In the third of a series of blogs about how contemporary events in politics are affecting nursing and the work nurses do, Chris Hart looks at how the increasingly close relationship between Donald Trump and Theresa May links to safe staffing and nursing numbers
After the last few weeks, any nurse still wondering what connects them to Donald Trump’s policies only need ask a Muslim colleague. Or any nurse who joined the recent women’s marches.
Just don’t ask Theresa May.
After holding hands with Trump on her recent White House visit, May enthused about a ‘new Britain’ and its new, even more special, relationship with a ‘new United States.’ But now she doesn’t want to talk about her new best friend, repeatedly refusing to denounce Trump’s Executive Order banning allowing Muslims and refugees entry to the United States.
Only international pressure forced government spokesmen – not her – to comment, but still falling short of denouncing a move unprecedented in Western modern democratic politics. Even as Trump sacked his acting attorney general because she thought his Executive Order unlawful, Boris Johnson declared ‘everything is okay’ because he’d gained an exemption for British Muslims holding dual nationality, betraying the complete lack of any moral centre in our government.
Maybe Trump and May have more in common than we think. She’d love to be able to issue Executive Orders without pesky things like parliament and the Supreme Court holding her to account. She’s had to backtrack on her initial decisions to trigger article 50 on her own, not consult with parliament or issue a white paper on Brexit.
Is she a closet native nationalist? The Prime Minister has repeatedly misrepresented the Brexit vote, remaking herself as the spokesperson for every little Englander, saying “The message from the public was clear. Brexit must mean control of the number of people who come to Britain from Europe.” This isn’t true. Many Leave campaigners argued the opposite.
The British Election Study (BES) confirmed the Brexit vote was about more complex issues than immigration, which never topped Leave voters’ concerns, and only rarely topped those of voters in national elections. Instead, the BES reveals Farage, Johnson, Gove and co’s negative campaign tapped into strong feelings of powerlessness, nostalgia, a distrust of people generally and experts in particular, as well as a lack of social capital. The idea that immigration is the cause of these problems was simply used by Gove and Johnson as it has been by UKIP before them.
But as the vicar’s daughter and the Disrupter-in-Chief get closer together, especially on trade, it’s becoming even harder for the UK to maintain a healthy relationship with Europe. Boris Johnson hands out schoolboy insults to European leaders while Mrs May misleads everyone by suggesting we can get a decent deal from our former European allies, which will surely stoke a slow burning anger towards a Europe she knows can’t respond to her demands, creating greater resentment towards ‘foreigners’ here and abroad.
“She’s desperate for a deal at any price with Trump, putting that above every other consideration”
Which is why she’s desperate for a deal at any price with Trump, putting that above every other consideration. But our tariffs with the US are already low. A trade agreement that links the UK and US on non-tariff barriers is unnecessary but will mean regulation on things like healthcare, the environment and employee rights, damaging us and helping the US further cannibalise our economy – and NHS.
Barely reported from May’s US visit was what part the NHS may play in any future deal with Trump. Yet again, she wouldn’t answer questions on the subject, fuelling fears she will provide greater openings for US companies, paid for by British taxpayers, to provide services to our ‘crisis ridden’ NHS.
Ms May has allowed herself to be caught between the proverbial rock and a hard place. Placing immigration ahead of remaining inside the single market, which was an option, means we will get a much worse deal from the EU as we leave. Best friends or not, Trump’s mantra is “America First” and his row with the Australian prime minister shows how unstable his relationships with partners are.
“Best friends or not, Trump’s mantra is ‘America First’”
And we have to remember that Trump’s narcissism appears to be at the level of a diagnosable mental disorder. We shouldn’t normalise anything going on in the White House. What he says today is no guarantee of what he’ll do tomorrow. Any deal with the US will disadvantage us.
Broader economic pressures inevitably impact further upon the NHS, whose current inadequate funding is, with the mess created by the Tories’ reorganisation of 2011, at the heart of its current crisis. As that crisis deepens, the press might highlight the problem, the public might get angry but with Labour unable to effectively call them to account in parliament, May and Jeremy Hunt are sitting it out comfortably, letting each storm pass and rarely even finding it necessary to comment.
And nursing suffers. And nurses work harder, for less. 2015 saw the lowest output of qualified nurses for years. Only 60% of newly qualified nurses now enter the NHS. The extra nurses Jeremy Hunt boasts were employed by the Tories were largely recruited from abroad – including the EU – to cover the training places lost to cuts since 2010, since when the workload has risen sharply.
Nursing numbers have increased by 9% but 22% more patients have been seen in emergency departments, there have been 31% more hospital admissions and 45% more hospital procedures undertaken. The crisis facing mental health nursing is the worst in 30 years.
As concern grows about safe staffing, a Department of Health spokesman recently said: “We expect all parts of the NHS to make sure they have the right staff in the right place at the right time to provide safe care.” Asked by The Health Service Journal how trusts can provide safe staffing and balance the books, Hunt said gnomically, “Trusts need to look beyond that binary choice”. To what? Planting money trees?
“Only 27% of NHS trust chief executives were confident they had the right staff numbers”
In England’s hospitals, a nurse is meant to look after no more than eight medical patients. The ratio can be as low as one to one in neonatal and intensive care units. Analysis of official data by the HSJ showed almost every hospital in England had insufficient nurses on duty to guarantee safe patient care. 96% of hospitals had fewer nurses covering day shifts in October than planned and 85% were short staffed at night. Indeed, only 27% of NHS trust chief executives were confident they had the right staff numbers, quality and skill mix to deliver high quality healthcare for patients. Fewer still, 22%, were confident about having the right staffing levels in six months’ time,
These figures highlight the chronic shortage of nurses. The RCN estimates there are as many as 24,000 vacancies for nurses across the UK while nurses told the HSJ that understaffing meant hospitals were already providing substandard care, compromising patient safety.
Hospital staffing figures are the worst on record since details were first published in 2013, in the wake of a report on the Mid Staffs scandal.
Ruth May, executive director of nursing at NHS Improvement, has said, “There is more we can and should do to help” NHS staff, emphasising the need for trusts to recruit and retain more staff. Similarly, the Chief Nursing Officer has said she’ll intervene in skills mix disputes within Trusts and stated both she and NHS England chief executive Simon Stevens “agree more nurses are needed”. But neither Dr May or Ms Cummings can say where the money will come from to fund the posts or how they will impose their will when Trusts either cannot or will not comply.
A short term step would be to remove constraints introduced in 2015 on the amount hospitals can pay to hire agency nurses, which are contributing to the current problem. It would increase costs but mean safer care for patients and take some pressure off nurses facing intolerable levels of stress. Reinstating monies for continuing professional development could also have an impact on retention.
Salaries definitely won’t be an incentive for recruitment and retention. With inflation hitting 2.5% in December, the TUC estimates that nurses face losing more than £2,500 in real terms by 2020, with the average public sector salary already more than £1,000 lower in real terms than in 2010.
Inevitably, some trusts are covering gaps by employing more – cheaper - healthcare assistants. This increases numbers but doesn’t solve the problem of key tasks that need completing and care that needs providing by registered nurses.
And the situation looks set to worsen. Reviews of Sustainability and Transformation Plans forecast a 1.6% reduction in whole-time equivalent staff between 2016-17 and 2020-21, with a 2.3% reduction in registered nurse posts. If this is applied across England, it would mean reductions of 17,300 staff overall and 7,300 across nursing, midwifery and health visiting.
It’s easy to forget the pressure nursing directors face when it comes to Trust finances, with stories of bullying common, and how precarious it must feel at national level, given the economic climate, lack of support for nursing and reductions in numbers of senior nurses within the Department of Health. With Unison even less influential than ever in the wake of Labour’s terminal decline, the RCN’s task is far harder and nursing’s voice is weaker than ever.
One of the most worrying aspects of the past fortnight is the speed with which Trump’s former critics now lend support to the Muslim ban, climate change denial, the Mexican wall, the madness of pretending his inauguration crowd was bigger than Obama’s, indeed, what has now been officially termed by the White House, “alternative facts.”
Yet, in such dark, disturbing times leadership is required, which requires speaking out, helping people organise, and protecting the vulnerable. The most obvious and urgent issue for national and local nursing leaders to speak out about is safe staffing. Which links directly to the uniquely great moral issue of the moment, immigration and the place of people from overseas contributing to the health and well being of our society, economically and culturally. Many are nurses and other healthcare workers. They should be guaranteed the right to stay in this country now and not be bargaining chips in Mrs May’s ill advised political strategy.
This is, however, not just about leaders. The time for fretting is over. Nurses everywhere will need to start taking action if they want to protect their own rights, their patients, their future.
Chris Hart is a senior lecturer at Kingston University and St George’s University of London, and independent nurse consultant
Also in this series:
- ‘If we are edging closer to a US model of healthcare, no one is going to rescue nursing’
- Into the darkness: Trump, Brexit and nursing
- What can nurses do to protect their own rights, their patients, their future?