NHS staff crisis
threatens patient safety

National picture disguises regional variations

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The NHS staffing crisis has been highlighted in the North East and Yorkshire where demand for nurses is increasing quicker than supply, according to data from the Kings Fund.

A parliamentary select committee report recently warned there was a “serious risk to staff and patient safety” from understaffing, with a shortage of 12,000 hospital doctors and more than 50,000 nurses and midwives across the country.

But although the government claims it is making progress in its long-term aims to recruit more staff, there are regional variations. The health think tank the King’s Fund says that although the North East and Yorkshire and Humber are recruiting more nurses, the number of vacancies is growing even faster.

“It looks like they’re struggling an awful lot,” said King’s Fund policy adviser Jonathon Holmes

“Yes, they have seen almost a 7 per cent increase in the full-time equivalent number of nurses working in that region, but then at the same time the number of vacancies grew more so.”

The King’s Fund does not believe retention of nurses is a national problem but it may be in the North East and Yorkshire and Humber.

“You had a 7 per cent uptick in number of nurses, though you had an 8 per cent uptick in the number of vacant posts,” said Holmes. “That suggests that in that region there might be issues around retention of staff.”

Harrogate Hospital in North Yorkshire has reported increasing pressures on staffing levels with around 80 staff currently off work and absences reaching above 130 in June.

“We are currently at risk of worsening care for our population.”

Its chief executive, Jonathan Coulter, said rising Covid cases and a lack of beds has added to the pressure the hospital is under.

He told the Harrogate Advertiser: “We know that if people stay in hospital for a significant time that outcomes deteriorate, and we are currently at risk of worsening care for our population as a result of some of the urgent care pathway pressures being felt across all organisations.”

Patients group Healthwatch York called the current state of the healthcare system a “perfect storm” despite local health chiefs doing everything they could to provide safe care.

Sian Balsom, Healthwatch York manager, said: “Despite the enormous pressure in our system, it is important to remember that people continue to regularly report good experiences of care to us. But in recent months there has been a steady increase in those contacting us concerned about the care they or their loved ones has received.

“Some of these reports tell us of failings to provide basics – a clean bed, food, water, help with going to the toilet. These are tough stories for us to hear, so I can only imagine how tough it is for patients and staff living these challenges every day.”

Nursing shortages are less prominent in the North West, with full time nurses increasing and vacancies reducing.

The government’s earlier pledge to hit 50,000 nurses is making good progress, according to the Kings Fund, but this is not accounting for short term problems.

Holmes said his confidence is “very, very low” that these problems will be quickly addressed.

“We’re going to see waiting lists for NHS services continue to grow,” he said. “We are going to see waiting times remain an issue. We are going to see significant inequalities in health persist.

“We are probably going to be looking at a situation where additional funding isn’t forthcoming to meet some of the pressures on pay in the NHS. Some trade-offs may have to start being made about what the NHS continues to do and as taxpayers we might see the range of services offered diminish.”

The Health and Social Care Committee’s report, published on 25 July, warned that the NHS is facing “the greatest workforce crisis in its history”.

Maternity services are “very fragile” and morale is struggling

As of September 2021 there were more than 99,000 NHS vacancies and 105,000 in social care. Concerns including pay, racism and staff mental health were highlighted throughout the report, particularly as the NHS tries to clear a backlog of Covid-delayed treatment.

Maternity services have also been at the forefront of concerns, with Gill Walton, chief executive of the Royal College of Midwives, quoted in the report saying the sector is “very fragile” and morale is struggling.

A 2021 NHS staff survey showed that just 36.7 per cent were satisfied with their pay, and over half of staff reported working additional unpaid hours on a weekly basis. The committee said it was told about nurses “who are unable to pay their rent, unable to afford petrol to get to work and unable to get a mortgage and who were even reliant on food banks”.

The government has recently said it will accept the findings of NHS pay bodies and offer one million NHS staff – including nurses, paramedics and midwives – a pay rise of at least £1,400, with lowest earners to receive up to 9.3 per cent. Eligible dentists and doctors will receive a 4.5 per cent pay rise.

But the British Medical Association said that with inflation this amounted to a “brutal” pay cut that will further encourage doctors to leave.

It said: “Some doctors have seen their pay fall in real terms by around a third in the last 14 years, and any workforce strategy will fall flat with no commitment to reverse this huge cut.

“Doctors are sick of being undervalued; whether that’s through years of cuts to our wages, being forced to pay for the ‘luxury’ of parking at our own workplaces, or having no access to a decent meal on night shifts.”

The Royal College of Nursing was equally critical of the pay offer and is now balloting members on industrial action.

RCN general secretary chief executive Pat Cullen said: “This is a grave misstep by ministers. With this low award, the government is misjudging the mood of nursing staff and the public too.

“There are tens of thousands of unfilled nursing jobs and today ministers have taken the NHS even further from safe patient care.”

In the care sector, 95 per cent of providers find staff recruitment difficult and 75 per cent were struggling to keep existing staff, according to Care England.

The select committee reiterated in its report an earlier call for an increase in funding for the sector of £7 billion by 2023-24. It called for workers employed on zero-hours contracts to be given a choice of contract after three months employment.

“Witnesses to this inquiry left us in no doubt that pay is a crucial factor in recruitment and retention in social care,” said the report. “Social care providers are consistently being outbid by the retail and hospitality sectors.”

Health and Social Care Select Committee chair Jeremy Hunt – a former health secretary – was sharply critical of the government’s lack of workforce planning for both the NHS and social care. The government had promised one in spring but has not completed it, and the committee fears it will lack specific numbers and targets when it is published, possibly in autumn.

“It’s also about needing more care homes with nursing, more care in people’s own homes.”

“NHS professionals know there is no silver bullet to solve this problem but we should at least be giving them comfort that a plan is in place,” said Hunt. “This must be a top priority for the new prime minister.”

Balsom said: “It is deeply concerning that our health and care system is struggling. It isn’t just about ambulances or hospitals. It’s not just about access to GP practices, and meeting that demand. It’s also about needing more care homes with nursing, more care in people’s own homes.

“At times of high demand, local health and care partners usually try to help each other out. But every part of our system is so stretched at the moment this mutual aid isn’t enough.”

In response to questions from Big Issue North, a spokesperson for the Department of Health and Social Care said in a statement: “We hugely value and appreciate the dedication and contribution of NHS and social care staff.

“We are growing the health and social care workforce, with over 4,000 more doctors, and 9,600 more nurses compared to last year, and over 1,400 more doctors in general practice compared to March 2019.”

The spokesperson added that ministers are continuing to deliver on the 50,000 more nurses pledge and also investing £95 million investment maternity services recruitment.

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