STAFFING PROBLEMS

What Impact does Brexit have on nursing? (The Guardian: 28th February 2017)

The NHS faces a major shortfall in nurses – and the EU referendum result threatens to derail supply further.

The NHS faces a severe nursing shortage. An ageing population has pushed up demand, while an ageing nursing workforce – with one in three nurses set to retire in the next 10 years – is reducing supply. The shortage is particularly acute in mental health, with specialist nurse numbers falling more than 10% in the past five years.

And the Brexit vote may make it even worse. A July 2016 Institute for Employment Studies (IES) report reveals about 4.5% of NHS nurses in 2015 were from EU countries excluding Ireland, a steep rise from the 1% of 2009. In some trusts in London and the east of England, the proportion is as high as 20%.

Nurses who have been here more than five years will be eligible to remain. But what will happen to the others? Helen McKenna, senior policy adviser at the King’s Fund thinktank, believes that the government “urgently needs to clarify its position on the status of nationals who are already here in the UK working in health and social care roles”. While the prime minister has said she would like to guarantee the rights of EU citizens already living here, that is by no means certain. McKenna says: “Her position is likely to be dependent on reciprocal agreements for UK citizens living elsewhere in Europe.”

Rachel Marangozov, IES senior research fellow and report co-author, notes that the uncertainty and perceived hostility towards migrants may put some EU nurses off: “What are you going to say? ‘Come and work in London or the east of England – we can’t guarantee your future status, but come and work for us.’ It’s a very difficult sell.”...Read More

Maternity units across England facing the axe under plans to transform NHS care (The Mirror : 16 February 2017)

Eleven maternity and neonatal units across England are reportedly facing either being axed or merged under plans to transform obstetrics care in the NHS .

Proposals to remodel the health service in order to plug a £22 billion hole by 2021 reveals major changes across toe maternity services.

Now hospitals in Lancashire and South Cumbria, West Yorkshire and Harrogate, South Yorkshire and Bassetlaw, Lincolnshire, Leicestershire and Rutland, Birmingham and Solihull, Milton Keynes, Dorset, Coventry and Warwickshire are being marked to shut or to move substantial distances.

A week ago the Royal College of Midwives’ annual report said maternity services across Britain could already reach “crisis point”, as more than a third of midwives are nearing retirement age.

The report said that more student midwives are needed to be trained as a “matter of urgency”...read more

 

NHS intensive care ‘at its limits’ because of staff shortages (The Guardian : 29 January 2017)

The NHS’s network of intensive care units is “at its limits” because they are overwhelmed by staff shortages and the sheer number of patients needing life-or-death care, senior doctors are warning in an unprecedented intervention.

Intensive care units (ICUs) are becoming so full that patient safety is increasingly at risk because life-saving operations – including heart, abdominal and neurosurgery – are having to be delayed, the leaders of the specialist doctors who staff the units have told the Guardian.

“Intensive care is at its limits in terms of capacity and struggles to maintain adequate staffing levels,” said Dr Carl Waldmann, the dean of the Faculty of Intensive Care Medicine (FICM).

“It is important that bed occupancy rates do not exceed 85% in order to ensure there is capacity for emergencies. The reality is that many units are quickly reaching 100% capacity whenever there is excessive hospital activity,” he added.

The Guardian can reveal that, in a stark example of the growing problems, Hull and East Yorkshire Hospitals NHS trust last week ran out of intensive care beds at its two hospitals and was struggling to provide normal care to the many patients needing treatment for life-or-death conditions...read more

 

Over a third of GPs in Scotland plan to retire in the next five years (British Medical Association: 13 December 2016)

More than a third of GPs are planning to retire from general practice within the next five years according to the latest figures from the BMA’s survey of GPs in Scotland.

The findings are the second set of results from the BMA’s survey of the profession in Scotland

Key findings from the survey about the current state of the GP workforce include:

  • One third of respondents (35%) are planning to retire from general practice in the next five years. One in five (20%) said they are planning to move to part time. Six per cent are planning to move abroad and six percent are planning to quit medicine altogether.

  • Over two thirds of GPs (70%) state that while manageable, they experience a significant amount of work related stress. However, 15% feel their stress is significant and unmanageable.

  • Asked to rank what factors were having a negative impact on their commitment to being a GP, 55% of respondents said that workload had the most negative impact, 21% said that unresourced work being moved into general practice was the biggest negative and 13% said that insufficient time with patients was the biggest negative...read more

 

RCM warns against permanently altering midwife roles to plug staff gaps (National Health Executive: 12 December 2016)

The Royal College of Midwives (RCM) has issued guidance urging NHS organisations to ensure that midwife roles are protected as they struggle to ensure safe staffing levels.

The RCM argued that an additional 3,500 midwives are needed as the NHS faces persistent staffing shortages at a time of rising demand due to a historically high birth rate, increasingly complex pregnancies and expectations that midwives will deliver more support and advice.

In ‘Getting the Midwifery Workforce Right’, a new report it published today, the RCM agreed that midwives may need to take on changed roles and new skills in order to cope with a changing role.

However, it added: “Whilst the RCM accepts that NHS organisations wish to maximise the flexibility of their workforce, it is not acceptable to permanently alter midwifery roles to compensate for staffing shortages or changes in doctors’ roles (for example, by routinely requiring midwives to assist in caesarean sections).

“We do not believe that this kind of response solves the fundamental problem of medical shortages, but merely moves the problem onto another profession.”

The organisation claimed that maternity support workers have “proved time and time again their value” since being created 20 years ago. Despite this, it noted that maternity support workers (MSWs) suffer from a lack of a national standard role or pay grade, and from a paucity of options for career progression....read more

 

Workload damages patient care, say GPs (British Medical Association: 9 December 2016)

GPs in Scotland have sent a clear message that their workload is unsustainable and is affecting patient care.

A BMA survey has shown that more than nine out of 10 GPs believe their workload negatively affects the quality of patient care.

GPs also believe that they should have more time to spend with patients, with just 7 per cent saying consultation times are adequate.

The Scottish Government said action was already under way to address GPs’ concerns, including additional investment in primary care, and an agreement with the BMA on the future direction of general practice.

The 900 GPs in Scotland who responded to the survey were asked to rank the measures they thought should be top priority to help them deliver general practice.

Almost half (44 per cent) said increased funding for general practice was the top priority, while 36 per cent said the most important thing was to increase numbers of GPs. Almost one in five (18 per cent) said longer consultations should be the top priority.

More than half (53 per cent) believe there should be longer consultations for certain groups of patients, including those with long-term conditions, while four in 10 say that all patients need more time with their GPs ...read more

 

Overwhelmed’ social worker who deflected from struggles sanctioned (Community Care: 9 December 2016)

Conduct panel issues three-year caution after social worker whose team was “fire fighting” fails to prioritise high-risk cases

An experienced social worker who was “overwhelmed” by her workload has been cautioned by the HCPC after she failed to admit she was struggling.

A conduct committee found the social worker, who was a team manager in children’s services at the time, moved a disabled child into a foster placement without a placement planning meeting having taken place and failed to ensure visits were carried out to service users in two high-risk cases that needed urgent action. These matters constituted misconduct, the panel found.

The social worker put the failings down to the pressures and staff shortages in her team which had left her social workers “fire-fighting”....read more
 
 
One third of GP vacancies remain unfilled (British Medical Association: 5 December 2016)

Nearly a third of GP partners in England have been unable to fill staff vacancies during the past 12 months, a BMA survey has found.

Thirty-one per cent of partners responding to the association’s GP survey admitted they had had to put up with vacancies, having not been able to recruit over the year-long period.
 
The survey also found that one in five partners reported their practice taking between three to six months to appoint staff to a vacant posts, while only one in eight said they had had no gaps to fill.
 
Areas with the highest levels of unfilled vacancies include the west midlands and east of England, each at 35 per cent reporting, and the east midlands at 34 per cent.
 
BMA GPs committee chair Chaand Nagpaul said that the figures showed the severity of the staffing crisis adding that, in many cases, locum cover was the only thing keeping such practices ‘afloat’...read more
 

Children’s trust grappling with staff shortages ahead of launch (Community Care: 2 December 2016)

Sunderland council is 79 permanent staff short ahead of the trust's launch in shadow form next year

Sunderland council is stepping up efforts to address staff shortages as its currently 79 permanent staff short of what is needed to run a new trust model launching next year.

The latest council report on plans for the trust, published in October, revealed the council estimates 235 permanent staff are required to deliver the new model but services only had 156 employees. Another 114 staff are currently in agency posts.

The trust will formally take over the running of the council’s children’s services next year, following a negative Ofsted report published last year.

Meeting the recruitment targets was “crucial” to the trust’s organisational performance and cutting agency spending but the council faced high competition from neighbouring authorities, the report said ...read more
 

Risk of doctor training being ‘eroded’ by high workloads (National Health Executive: 2 December 2016)

Doctors in training are increasingly complaining of excessive workloads and workplace exhaustion, leading to warnings from the General Medical Council (GMC) that medical training is being “eroded”.

The GMC annual survey of medical education and training found that 43% of doctors in training described their workload as ‘heavy’ or ‘very heavy’, a 2.3% increase compared to 2012.

Furthermore, 44.5% said they were unsatisfied with their workload, although this represented a 1.5% drop from the rate in 2014. Nearly a quarter of doctors in training also complained of feeling sleep deprived on a daily or weekly basis, a 3.4% decrease from 2012.

Emergency medicine, acute internal and general internal medicine, respiratory medicine, and gastroenterology were among the specialties with the highest workloads.

Charlie Massey, chief executive of the GMC, said: “We know the very real pressures our healthcare services are under and appreciate the challenges organisations involved with the training of doctors are facing, but it is vital training is not eroded.

“Those responsible and accountable for the delivery of medical education locally must take appropriate steps to ensure the training of doctors remains protected. Medical training is so often a bellwether for the quality and safety of patient care and patients are directly at risk if support and supervision of doctors in training is inadequate.” ...read more
 

Staff shortages now outweigh funding fears among NHS leaders (The Nursing Times: 29 November 2016)

Only 27% of NHS trust leaders are confident they have the right staff numbers, quality and skill mix to deliver high quality healthcare for patients and service users.
 
Fewer still, 22%, are confident about having the right staffing levels in six months’ time, reveals the largest ever survey of trust chairs and chief executives.
 
The findings show that, for many trust leaders, worries over staffing are becoming even greater and more urgent than those over funding.
 
The survey was completed by 172 chairs and chief executives from 136 acute, mental health, community and ambulance trusts – well over half of all England’s 238 NHS trusts.
 
It revealed that trusts were struggling to meet a series of workforce challenges, including shortages in key specialties and rising pressure on staff….read more
 

South coast community trust warned over staffing levels (The Nursing Times: 23 November 2016)

Solent NHS Trust has been told to address staffing shortages in its community nursing teams that are putting patients at risk, according to inspectors.

The trust, which provides a range of community services including community nursing, specialist nurses, health visiting and school nursing, was rated “requires improvement” overall, following visits by the Care Quality Commission in June and July this year.

CQC inspectors said they had identified many good areas of care. However, they found staff vacancies were affecting quality and “many services were experiencing difficulties in coping with demand”.

At the time of the inspection, there were significant vacancies in community nursing teams, especially in Portsmouth where rates of medication errors and pressure ulcers were getting worse.

In 2015, the trust reported 151 serious incidents with the majority – 57.6% – in community nursing and linked to pressure ulcers...read more

 

Danger of Scotland's maternity wards revealed (The Express: 22 November 2016)

MORE than 25,000 serious incidents have been recorded in Scotland's maternity hospitals in the past five years, new figures have revealed.

The most serious so-called "adverse events" - defined as incidents which cause harm or have the potential to cause harm - included the deaths of 26 newborns and 79 stillbirths.

Three mothers have also died in such circumstances since 2011, according to the figures revealed under Freedom of Information laws.

The details, accessed by the BBC, showed staff shortages, medicines administered in error and treatment delays were among the incidents logged...read more

 

NHS draws up plans to swap high grade nurses with less qualified staff (The Telegraph: 17 November 2016)

The NHS is drawing up plans to replace nurses with cheaper staff, despite Government insistence that new roles will be used to boost staffing numbers, new plans show.

Health service managers in charge of services in Buckinghamshire, Oxfordshire and Berkshire West intend to save more than £30 million by using more “generic support workers”  and healthcare assistants while cutting back on highly qualified nurses.

The four-year plan – one of 44 being drawn up around the country – follows BMJ research earlier this week which linked increased reliance on nursing assistants to a sharp rise in death risks.

The study raised questions about Government plans to introduce 2,000 nursing associate roles across England. ...Read More.

 
GP closures could leave 5 million people without access to local practice (The Independent: 5 November 2016)

More than five million patients could be left looking for new GP’s after ten per cent of practices in England claimed they were at risk of closing within the next year.

Closures are already at record highs with underfunding and staffing problems given as the main reasons why.

A total of 201 practices have closed in the past year and another 750 may follow suit in the coming months, according to GP Online magazine

BMA GP committee deputy chair, Dr Richard Vautrey, said that although resources were available they are not being spent on where they are needed....read more
 

Number of NHS mental health nurses has fallen by 15% under Tories (The Guardian: 1 November 2016)

The number of mental health nurses working in the NHS has dropped by almost a sixth since the Conservatives came to power in 2010, figures show.

The revelation has sparked fresh doubt that government pledges to improve mental health services are being matched by progress at the NHS frontline.

Philip Dunne, the health minister, has admitted in a written parliamentary answer that while there were 45,384 mental health nurses working in England in 2010, there were just 38,774 in July this year. That fall of 6,610 nurses represents the loss of about 1,000 such specialists a year, or almost 15% of the entire workforce providing that sort of vital care to patients over the last six and a half years.

“This is a very worrying downward trend that shows no sign of turning around, despite all the government’s pronouncements and pledges about equality for mental health care compared to physical health care,” said Labour MP Luciana Berger, the ex-shadow health minister who obtained the answer.

The loss of so many posts meant that patients are at risk of receiving lesser-quality care than before and their recovery is being jeopardised by having less contact time with nurses, who were likely to be busier than ever, Berger warned.

The Royal College of Nursing claimed the figures proved that patients were being let down and ministerial pledges of recent years were not being delivered....read more

 

 
 
600 GP practices at risk of closure, says RCGP (Pulse: 19 September 2016)

Around 600 practices are at risk of closure by 2020 due to problems recruiting GPs, the RCGP has claimed.

These practices all have at least 75% of their GPs aged 55 and over, the college says, which will lead to a shortfall of almost 10,000 GPs across the UK within four years.

It comes as the RCGP has launched a new video campaign aimed at foundation doctors, medical students and sixth-form students.

The campaign is designed to show that general practice is ‘exciting and challenging’, and address the myth that ‘the role of a GP is somehow run-of-the-mill, with family doctors simply treating coughs and colds’....read more

 

Seven-day NHS: Labour demands inquiry as leak reveals crisis warning (The Guardian: 23 August 2016)

Labour is demanding an inquiry into revelations that senior civil servants fear the government’s push for a “truly seven-day NHS” may be derailed because it faces staffing and money problems.

Tom Watson, the party’s deputy leader, claimed that leaked Department of Health documents obtained by the Guardian and Channel Four News showed Jeremy Hunt had misled the public by pushing ahead with expanding the NHS in England despite his own mandarins’ concerns.

“Leaked secret papers show that junior doctors’ concerns were right. This warrants an inquiry. Hunt misled the public,” Watson tweeted in response to the disclosures, which have prompted renewed scrutiny of a policy that the Conservatives have pledged to deliver in full by 2020.

Senior Tories have responded to the publication of the department’s own risk assessment of the seven-day plan and other papers by making clear that they share the civil servants’ previously private worries....read more

 

Secret documents reveal official concerns over 'seven-day NHS' plans (The Guardian: 22 August 2016)

The health service has too few staff and too little money to deliver the government’s promised “truly seven-day NHS” on time and patients may not notice any difference even if it happens, leaked Department of Health documents reveal.

Confidential internal DH papers drawn up for Jeremy Hunt and other ministers in late July show that senior civil servants trying to deliver what was a totemic Conservative pledge in last year’s general election have uncovered 13 major “risks” to it.

While Hunt has been insisting that the NHS reorganise around seven-day working, the documents show civil servants listing a string of dangers in implementing the plan – as summarised by a secret “risk register” of the controversial proposal that has prompted a bitter industrial dispute with junior doctors.

The biggest danger, the officials said, is “workforce overload” – a lack of available GPs, hospital consultants and other health professionals “meaning the full service cannot be delivered”, they say in documents that have been obtained by the Guardian and Channel 4 News.....read more

 

Hospital doctors ‘miss signs of illness’ because of chronic staff shortages (The Guardian: 20 August 2016)

“Dangerous” medical understaffing in hospitals is so rife that signs of illness are being missed, blood tests delayed and newly qualified doctors left in charge of up to 100 patients.

Chronic shortages of medics are also leading to those with little experience of some types of illness taking responsibility for wards full of medically needy patients, or with complex issues, whose conditions they know little about and do not feel qualified to give proper care to, including in intensive care and stroke and surgical units.

A survey of UK doctors, the results of which have been given to the Observer, reveals widespread concern that gaps in rotas were risking patients’ safety. Doctors said they were left stressed and in tears at being “pressurised” by managers to work more shifts to help hospitals cope with rising demand and said their relationships with patients were suffering.

One trainee surgeon said shortages meant a colleague in his first year of training was the only doctor in charge of more than 100 surgical patients overnight....read more

 

Nurse shortage puts children's mental health plan ‘at risk’ (Nursing Times: 19 August 2016)

A government mental health strategy is at risk because most children and young people’s mental health trusts have nurse recruitment difficulties, suggests an independent report.

Experts evaluated whether children and young people’s mental health care had improved since the publication in March 2015 of the government strategy Future in Mind.

The strategy, backed by £1.4bn over five years, aimed to modernise the way children and young people’s mental health services operated and tackle the current treatment gap.

The vision was to move towards a system focused on prevention and early-intervention, where specialist services were integrated with wider health and care support.

The Education Policy Institute think-tank set up a commission in December, which was chaired by Liberal Democrat MP and former health minister Norman Lamb, to assess the progress of the strategy during its first year....read more

 

Cuts to health visitors could have ‘irredeemable’ effects on obesity and mental health (National Health Executive: 17 August 2016)

Leaders from major healthcare organisations have come together to call on the government to halt deep cuts to health visitor posts in order to keep other problems, such as childhood obesity and mental ill health, from escalating further.

In a joint letter to the Times – signed by the CEOs of 11 health bodies, such as the Royal College of Nursing (RCN), Unite, the Royal College of GPs, the RCPCH, the NSPCC and the National Children’s Bureau – professionals said cuts to the Health Visitor Implementation Programme is deteriorating public health.

The government’s Health Visitor Implementation Plan invested enough funds to train more than 4,000 health visitors, a job that plays a “vital and unique” role to prevent ill health and promote healthy lifestyles to children.

But five years on, posts are being cut harshly throughout England, with the latest workforce figures showing numbers have been falling since the beginning of the year – including a significant drop of 433 posts just between March and April.

According to the RCN, anecdotal evidence suggests this drop is “just the start of a significant reduction” in the number of these services due to ongoing cuts to local authority public health budgets.

In the letter, the 11 signatories argued the loss of health visitor posts could have “irredeemable consequences” for children and families, while “stunting the progress of several key government priorities”, from obesity and mental health issues in children and adults to promoting social inclusion....read more

 

Hundreds of adult nurse training places expected to be left unfilled (Nursing Times:5 August 2016)

Universities have recruited “significantly less” numbers of students to adult nurse training places than was planned in recent months, which is expected to leave almost 300 course places empty by the end of the year, the national workforce planning body has said.

In addition, problems with filling district nursing and health visiting courses have also continued....read more

Bursaries for student nurses will end in 2017, government confirms (The Guardian: 21 July 2016)

The government has confirmed plans to end bursaries for student nurses and midwives from next year, sparking anger across the health sector.

Replacing bursaries with loans would free up about £800m a year to create additional nursing roles by 2020 and help more students enter the profession, according to the Department of Health.

However, the Royal College of Nursing (RCN) said the changes were unfair and risky, while the Royal College of Midwives (RCM) argued that the move threatened the future of maternity services in England.

Student nurses, midwives and allied health professionals, including occupational therapists, speech and language therapists, podiatrists and radiographers, currently do not pay tuition fees. They receive a mixture of a non-means-tested bursary, a means-tested bursary and a reduced-rate student loan to help with their living costs. The government-funded Health Education England decides how many student places are available each year.

However, in a move first outlined by then chancellor George Osborne in November, bursaries will be replaced by loans in England to cover tuition fees and maintenance costs. The government claims this will allow the cap on student numbers to be lifted, creating up to 10,000 extra training places this parliament.

Health minister Philip Dunne said two-thirds of those who applied for a university nursing course were not currently offered a place and that the changes would give those in training about 25% more financial support while they studied....read more 

Jeremy Hunt to impose new contract on junior doctors (The Guardian: 6 July 2016)

Jeremy Hunt has said he will impose a new contract on the 54,000 junior doctors in the NHS in England, after they rejected it in a ballot.

The health secretary said the phased introduction of the contract would go ahead as planned from October in order to move on from the uncertainty created by an impasse between himself and the British Medical Association – “a no man’s land that, if it continues, can only damage the NHS”, he said.

He rejected holding any further talks with the BMA, the doctors’ union, pointing out that three years of talks on new terms and conditions for junior doctors had failed to produce a final agreement.

Junior doctors accused Hunt of deliberately choosing the day of the Chilcot report’s publication to confirm that he was pushing ahead with a contract that is deeply unpopular with doctors. One leading junior doctor, who did not want to be named, said Hunt had selected “a good time to bury imposition”.

Hunt made the announcement in an oral statement in the House of Commons a day after the BMA disclosed that junior doctors had defied its leadership’s advice by rejecting – by 58% to 42% – the version of the contract it had agreed with ministers in May and recommended as the best terms that could be secured.

Around 37,000 doctors in training and final- and penultimate-year medical students – 68% of those eligible to vote – took part in the BMA’s ballot....read more

 

Unions attack ‘ill-informed’ bursary reform plans (Nursing Times: 1 July 2016)

Government plans to replace bursaries for student nurses and midwives with a system of loans are “ill-informed” and represent an “unprecedented gamble”, the royal colleges have warned.

Both the Royal College of Nursing and the Royal College of Midwifery have submitted their responses to controversial plans to scrap the nursing bursary and tuition fees payment and replace them with a system of loans.

Under current government proposals, the new system would come into operation from September 2017.

The government has claimed that removing the bursary will free up universities to run as many course places as they can fill, potentially leading to 10,000 additional nursing, midwifery and allied health training places by 2020.

But unions have argued that the plans will saddle future students with large debts and deter many from choosing a career in nursing or midwifery....read more

 

Brexit 'will make NHS staff shortages worse' (BBC News: 30 June 2016)

The vote to leave the EU risks making staffing shortages in the NHS worse, health leaders are warning. The NHS Confederation said doctors and nurses from Europe may be put off accepting jobs after the referendum.

If that happened the NHS could face some major problems, it said. The organisation, which represents health managers, said there were currently 130,000 EU health and care workers in the UK, including 10% of doctors and 5% of nurses.

Elisabetta Zanon, the director of the NHS Confederation's European office, said: "There is a real risk the uncertainty and the falling value of the pound will make people think again.

"If that happens, we could see shortages in some key areas get worse."

A report earlier this year from the House of Commons Public Accounts Committee warned the front line in England may be as many as 50,000 staff short - out of a workforce of slightly more than 800,000 clinical staff.

Ms Zanon also said Brexit could have an impact on medical research and the free healthcare Britons received when abroad. But she said the workforce issue was the most pressing, as the impact could be felt straightaway.

And there were signs this had already started happening, with reports that an EU recruitment drive in West Yorkshire had already run into difficulties....read more

 

The other NHS crisis: the overworked nurses who are leaving in despair (The Guardian: 25 June 2016)

At what point is a qualified nurse – who entered the NHS expecting long hours and low pay – pushed so far that they can no longer carry on? For Stacey, a 27-year-old nurse from Liverpool, it was when she had become so broken that she felt she had lost every one of the “five Cs” that are instilled in nurses during their training: commitment, conscience, competence, compassion, and confidence.

Stacey worked in A&E for five years. When she started, there were 20 nurses on the emergency ward; by the time she left last month, there were 11. Meanwhile, there has been a dramatic increase in patients going to A&E: a rise of 400,000 in a decade. Stacey, like many other nurses across the country, felt she had reached breaking point.

“With A&E, you never know what is coming through the door,” she says. “It has to be very organised. We had three wards – majors, minors and observation – and each is supposed to have at least two nurses. But when I left, we were so stretched that there was often only one. There’s a reason you need at least two.”

She thinks back to her most stressful nights, on the observation ward, which admits patients suffering from problems such as overdoses or brain injuries, who are then observed over 24 hours.

“It was impossible to keep my eye on everyone, and there were times when someone would rapidly deteriorate and I would be too busy with other patients,” she says. On really busy nights, the observation ward became a “dumping ground” for patients with complex medical problems who could not get a bed anywhere else. “It was really tough. There were cases where patients were just put there, and I hadn’t been trained to deal with their problems....read more

 

More school nurses needed to tackle childhood mental health crisis (Royal College of Nursing: 19 June 2016)

At least three children in every classroom now suffer from a mental health problem.

But an RCN survey published today shows that without substantial investment in school nursing it won’t be possible to provide them with effective mental health support.

The number of school nurses has fallen by 10% since 2010 to only 2,700 caring for more than 9 million pupils.

The survey reflects the significant pressure on the current school nursing workforce.

More than two thirds of those surveyed said there were insufficient school nursing services in their area.

Seventy per cent said their current workload was too heavy, while more than a quarter work over their contracted hours every day.

The findings show the current school nursing workforce has neither the staff nor the resources to deliver the support that children and young people need....read more

 

GP vacancy rates at highest recorded with one in eight positions unfilled (Pulse: 1 June 2016)

Around 12% of all GP posts in the UK are vacant, the highest proportion recorded, a Pulse survey has revealed. The Pulse survey of 690 GPs has found that 11.7% of posts are currently vacant, up from 9.1% last year and 6.4% in 2014.

It also reveals that almost half of practices have had to recruit a partner within the past 12 months, taking longer than six months on average. GP leaders told Pulse this is a major reason why practices are closing, while other GPs said they have had to recruit advanced nurse practitioners (ANPs) as they are unable to recruit.

NHS England’s General Practice Forward View acknowledged the difficulties in recruitment, and committed more than £200m on a number of schemes, including recruitment of pharmacists, retention of GPs and training nurses, clerical staff and practice managers.

It comes as official figures have revealed there was a 2% drop in GP numbers last year, while a Pulse investigation has cast doubt on the Government’s pledge to recruit 5,000 extra GPs by 2020. Pulse’s survey on vacancy rates is the most robust study on the issue, and has frequently been cited by official bodies.

This year’s survey has revealed the situation is worse than ever, with more than one in nine posts vacant, despite many practices appointing non-GPs to fill the gaps....read more

 

Patients ‘at risk’ as the anaesthetists shortage is predicted to increase (The Observer: 12 June 2016)

The NHS faces a critical shortage of anaesthetists that could force operations to be delayed and even threaten patient safety, doctors’ leaders have warned.

New research shows that by 2033 every hospital trust will have 10-20 fewer consultant anaesthetists than they will need to meet rising patient demand. It estimates that, while the NHS has agreed that its total of anaesthetists should expand to 11,800 by that date, on current trends it is likely to reach only 8,000 – a shortfall of 3,800, or about 33%.

Anaesthetists play a vital role in preparing patients for surgery and monitoring them, are key members of the medical teams in maternity units and intensive care, and deliver pain relief and resuscitation. They become involved in the treatment of two-thirds of hospital inpatients.

Like many other areas of medical care, anaesthesia already has too few practitioners. Rota gaps – where there are too few doctors to cover every shift in hospital units – are increasingly common.

The Royal College of Anaesthetists (RCoA), which carried out the research, warned that patients and the smooth running of hospitals would be hit if the existing shortfallin numbers was allowed to increase. Dr Liam Brennan, the college’s president, said: “Anaesthetists possess a unique and non-transferable skill set that is essential to maintaining core hospital services, so the potential impact of a reduced anaesthetic workforce would have serious implications for patient safety across the whole NHS. We already have fewer than we need and the shortages are worrying.”

The college’s latest census of the UK’s anaesthesia workforce, the first since 2010, also found that 74% of hospitals already rely on locum anaesthetists hired from medical employment agencies to ensure their rotas are full. The cost of that is part of the NHS’s huge annual bill – £3.7bn a year in England alone – for temporary staff....read more

 

Majority of nurses 'would not have trained without bursary' (Nursing Times: 4 June 2016)

Two thirds of nurses would not have studied to join the profession if they had been unable to receive a bursary for their tuition fees and living costs and had to take out a full loan instead, a survey has suggested.

The Royal College of Nursing, which carried out the survey of 17,000 of its members, warned the findings indicated government plans to scrap bursaries in England next year would put off thousands of potential nurses.

Around 80% of nurses taking part in the survey said they believed the changes would have a negative impact on patient care.

In addition, almost 90% said they either “disagreed” or “strongly disagreed” with the plans, which will apply to all new nursing, midwifery and allied health professionals from August 2017.

The survey also revealed 80% of nurse educators did not agree with the plans....read more

 

Staff shortages cited as factor in delayed discharge (Nursing Times: 26 May 2016)

Workforce capacity issues in health and social care organisations are making it difficult to discharge older patients from hospital effectively, a report has warned.

Across the health and social care system, providers and commissioners said that staff recruitment and retention were a significant cause of delays, according to the National Audit Office report.

It warned that vacancy rates for nursing and home care staff were up to 14-15% in some regions, and fewer than half of hospitals felt they had sufficient staff trained in the care of older patients.

Efforts to speed up discharge was also being inhibited by health and social care organisations not sharing patient information effectively, despite a statutory duty to do so.

While hospitals were financially incentivised to reduce discharge delays, there was nothing similar to encourage community providers and councils to speed up receipt of patients, added the report titled Discharging older patients from hospital...read more

Economists claim there will be a 6% drop in student numbers after bursary scrapped (Nursing Times: 25 May 2016)

Economists have estimated that demand for healthcare courses will drop by at least 6% following the removal of bursaries next year, leading to thousands fewer nurses being trained in 2017.

They also predicted that universities would lose at least £57m next year, largely due to smaller student intakes, under the new arrangements that will see nursing, midwifery and allied health professional students in England having to take out loans to fund their tuition fees and living costs.

Meanwhile, the report – titled The Impact of the 2015 Comprehensive Spending Review on Higher Education Fees and Funding Arrangements in Subjects Allied to Medicine – estimated the government would fail to make the vast majority of savings it expects from the move because a large proportion of student loans would have to be written off.

According to the analysis, carried out by consultants London Economics for Unison and the National Union of Students, the cost to healthcare students to study at university would increase by 71% under the government reforms....read more

 

Why has the NHS deficit ballooned? One word: understaffing (The Guardian: 20 May 2016)

Why are NHS finances in such a mess? The biggest reason is staffing – or, to be more precise, understaffing. The NHS in England is struggling with a serious and growing lack of personnel, especially nurses and some specialist doctors. This is forcing hospital trusts to spend unprecedented amounts of money on locums, especially those supplied by employment agencies, many of which charge what have been described by the NHS England chief executive, Simon Stevens, and the health secretary, Jeremy Hunt, as “rip-off” rates.

The mark-ups these agencies charge takes money away from frontline care. Barts health trust in London – the largest in the NHS – spent about £80m on agency staff in 2015-16, roughly £30m of which was profit for the agencies.

The sharp increase in the bill for agency staff mirrors almost exactly the dramatic decline in the health service’s finances. These personnel cost the NHS £2.5bn in 2013-14, rising to £3.3bn in 2014-15. The bill for 2015-16 was expected to hit £4bn, but new caps on trusts’ agency staff spending, introduced by Hunt last year, brought that down to £3.7bn – a saving of £300m, but still astronomical. There has also been a crackdown on the use of management consultants.

Most trusts have hired extra staff, and increasingly rely on agency workers to fill rotas and wards to standards recommended by Robert Francis’s official report into the Mid Staffordshire hospital scandal,which identified a lack of nurses as a key reason for inadequate care at the trust.

However, Francis’s report was published amid the longest period of austerity in the 67-year history of the NHS, with its 1% annual real-terms budget increases far below the 4% year-on-year rise it had been used to....read more

 

'Almost half' of junior doctors 'will quit the NHS' if contract is imposed (Pulse: 17 May 2016)

Almost half of junior doctors plan to quit the NHS if health secretary Jeremy Hunt’s threatened contract imposition goes ahead, a survey has found.

The survey, launched by a GP trainee and attracting thousands of responses, was designed to gauge the opinions from doctors and medical students about the junior doctor contract row.

The GPC also reacted to findings, branding them ‘very worrying’ and with ’potentially serious ramifications’.

Out of 4,500 replies via kwiksurveys.com in April, 46% of eligible respondents said they would leave the NHS this summer if the contract goes ahead, with 28% saying they would work abroad in countries like Australia and New Zealand; 15% pledging to leave medicine and change career and 3% vowing to leave to work in private healthcare....read more

 

Plan to train NHS nurses to cover for doctors sparks alarm (The Guardian: 17 May 2016)

A plan to train nurses to stand in for doctors as a way to tackle the hospital staffing crisis has caused alarm among doctors and patient groups.

A report by the Nuffield Trust, commissioned by NHS Employers, recommends giving extra training to nurses and other support staff to give them “advance practice roles” or “physician associate” status.

It says this will provide a relatively quick solution to the current shortage of doctors and help ease the workload of more qualified medics.

Junior doctors have said the idea is dangerous while the Patients Association said it should be regarded as a quick fix to plug the NHS’s workforce gap.

The report claims that retraining staff “could provide a cost-effective and rapid solution to mitigating some of the pressures on more senior staff”.

The report envisages a new tier of medical staff between doctors and nurses. “Physician associate represent a new cadre of staff with the potential to address a number of workforce challenges,” it says.

The Patients Association said such proposals should not be seen as a cheaper alternative to hiring highly qualified staff.

Junior doctors, who are involved in a dispute with the government over a new contract, said the plans would put patients’ lives at risk....read more

 

Seven-day NHS plans fail to address staffing needs, say MPs (The Guardian: 11 May 2016)

There has been “no coherent attempt” to assess how many staff will be needed to ensure that a seven-day NHS can function, parliament’s spending watchdog has found. 

A report by the public accounts committee says the Department of Health (DH) has not yet worked out if the current supply of staff can adequately meet demand in the health service in England.

“National bodies need to get a better grip on the supply of clinical staff in order to address current and future workforce pressures,” it concludes.

The report will be seized upon by critics of the health secretary, Jeremy Hunt, whose long-running dispute with junior doctors is based on claims that there needs to be more staff working on weekends to ensure patient safety.

MPs add that the DH has failed to assess the staffing implications of the Tories’ pledge for a seven-day NHS....read more

 

Hunt: staff shortage due to excessive 'optimism' (BMA: 10 May 2016)

Health secretary Jeremy Hunt has admitted successive governments — including his own — have failed to train enough staff to satisfy the needs of the NHS.

Speaking during health questions in Commons, Mr Hunt blamed the rocketing NHS agency bill, which drained the service of £3bn last year, on an ‘optimistic’ view of how few staff could safely manage a ward.

Mr Hunt (pictured) claimed to be taking action to decrease the vast costs — suggesting the agency cap implemented by the Government last year, which gives hospitals a defined limit on spending with agencies, would save £1bn a year.

Answering a question put to the house, which asked what the Government’s plans were to reduce agency spending, the health secretary said: ‘We’ve taken tough measures to control unsustainable spending on agency staff. Agency spending is now falling.’

Mr Hunt was pushed to respond further by Southport Liberal Democrat MP John Pugh, who said: ‘I don’t share his [Mr Hunt’s] optimism.

‘The real problem is the shortage of permanent staff.’...read more

 

Trust blames 'bad behaviour' of neighbouring providers for staff shortage (HSJ: 4 May 2016)

A financially stricken foundation trust has blamed “bad behaviour” of neighbouring trusts breaking agency spending caps for its staff shortages.

Doncaster and Bassetlaw FT has been forced to suspend inpatient admissions and transfer patients to other hospitals.

In a board briefing last week, chief executive Mike Pinkerton warned the lack of locum agency staff to fill rotas “now poses an escalating continuity of services risk” to the trust. He has complained directly to local trusts and NHS Improvement over the issue.

Papers show staffing became a particular problem in the trust’s Doncaster and Worksop emergency departments following the agency caps being brought down again in February, with staff leaving to “surrounding trusts as a result of them breaking c

Key Facts

Since the Coalition came to power in 2010 the NHS has lost as many as 6000 nursing posts.

Paramedics stress-related sick days increase by 28% between 2012 and 2014

Hospital staff absences for mental health reasons double

Key Trends:

Between May 2010 and July 2012: the total NHS workforce decreased by 2%.

Within this change:

The number of doctors rose by 7.5%, qualified midwives by 5%, and qualified scientific, therapeutic and technical staff by 2%.

The number of qualified nurses decreased by 2%.

Largest decrease in NHS infrastructure support at 9%

A decrease in support to doctors and nursing staff by 2.5%.

  

 

Health and Social Care Information Centre Workforce Statistics
 
 
 
"The latest statistics show that the cuts to NHS staff show no sign of slowing down" Peter Carter, chief executive and general secretary of the Royal College of Nursing
 

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