“Shield the NHS” has been a recurring message that has formed the UK’s response to COVID-19. The hazard that the pandemic may overwhelm the NHS has by no means been far out of sight. As we strategy the five-day leisure of restrictions for Christmas, the query of whether or not the NHS will have the ability to cope is as pertinent now because it was in March.
What has turn into obvious is that the key restrict to therapy capability shouldn’t be the variety of hospital beds, nor even the variety of intensive care beds with ventilators, it’s the variety of appropriately expert nurses obtainable to offer care. The pandemic has uncovered an achilles heel: a deficit in nursing.
This isn’t a brand new downside. Round 10% of positions for registered nurses within the NHS have been vacant when the pandemic first hit. Evaluation from the charity the Well being Basis has discovered that over the past ten years, NHS exercise (the variety of sufferers seen and care supplied) has risen 12 months on 12 months, however with no corresponding rise within the nursing workforce.
Between 2010 and 2017, the variety of nurses within the NHS barely modified. From 2017 to June 2020 there was a 4.8% rise, however the hole between quantity of the work to do and nursing numbers has continued to widen. Because the scarcity of registered nurses persists, the NHS has employed bigger numbers of help employees, comparable to nursing and healthcare assistants. Previously 12 months, the expansion in help employees has been twice that of registered nurses.
A harmful state of affairs
Analysis factors to the dangers of not having sufficient registered nurses on obligation. A nine-country examine from 2014 discovered that rising a nurse’s workload by one affected person elevated the chance of a affected person dying by 7%. And in our personal analysis, my colleagues and I discovered that when staffing ranges have been decrease, nurses in England have been extra prone to report that needed care was left undone.
Additional evaluation, led by the College of Southampton, discovered that the quantity of “care left undone” contributes to the danger of surprising dying amongst hospital sufferers. Additionally, hospitals counting on decrease ranges of registered nurses and better ranges of lesser-trained help employees have increased mortality charges.
The dangers of low nursing numbers have been highlighted by the Francis Inquiry in 2013. Reductions in nurse numbers – made in earlier years to attain short-term financial savings – had not taken into consideration the dangers to sufferers. The inquiry revealed the dearth of coverage or requirements on nurse staffing ranges and advisable that nationwide tips be developed, based mostly on analysis. The Nationwide Institute for Well being and Care Excellence (Good) subsequently revealed tips on “secure staffing” in 2014.
The inquiry and the Good tips succeeded in elevating consciousness of the necessity to have ample registered nurses on obligation. When surveyed in 2017, three-quarters of chief nurses mentioned that help from NHS boards for bolstering the nursing workforce had risen because the inquiry.
Nonetheless, unsafe staffing ranges endured in lots of NHS trusts, primarily as they have been unable to recruit the registered nurses wanted. Coverage had succeeded in motivating a want for secure staffing however had not created the funding within the nursing workforce wanted to ship it.
Plugging the hole
In December 2019, the UK authorities recognised the necessity to tackle this long-term nursing scarcity. It pledged to extend the variety of registered nurses within the NHS by 50,000 by 2024-25. However how possible is that this goal?
Curiosity in nursing has elevated; 23% extra college students have been accepted onto nursing programs in England in 2020 than in 2019. The variety of candidates rose sharply after March 2020 – the profile of nursing having been doubtlessly heightened by COVID-19.
However the UK’s home provide of nurses per head of inhabitants is properly under the OECD common and is inadequate to fulfill demand. So the NHS depends on nurses from overseas to make up the distinction. A 3rd of nurses first coming into the UK register in 2019-20 educated outdoors the UK. In complete, 15% of the UK’s registered nurses educated elsewhere – greater than double the OECD common.
To realize the federal government’s goal, the Well being Basis notes that England will want to have the ability to recruit a median of 5,000 nurses a 12 months from outdoors the UK between now and 2025. With Brexit ending the free motion of labour to and from the EU, and COVID-19 inflicting journey disruptions for the foreseeable future, this can be difficult.
The Well being Basis additionally notes that rising home provide is a should. To do that, we’ll want to extend college capability and repair the dearth of medical placements for college students, that are typical bottlenecks. The Council of the Deans of Well being, which represents UK universities that educate nurses, has proposed providing simulation-based medical expertise – utilizing lifelike digital environments, mannequins, role-playing and educated actors to duplicate treating actual sufferers – in addition to lowering the full medical hours wanted to qualify as a registered nurse (the required hours within the EU are double these wanted to qualify within the US and Australia). We additionally want to take a look at increasing the sooner two-year graduate entry programme.
Reaching internet development can even require decreasing the variety of nurses leaving the occupation. Round 33,000 (10%) nurses exit the NHS annually, many citing “an excessive amount of strain” because the trigger. Arguably a modest oversupply of nurses is what we needs to be aiming for, as this reduces the prices of excessive turnover and reliance on short-term cowl.
Assembly the 50,000 goal is a starting, not an finish. Setting a top-down goal represents a political try to galvanise a system that has been failing for years to coach and retain the nurses it wants, counting on one short-term repair after the following. COVID-19 has uncovered a nationwide deficit in nursing expertise that can require longer-term imaginative and prescient, sturdy plans based mostly on correct information, and funding to resolve.