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'We need more care in our hospitals and community settings'


The health select committee’s recently announced inquiry into workforce gives the profession an opportunity to make its voice heard over the issue that is affecting nursing and patient care more than any other – nursing staff shortages.

The influential cross-party committee of MPs will examine exactly what has happened to create a situation where the Nursing and Midwifery Council register is losing more registrants than it is gaining. It will also consider whether the government and any other bodies have a robust plan in place to tackle this crisis.

I could probably save those politicians involved in the committee a lot of time and energy spent listening to evidence from various parties. No, there is not a strategy and we desperately need one fast.

So far, the plan seems to have been to create new routes into nursing, but that is not happening fast enough and comes with a whole set of other concerns around status and safety. For example, the committee should hear that, while nursing associates are one possible solution to support the workforce, they should not be used to substitute it. At a time when patient acuity is worsening and the volume of demand is going up, we need more care in our hospitals and community settings. This means we need to defend the number of registered nurses, and not allow new routes into nursing to replace the tried, tested and much-demanded existing routes.

“The impact of Brexit, the pay cap, the removal of the bursary, under-resourcing and agency caps have all led to a worsening staff crisis.”

Nursing associates will be very valuable to the care of patients, and they will do a tremendous job. But they are not registered nurses and will not be able to practise at the same level as a nurse who has gone through a three-year degree.

It is good news that at long last the situation is at least going to be taken seriously by those outside of the profession and the NHS. Because the impact of Brexit, the pay cap, the removal of the bursary, under-resourcing and agency caps have all led to a worsening staff crisis. 

Every month brings a new blow to the profession, and it’s time someone recognised that and reassured the profession and the public about what needs to be done to secure the future of registered nursing.

I hope that a vast range of organisations and individuals will share their evidence with the health select committee and are brave enough to reveal how difficult it is at the frontline, and the dangerous situations that much of our care is being provided in. I do not want the MPs to get the sanitised PR version of what is happening out there every day, but rather the truth, the whole truth and nothing but the truth. Only when everyone in the system is honest about just how big a problem we have, can we start to work on how to fix it. And my word, this does need fixing.

You can send submissions – based on fact and evidence rather than opinion – of no more than 3,000 words by 12 October. The committee expects to hear evidence in November. Click here for details.


Readers' comments (4)

  • Please send submissions. Please do this.


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  • The QNI is putting together a submission for this - if you have any suggestions or questions you think we should put to them, please email us at as soon as you can.

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  • As I watch the Nursing "situation" in the UK, I would like to share one view from "across the pond".
    In a November 2016 news article, Elizabeth Whitman, a quality and safety reporter for Modern Healthcare ( posed the question : ” Could replacing nurses with nursing assistants pose risks to patients?”
    Whitman stated: “While swapping professional nurses for nursing assistants might seem less expensive for hospitals in the short term, new research suggests it's associated with lower quality of care, increased patient risk and thus higher costs in the long run.”
    The study, published on-line in November 2016 issue of BMJ Quality and Safety ( examined data from hospitals, patients and nurses in Europe. The richer the skill mix of nursing staff, the lower the mortality rates and odds of poor patient ratings or quality reports, it found, although it did not establish a causal relationship or identify specific mechanisms by which outcomes worsened. Aiken LH, et al. BMJ Qual Saf 2017;26:559–568. doi:10.1136/bmjqs-2016-005567

    Perhaps this is the notorious "N=1" research report, but the study examines data from 13,077 nurses in 243 hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland, and 18,828 patients in these hospitals. There were two major conclusions from the results: 1) A bedside care workforce with a greater proportion of professional nurses is associated with better outcomes for patients and nurses. 2) Reducing nursing skill mix by adding nursing associates and other categories of assistive nursing personnel without professional nurse qualifications may contribute to preventable deaths, erode quality and safety of hospital care and contribute to hospital nurse shortages.
    Pretty bold stuff, eh?!

    Joseph B. Warren RN BSN, Division of Neurology, San Antonio Military Medical Canter, Texas

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  • Thought provoking. More in the community certainly but the case for more in hospitals is surely less compelling.

    The NAO (2016) estimated 2.7 million hospital bed days for older people no longer needing acute care - the equivalent of 250-300 wards every day.

    In addition, there are significant variations in Length of Stay for elective and emergency care, and ever more potential to offer services in the community. Although it’s hard to demonstrate, a relative lack of community nursing capacity has to be a major driver of demand for hospital nurses.

    The acuity of admissions is rising but is there persuasive evidence that the acuity of hospital care is rising too? [Im sure colleagues will have measured and can demonstrate this.] The presence of so many patients on wards whom might be safely and effectively cared for elsewhere lowers the overall acuity.

    Clearly we need to address immediate (hospital) pressures but shouldn’t our medium term priority be expansion of community nursing to keep people at or close to their home as much as we can?

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