined some of the problems that the NHS faces in this area.
“Due to the high demand for immigration certificates in June and July, for example, all of the applications for nurses were rejected. Whilst there was some improvement in August, with 200 certificates being issued there remains significant numbers of outstanding applications for entry to the UK to take up nursing posts in our hospitals.”
The Chief Executive concluded by outlying his belief in migrant nurses.
“Non-EU nurses are invaluable to the NHS. Whilst we are experiencing a mismatch between supply and demand we are asking that this is recognised and that nursing be placed on the shortage occupation list for the next two years.”
The issues related to recruitment could be regarded as particularly serious considering the plans of Prime Minister David Cameron to create a seven-day culture in the NHS.
This scheme of the Conservative government will no doubtless be examined closely by the Labour Opposition after the election of Jeremy Corbyn.