Considering the cost of harm

This week, the UK government finally announced the NHS pay award for nursing staff in England. The NHS pay deal announced by the UK government has an impact on the money available for NHS pay in Northern Ireland, Scotland and Wales. It is for the devolved governments in those countries to decide what pay rise to offer staff working there. Our members in Scotland are currently being balloted on the Scottish government offer of a 5% pay increase to NHS staff and an announcement by the Welsh government is expected soon. The situation in Northern Ireland is complex as a government hasn’t been formed following elections in May. We continue to demand the immediate restoration of the Northern Ireland government to address the escalating nursing crisis.  

The pay award is a real-terms pay cut given that RPI inflation is currently at 11.7% and doesn’t address the cost-of-living crisis currently impacting nursing staff, working across health and social care. Only last week, I spoke to an RCN nurse member who shared with me the amount she has to pay out for monthly bills. Just to get to work, her petrol costs have significantly increased and also her parking permit is expensive - there are limited public transport options where she works.  This nurse is struggling to pay her rent, her increased fuel bills, pay back a student loan, trying to fund her professional development course and has just been turned down for a mortgage. She works in a team that has large number of vacancies and is having difficulty recruiting - sadly, she is now considering a career change.

Another member shared with me that her child’s nursery fees are going up by nearly an additional £100 per month. She is pregnant with her second child and says that she no longer thinks that continuing to work as a nurse is possible given her current salary. The reality of the current cost of living crisis means that right across the UK, our health and care system is losing experienced and skilled nursing staff at a time when the pressures on services have never been so great.

The current severe nursing workforce shortage continues to impact across the UK, in particular on nursing retention. Fair pay, terms and conditions and CPD directly impact on staff feeling valued.  Through this, staff retention helps contribute to safer staffing. Without fair pay, safety and the quality of care that can be delivered is impacted; which in turn impacts on the stress nursing staff feel when they are unable to deliver safe care; which in turn leads to high levels of stress leading to increased sickness; which in turn leads to decisions by many to leave and find employment elsewhere.

We know there is a global and national critical shortage of nurses, and the NMC Registration Data report highlighted the significant issues with nursing retention. The mid-year report in September 2021 reported 21,800 nurses, midwives and nursing associates left the NMC register between July 2019 to June 2020. Many cited reasons such as those I’ve mentioned above - including too much pressure; stress; poor mental health; a negative workplace culture including bullying and poor management; difficulty raising concerns; staffing levels; and disillusionment with the quality of care they are able to provide patients. 

It is nearly 10 years since the Francis Report (2013) into the Mid Staffordshire Hospital drew attention to examples of poor care and high mortality rates. How many more health care scandals will we see emerge as a result of these severe shortages and what has been learnt since 2013? Has there been an acknowledgement by governments of the need to invest in the nursing workforce and a recognition that the cost of harm is actually more expensive than investing in the workforce?

Aside from the moral cost, the importance of ensuring sustainable safe staffing levels, when compared to the cost of plugging the gaps through a temporary workforce, provides a compelling economic argument to fund safe nursing care through long-term, sustained investment in the nursing profession.

The National Audit Office (2017) predicted a rise of 4% in clinical negligence claims in England from £2.4 billion, equating to approximately 2% of NHS England’s total budget. It is clear to see why safe staffing across health and care is so important, when you add to this cost of harm for additional treatments, increased length of stay and community and social care costs. For example, a patient falling in hospital and sustaining a fracture begins to illustrate why safe staffing is so important. This is further evidenced in the recent NHS Resolution Learning from Emergency Medicine compensation claims reports. And we know that safer staffing helps to prevent adverse event types for example venous thromboembolism, pressure ulcers, infections and medication errors. 

Preventable harm costs the UK health system a considerable sum of money that could be used to fund thousands more staff across the UK. In England, the 2019 NHSE/I Patient Safety Strategy suggested that reducing levels of avoidable patient harm could potentially result in savings of £750m a year in clinical negligence costs and up to £100m in care costs by 2025. In addition, there are 33,000 patient safety-related disabilities and 110,000 patient safety-related treatment episodes each year. NHS Trusts in England also spent £1.46 billion on temporary staff in 2018. In Northern Ireland, the Northern Ireland Audit Office reported in 2019 that almost £400m was expected to be spent settling legal claims caused by alleged harm events in just five years. In Scotland, the Clinical Negligence & Other Risks Indemnity Scheme annual report reported a claims value of £38.0 million during 2019-2020. And in Wales, the NHS spent over £148m on clinical negligence in 2019-20 and over £84m in 2020-21.

When we add all of this together the economic business case has never been so compelling - governments simply can’t afford not to invest in our nursing workforce. We must work together with one voice and speak up for nursing and for the populations that we all serve - you and they deserve this.