The Royal College of Nursing is demanding that the UK follows Wales’ lead and protects safe staffing levels with new legislation. NHS patients across the UK will be at risk of falling care standards unless all four countries have legislation to guarantee safe staffing levels, the Royal College of Nursing said.
The RCN has called for safe staffing to be enshrined in law across the UK for the first time as it exposes a ‘lethal cocktail’ that is leaving record numbers of nursing jobs vacant. RCN Wales Director Tina Donnelly said: “In Wales, after much hard work and effective engagement with politicians within the National Assembly for Wales, from across the political spectrum, we have achieved the Nurse Staffing (Levels) Wales Act 2016.
This ground-breaking legislation holds Health Boards in Wales accountable for nurse staffing in acute medical and surgical wards – however we need the legislation to be extended to all areas of nursing. The RCN Wales has worked on this legislation since 2009, because we recognised a long time ago that only legislation changes the behaviours of those involved in workforce planning and management. Alongside our work to embed safe-staffing levels into the law, the RCN in Wales has also worked closely with the National Assembly to dramatically increase the numbers of student commissions each year ahead of the legislation being enacted.
Student commissions have increased each year from 919 in 2012 to 1610 in 2017 – an increase of 75 per cent. This means that Welsh Health Boards are in a strong position to comply with the legislation on staffing numbers. The RCN UK also successfully campaigned to reinstate nurses onto the Shortage Occupation list so that overseas recruitment could continue. We now look forward to working with the Welsh Government to ensure the implementation of Nurse Staffing (Levels) Wales Act 2016, which will deliver sufficient time for nurses to deliver safe care, and are now campaigning to get this Act extended into other areas, including community nursing, paediatrics and mental health.”
New figures from NHS trusts in England reveal that one in nine nursing posts (11.1 per cent) are unfilled and suggests that care providers have increasingly hired fewer registered nursing staff. The number of vacant nursing posts has doubled since 2013. Recent figures suggest that in Wales there are around 1,200 nursing vacancies in the Welsh NHS and the Royal College of Nursing Wales estimates that there are a further 1,700 nursing vacancies across the third and independent sectors of care provision.
The RCN Wales has produced an overview of staffing numbers in Wales that shows overall numbers of employed NHS nurses in Wales have been static for years, although this does not reflect increased patient numbers, higher patient dependency and higher bed occupancy. The overall numbers can also obscure very sharp shortages of registered nurses and nursing is some specific fields, like neonatal nursing and children’s nursing in the community. It is possible to demonstrate the need for additional nurses in Wales relatively easily. Firstly by looking at the overreliance on agency spend. In 2015/6 the cost of agency nursing in Wales to the NHS was £48,278,757. This cost is the equivalent value of an extra 2,182 newly qualified nurses.
The NHS also continues to demonstrate a heavy reliance on overtime. The RCN Employment survey shows that 69 per cent of nurses work overtime at least once a week and more than half of that overtime is unpaid. This adds to stress, sickness and low morale. There are 22,146 nurses employed in the NHS (Stats Wales 2015). Sixty-nine per cent of this figure would represent 15,281 nurses. If each of these worked just two hours more in one week the NHS would be receiving 30,562 additional hours of work in that week. Every week nurses in Wales give the NHS extra hours to the value of 815 full-time nursing staff.
A Freedom of Information request by the RCN shows two-thirds of NHS hospital trusts in England planned for a greater proportion of nursing support staff in 2016 than a year earlier. RCN Chief executive and general Secretary Janet Davies warns that the move leaves the Government open to the accusation of offering ‘nursing on the cheap’ in place of recruiting and retaining registered and experienced nurses. Separate research in all four UK countries, carried out by ComRes for the RCN, shows four in five NHS nursing directors worried that their hospital relies on the goodwill of staff to keep services running. The Directors of Nursing bore out the findings of the FoI, with four in ten concerned about the impact of delegating nursing care to unregistered staff. Two in three (64%) say that, compared with two years ago, finances have become worse.
While half (49%) agree that financial pressures mean they cannot always make the best decisions for patients in their care. The Welsh Government’s latest campaign promoting Wales as a fantastic country for nurses to train, work and live, will help boost nurse numbers – especially when coupled with the news that NHS Bursaries for eligible student nurses, midwives and allied health professionals will continue to be available in Wales in 2018/19. The bursary will be based upon individuals committing, in advance, to taking up the opportunity to work in Wales, post qualification, for a period of two years.
“The messages that this campaign conveys are vitally important in the current health care climate; acting as a reminder of the benefits our country truly has to offer to those who decide to train, and remain, as a health care professional in Wales,” said Tina Donnelly.
“Encouraging these individuals to work in Wales must continue until we see stable workforce levels that our NHS requires to function efficiently and effectively, allowing patients to receive the highest standard of care possible.”
Janet Davies, Chief Executive and General Secretary of the Royal College of Nursing, said: "A lethal cocktail of factors in the NHS has resulted in too few registered nurses and patient care is suffering. "Pressure and demand has spiralled upwards at the very moment nurses' pay headed the other way. They stay behind after 12-hour shifts to give patients extra care and go home exhausted and sometimes in tears. Too many now feel no alternative but to leave nursing.
"There is no certainty about the next generation of UK nurses joining either - deterred by low pay, pressure and new training costs - so the Government desperately needs to keep the experienced ones we have. "When finances are tight, nursing budgets are slashed and patients can pay the highest price. Hospitals are hiring unregistered staff and delegating jobs that should be done by trained nurses. The Government cannot allow 'nursing on the cheap'. "Ministers must draw a line under this false economy and address safe staffing levels in new legislation. Nursing directors should not have to fight for the funding."