The UK is once again facing an acute shortage of qualified nurses, at a time when the public is being promised higher standards and safer patient care.
The staffing crisis comes three years after the old strategic health authorities cut nurse training places across England. Unsurprisingly, the greatly reduced nursing class of 2011 graduated this summer to open arms across the NHS.
There is now overwhelming evidence to suggest that if the number of nurses does not increase within the next two or three years, we can expect a significant impact on standards of patient care. What is missing is any meaningful public debate about the cost of safe, high-quality patient care, and whether the country is prepared to pay it.
Financial restrictions on trusts, under the governance of the NHS Trust Development Authority, makes affordability the most significant indicator in workforce plans, rather than need.
To make the books balance while meeting essential staffing levels, trusts are forced to siphon resources from other areas of care to fund costly overseas recruitment or expensive agency staff.
A national call to encourage “ex-nurses” to return to practice is now under way. The University of Worcester and other universities engaged in nurse training will support this initiative by running intensive update programmes to prepare returning nurses. But is this too little, too late to prevent a care crisis? We do not know how many people will seek to regain their registration or whether they will be in a position to take on the training and the working practices of the NHS.
In the wake of the 2013 Francis report into failings in care at Mid Staffordshire Foundation Trust, the public were assured that such problems across the health service would be rectified, and a review of staffing levels and a better ratio of nurses to patients was recommended. The National Institute for Health and Care Excellence (NICE) has now endorsed the Safer Nursing Care Tool as an acuity-based toolkit to be used alongside the NICE guidelines on safe staffing. The presumption is that fewer than one nurse to eight patients should trigger a possible “red flag cause for concern”.
While this is a step in the right direction, the guidance is not yet mandatory and does not identify where the “extra” nurses to meet the safer staffing levels would come from.
It takes three years and 2,300 hours of patient care to qualify as a nurse, and the government controls the number of training places that universities can offer each year. It is too late to rectify the training place cuts of 2011, 2012 and 2013, but there needs to be an urgent rethink for this year. The 17% cut in training places locally needs to be reversed immediately, at the very least.
There is no shortage of well-qualified applicants - at Worcester we are turning away students with high academic grades who have proved during the interview process that they have the compassion to make excellent nurses.
Since the Francis report was published, the health service has been making huge strides to improve care standards and there are many examples of great practice. But if we do not address the acute crisis in nursing, progress will not be sustained. Too few nurses are being asked to do too much. Without a clear and effective strategy for recruitment and retention, I fear we could be faced with another crisis of care.
Jan Quallington is head of the Institute of Health and Society at the University of Worcester and a member of the steering group for the Centre for Ethical Leadership