Nursing on red alert
The Royal College of Nursing (RCN) has been examining the impact of financial pressures on the NHS since 2010 through our Frontline First campaign. This is our first report following the publication of Robert Francis QC’s findings into the scandal at Stafford Hospital (Francis, 2013). His report found that care failings – and even hundreds of excess deaths – were partly caused by cuts to nursing staff and a dilution of skill mix. Although there were many warning signs that something was wrong, noone put together the pieces of the jigsaw to see the whole picture until it was too late.
We believe that there are now red lights flashing across the UK, warning that we are heading for a nursing shortage that could have serious implications for health services and patients. Over the last few years we have seen cuts to student nursing places and nursing posts. Our members consistently tell us about the increased pressure they are under, as they see more patients with greater needs, while at the same time have fewer staff to look after them.
In 2011, the RCN commissioned research to model the future size of the workforce in England, looking at the impact of changes to ‘inputs’ and ‘outputs’ (Buchan and Seccombe, 2011). The two worst-case scenarios showed what would happen if student places decreased and more people left the workforce or retired. Under these conditions, the study showed a decrease of between 23% and 28% of the qualified nursing workforce over a ten-year period – a loss of between 81,000 and 99,000. While this is academic modelling, it shows the huge impact of decreasing the number of people entering the workforce and increasing the number leaving.
Just like at Stafford, there are now numerous and obvious warning signs, which this report highlights with hard evidence. We must recognise the problem and act now to prevent a nursing shortage, and we have identified eight recommendations that governments and health care organisations across the UK should follow.
The Westminster Government’s headline response to Francis was that prospective nursing students should work for up to one year as health care assistants (HCAs). The RCN believes this is the wrong priority. As a matter of urgency, the Government must call for a major review of the state of the nursing labour market in England and make sure that supply matches future demands. This is crucial if we are to maintain a safe, high quality service for patients.