The majority of nurses will never be able to scrape together enough to buy a home in the capital, according to the Royal College of Nursing’s new director for London, who warns more must be done to tackle the high living costs that are exacerbating staffing shortages.
Jude Diggins, who took over as RCN regional director for London from Bernell Bussue at the end of March, said transport and accommodation costs were key factors behind higher vacancy rates in the capital.
“A band 5 staff nurse would be saving until they were pushing up daisies to raise the deposit for something like that”
She stressed that the solution was not simply building “rabbit hutch” keyworker housing or trying to secure more “affordable” homes”.
“In recent times, I think the cheapest supposedly affordable homes in London have averaged around £358,000,” she told Nursing Times in an exclusive joint interview with her predecessor.
“Frankly, a band 5 staff nurse, or even band 3 or 4 support worker, would be saving until they were pushing up daisies to raise the deposit for something like that,” she said. “So, we’re going to have to look at this from as many angles as we possibly can.”
Looking at innovative and effective ways to make working in London genuinely more affordable for nursing staff would be vital in addressing ongoing staffing shortages, she noted.
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However, Mr Bussue stressed the number one priority in London had to be ensuring “safe and effective care”. He said the fact that services in the city continued to be “very safe and effective” was to the credit of hard-working nurses and colleagues. But he said he was concerned about how much longer this could continue in the tough financial climate.
“Cutting across everything is the fact we are operating in an austere environment and, because of that austerity, some of the decisions being made are focused on the bottom line whereas the focus should be around clinical need,” he said.
“We see our staff coping with the pressures – and coping in a very admirable way – but it isn’t sustainable long-term, so something has to give in order for services across the piece not be harmed,” he warned.
“We have a strong view that NHS land shouldn’t be sold off to the highest”
Throughout the winter less than 5% of hospitals in London met safe bed occupancy levels, as defined by the National Institute for Health and Care Excellence. Average bed occupancy was around 95% – well above the 85% level recommended by NICE – with some occasionally hitting 100%.
Nevertheless, robust contingency and emergency planning – with England’s chief nursing officer Jane Cummings playing a lead role – had helped the capital’s health services get through the difficult period, said Ms Diggins.
“London has actually done really well around cancelling routine operations. It was very measured in its approach and many organisations managed to avoid cancelling operations, which was fantastic,” she said.
“There was some really good planning and that paid off but that does not take away from the fact it has been a really difficult winter for flu, norovirus and then poor weather and our frontline staff have absolutely maxed out and gone to the ’’nth degree,” she noted.
“I think it’s really important we change some of the language around nursing”
When it came to addressing staffing shortages, Mr Bussue and Ms Diggins both cited multiple challenges, including concern about the impact of Brexit with London having the highest concentration of staff from other European Union countries.
Currently, around one in six nursing posts in the capital was vacant, compared to one in nine in other parts of the country, with the higher cost of living in London a key factor in recruitment difficulties. Mr Bussue highlighted that staffing shortages were not only hitting NHS provision but London’s large independent sector as well.
“Another sector that is of growing concern is the care sector,” said Ms Diggins. “Colleagues in social care tell us they have 40% vacancies, so that creates a challenge and the knock-on effect is pressure back into the independent and NHS sectors.
“It’s like the back door is bolted on for those people who are not able to get out of hospital because there isn’t the resource,” she said. “It’s not just about cuts in social care but also the difficulty in getting the right skill mix to put people safely into community provision.”
Mr Bussue said RCN London had been exploring ways to address the cost of living issue, especially when it came to accommodation and travel costs, and was in discussion with the Greater London Authority and some NHS employers.
“One of the things we have done some work on is the issue of NHS land when it is sold on and how that NHS land is then used,” he said. “We have a strong view that NHS land shouldn’t be sold off to the highest bidder so that private investors are lining their own pockets.
We think there needs to be a more ethical and more considered approach whereby any plans or agreements have a big emphasis on affordable homes and affordable homes for people who are providing health services.”
Ms Diggins said increased provision of “keyworker” housing was just one element when it came to ensuring nurses and others could afford to live and work in the capital.
“Sometimes keyworker housing is not what people want – they may want to raise families, have a bit of a garden,” she said.
Other solutions might include providing somewhere for people to stay for a short time while doing a run of shifts.
“A couple of trusts have what they call their hospital hotel and staff will come and do two or three shifts, pay a very low rent and then live with their families the other three or four days of the week outside London,” said Ms Diggins. “That again is not for everybody so the solution to this has to be rounded, multi-factorial.”
She said there were many other factors when it came to tackling staffing shortages, especially via retention, including ensuring access to good support and continuing professional development.
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“We have a responsibility in the college to work with employers across London in all sectors to do everything we can with them to help them maximise their staffing and retention including us offering CPD,” she said.
“The higher education budget has been slashed in recent years, so this is about working with partners and colleagues around more creative ways to deliver CPD, because we know CPD is something that really helps retain nurses,” she added.
Under her directorship, she said RCN London would also continue to work “hand in glove” with Health Education England’s CapitalNurse programme. “I personally have been very involved in that and there are some really fantastic pieces of work that are beginning pay off,” she said.
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These included “career passports” designed to help nurses demonstrate specialist skills and ensure consistency in care standards across London and a new preceptorship framework to help improve support for newly qualified nurses.
She said the scheme was also looking at ways organisations could work with higher education institutions to create in-house programmes to develop skills in specific areas in a cheaper way than previously.
“Wouldn’t it be amazing if in the next two years we turned the tide”
Meanwhile, she said there was no getting away from the fact that pay was a key issue when it came to staff recruitment and retention.
“The elephant in the room around all of this will be pay – making sure that the pay deal is right – and those conversations will emerge in the weeks and months ahead,” she said.
Another key issue in London is the need to improve equality, diversity and inclusion, with the capital performing worse than other parts of the country in seven out of nine key performance indicators under the new Workforce Race Equality Standard (WRES).
This includes the fact the proportion of BME staff in senior positions in NHS organisations is disproportionately low, given 43% of London’s workforce is BME. “If you look at the lower grades, you’d think we haven’t got a problem but as soon as you get past band 7, band 8 it becomes much more challenging,” said Mr Bussue.
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WRES data also shows BME staff in London are 1.8 times more likely to enter a disciplinary process – the highest rate in the country – and less likely than white staff to be appointed to a role from a shortlist.
London has the worst rates for bullying and harassment of BME staff and just 69% of BME staff in the capital feel their trust provides equal opportunities for career progression against a national average of 75.5%.
While WRES provides a useful baseline for NHS organisations and ensures the issue is being talked about – with performance scrutinised by the Care Quality Commission, Mr Bussue stressed “WRES on its own isn’t going to make the difference”.
“We need a systematic, long-term push to address these concerns – these aren’t things that will change overnight – it’s an issue that just has to keep being pushed along,” he said.
“Something has to give in order for services across the piece not be harmed”
Ms Diggins said RCN reps in London were asking questions and challenging practice within organisations.
Meanwhile, a programme called the Inclusion Solution, launched in September last year, was encouraging “system leaders” across the NHS, independent and local authority sectors to make London a more inclusive workplace.
RCN London would also be working with a trust as part of the national roll-out of its “cultural ambassador” programme – successfully piloted in the West Midlands – on tackling the disproportionate rates of BME staff facing disciplinary action.
Ms Diggins said her goal would be to champion diversity and inclusion in its widest sense and one of the most important elements was ensuring organisations truly represented the communities they served – as highlighted in a King’s Fund report published last year.
She said the RCN was well-placed to push the agenda forward, given 46% of members in London were BME. “There is an economic argument to getting this right,” she added. “If you get this right you get retention, happier staff and better care for patients.”
Mr Bussue said he was “delighted” that Ms Diggins was taking over from him, because he felt she had similar values including championing fairness and inclusiveness. Ms Diggins, in turn, said she was aware she had “big shoes to fill”.
“Bernell leaves a fantastic legacy – there isn’t a health organisation in London that doesn’t know Mr Bussue – so trying to match that will be challenging,” she said.
“It will be about continuing those relationships but there will also be some new relationships to build, especially with local councils because of the way the whole landscape is changing,” she said.
While it was “without question challenging on the frontline”, she said one of her key priorities was to paint a less gloomy picture of nursing in the capital and highlight the many positives, including the fact London was home to “some of the best specialties in the world”.
“I think it’s really important we change some of the language around nursing,” she said. “There has been a lot of doom and gloom, stress and angst and actually that doesn’t do nursing justice. London is actually an amazing place to have a nursing career – there isn’t a specialism you can’t do.
“It will be the 200th anniversary of the birth of Florence Nightingale in 2020 and wouldn’t it be amazing if in the next two years we turned the tide and created a new narrative that was really positive about nursing in the 21st century,” she said.
Mr Bussue, who retired on 29 March after 44 years in the profession, agreed it was vital to do more to promote nursing as a “fantastic career”, especially in light of potential disincentives such as the scrapping of the student bursary.
“I have seen a lot of change but if I was to do it again I would still choose the same profession, because there are so many possibilities in nursing,” he said.
He added: “One of the things that is going to be a challenge going forward is to get the message over that it is as an absolutely fantastic career.”
Read more coverage from our exclusive interview with Mr Bussue: