As part of our continuing series of articles looking at Sustainability and Transformation Plans to shake up NHS services in a bid to save money, today The Great NHS Gamble looks at the staffing timebomb facing the service.
Lancashire’s NHS may soon be forced to rely on ‘nursing on the cheap’ as vacancies of qualified staff mount and trainees on cheaper and quicker courses are hired, the Royal College of Nursing has warned.
Some NHS organisations in the county are trialling the use of ‘nursing associates’ being brought into the NHS in support roles for fully qualified nurses.
The Department of Health has introduced 1,000 trainee nursing associates this year at 11 test sites, with a further 1,000 to follow later this year.
Among the NHS organisations participating in the trial are North West Ambulance Service NHS Trust, Wrightington, Wigan and Leigh NHS Foundation Trust, Pennine Care NHS Foundation Trust and Pennine Care NHS Foundation Trust. But the RCN has warned the new staff “must not be used as substitutes for registered nurses” with 24,000 unfilled nursing vacancies across the country.
Nationally, the number of trainees applying to be nurses has fallen by 23 per cent this year after the Government controversially axed a bursary scheme to support students through education in a bid to save £800m while new figures have revealed a 90 per cent reduction in the number of EU nationals applying to work as nurses in British hospitals following the Brexit vote.
Just 101 nurses and midwives from other European nations joined the register to work here in December - a drop from 1,304 in July, the month immediately after the EU referendum.
RCN figures show there are already 24,000 unfilled nursing vacancies across the country. Tom Sandford, director of the Royal College of Nursing in England, says he is concerned the shortfalls will lead to a greater reliance on new nursing associates being asked to do more than what is in their job descriptions.
Mr Sandford said: “We are very worried they are going to be a nursing workforce on the cheap. We want to understand more about the training. It is not just in nursing, in almost every area of public service they are looking for substitution cheaper labour.”
Mr Sandford said the RCN are now pushing for more details from health bosses on the intended use of nursing associates in the next few years as the NHS looks to plug a £22bn funding gap through the development of Sustainability and Transformation Plans (STPs). He says he is concerned whether the plans will be achievable without enough nurses and is calling on the Government to reinstate the bursary programme, as well as reassuring EU workers they are welcome to keep working in Britain. He said: “We are massively down on EU nurses at the moment. There are just under 60,000 staff with an EU nationality working in the NHS at the moment, 22,000 or 23,000 are nurses.
“In some emergency departments, you will find an almost completely Portuguese workforce.
“But in December only 101 nurses applied to be registered in Britain.
“EU staff have just turned off from coming here. I’m very, very concerned that the Government sends a positive message that despite Brexit you are going to continue to work here if you want to work here.”
Mr Sandford said the RCN have been doing a huge amount of work trying to understand what the STPs will mean in practice.
He said: “The implications for local authorities are massive. The absence of social care is still the reason we have acute beds blocked in hospitals. Most local authorities have lost 40 per cent of their budgets in the last few years. We have a major problem in that area.”
Guy Collis, health policy officer at Unison, has also raised concerns about the use of nursing associates and the use of non-clinical staff without training.
He said: “If there are ways of expanding what they’re doing and taking on other roles, providing there was appropriate training, potentially depending on the way it was done, there might be something positive to be said. Our concern is that with some of those it’s going to be care on the cheap. We’ve seen this in particular with nursing staff, there’s suggestions they will be trying to use nursing associates.
“If they’re being used in place of registered nurses there’s a concern there it’s being driven by cost cutting, rather than any desire to improve the quality of services.”
Drop in applications
Latest figures by UCAS reveal a drop in student applications for nursing and midwifery places of almost 25 per cent.
UCAS has published analysis of full-time undergraduate applications made by the January 15 deadline which is the first reliable indicator of demand for UK higher education for the 2017 cycle.
The figures show 564,190 people have applied to UK higher education courses for 2017 - a decrease of five per cent compared to the same point last year.
Nursing and midwifery has seen the most notable decrease in applicants.
Applicants from England making at least once choice to nursing or midwifery fell by 23 per cent to 33,810 in 2017.
Most applicants to nursing and midwifery are over 19 and English applicants from this age group decreased by between 16 per cent and 29 per cent.
Jon Skewes, director of policy, employment relations and communications for the Royal College of Midwives said: “It seems a remarkable coincidence that this drastic fall in applications comes soon after the anouncement that midwifery and nursing students are having their bursar scrapped and will have to pay tuition fees.
“This could leave them as much as £60,000 in debt when they qualify.”
Case Study - Christian Wrathell
Christian Wrathell, 29 is training to become a mental health nurse and is in his second year at the University of Central Lancashire in Preston.
But he admits that without the bursary support, it would have made it almost impossible for him to pursue his ambition of becoming a nurse.
Christian, from Clitheroe, said: “I worked as a healthcare assistant for about five years and training to become a nurse seemed the natural progression and I wanted to increase my skills and play more of a part in delivering care. I have worked in mental health and have a real interest in this area and I want to help and support people who can be facing harrowing and isolating times in their life. But when I started my training, there was a bursary and without this, I don’t think I could have afforded to go into nursing.
“I have spoken to quite a few of my fellow trainee nurses and they are in the same situation and say they would not have been able to do it without the bursary.”
Christian has a mortgage and is already paying off the student loans he took out while studying his degree in American Studies.
Christian said: “A lot of people going into nursing are mature students in their late 20s and 30s and they bring a wealth of experience from different areas.
“The financial pressure of doing nursing courses can be too much for people, especially if they have mortgages and families. The removal of the bursary will certainly put off people from lower income backgrounds from going into nursing. We are already seeing a drop in nursing applications and that is worrying.
“Doing a nursing course is very pressurised as you have a full-time placement and have university work to do as well so it is difficult to have part-time work on the side too.
“I do shifts as a healthcare assistant but this can be difficult when the university work is piling up. When I do my placements, I can see the pressures on staffing in the NHS and there is a lot of reliance on agency staff, but this is expensive for trusts and not a good use of NHS money.
“However, it is difficult to see how these vacancies will be filled when there has been such a huge drop in student nurse applications. It is futile making all these plans for the future of the NHS is there aren’t going to be enough staff to deliver it.”
‘Trying to stay optimistic’
ESTEPHANIE DUNN, NORTH WEST REGIONAL DIRECTOR FOR THE ROYAL COLLEGE OF NURSING
“There is already a shortage of 24,000 nurses across England and we won’t know the full extent of the removal of bursaries until this September and October.
“We are trying to remain optimistic that people will still want to come into nursing,
“But we know from speaking to nurses who are in training now that if they had had to pay their fees, they could not have done it. Many have families and mortgages.
“If they have to pay £9,000 a year fees and then take out loans, they could be leaving with £56,000 of debt before they start their nursing careers.
“Student nurses work shifts, nights and evenings and have assignments to do so it is difficult for them for work part-time to earn money.
“The STPs should not be about doing care on the cheap but about knowledge, skills and expertise.”