Failure to train enough nurses proves very costly for NHS

PUBLISHED: 06:30 25 February 2015 | UPDATED: 08:44 25 February 2015

The Tilney Ward at the Queen Elizabeth Hospital, King's Lynn. Picture: Ian Burt.

The Tilney Ward at the Queen Elizabeth Hospital, King's Lynn. Picture: Ian Burt.

Archant © 2011

Hospitals in the East of England have hundreds of nursing vacancies and are spending millions of pounds on trying to plug the shortfall.

Recruiting nurses from abroad

In 2014, nearly three-quarters (72pc) of hospital trusts went abroad to recruit nurses, ranging from India, the Philippines and European countries, compared to 50pc in 2013.

NNUH recruited in Spain and Portugal, while JPUH recruited from Porto and Rome and the QEH recruited in Spain.

Karen Webb, RCN director for the eastern region, said while the NHS has always relied on staff from overseas, healthcare is now a global labour market and most developed countries have shortages of skilled healthcare professionals.

She said: “In recent years we have seen an net outflow of UK nurses who have left this country to go and work in places like Australia, New Zealand, Canada, and the US.

“At the same time the numbers of UK nurse training places were cut by the Government at a point when demand for registered nurses was rising. This is a failure of planning that is costing the NHS dearly.”

Information obtained by the Royal College of Nursing in the East of England shows a 69pc rise in agency nursing expenditure across the region by £20m and a 26pc growth in the number of nurse vacancies across the region.

The data shows that many hospitals are struggling to recruit permanent staff and are having to spend increasing amounts of money on temporary staff to look after patients and increasingly looking overseas to recruit nurses.

Acute hospitals were asked under the Freedom of Information Act for registered nurse vacancies, nurse agency spend and overseas recruitment during 2014.

RCN director for the eastern region, Karen Webb, said: “The cost of central government’s failure to plan properly for the NHS’s workforce needs is proving cripplingly expensive.

Changes in nursing

50 years ago, nurses were female, wore starched aprons with cotton caps, were taught hospital etiquette and lived in fear of their ward sister and matron.

Now one in ten nurses are men and they need to be qualified professionals with degrees as well as a decent bedside manner.

The government says the aim of getting all nurses to university before they step onto a hospital ward is to increase skills and train a medical workforce capable of operating in a more analytical and independent way.

But many feel nursing is a vocational career and a degree is pointless piece of paper which does nothing for the profession.

On-the-job training transformed into diplomas and then into degrees to make nursing more attractive to young people who want a qualification which will reap higher salaries and more senior roles.

But NHS bosses hope as the profession evolves, the common values of compassion, dignity, and respect to good nursing practice remain unchanged.

“Through no fault of their own, NHS trusts in our region are scouring the globe looking for nurses and, in the meantime, having to make do with the sticking plaster approach of using expensive agency nurses.

“It’s not good for patient care and it is the most inefficient and most expensive way to try and staff wards.”

Towards the end of last year, the RCN revealed that the UK had become a net importer of nurses for the first time in eight years.

The Nursing and Midwifery Council (NMC) figures showed that in 2013/14 there were 6,228 nursing registrations from abroad – an increase of nearly 45pc on the previous year. In the same year 4,379 nurses left the UK to work overseas. This was the first time since 2005/6 that the UK has registered more nurses from overseas than have left to work elsewhere.

A Norfolk nurse has said the profession is almost unrecognisable since he started 40 years ago.

The nurse, who does not want to be named, said his hospital is sometimes “desperate” for staff.

He said NHS bosses are not training enough nurses to do the work, which often is taken over by admin-based tasks.

“There are so many tick-boxed these days,” he said. “There’s a massive amount of paperwork to do and everything is done by the computer.

“There’s more and more paperwork to do than looking after patients. There are now so many targets and a lot of budget restraints.”

Since he joined the NHS in the 1970s, the nurse said the joys of the job have always been the same – caring for people.

But he said for new recruits, the prospect of working under mounds of paper-work is not an appealing one.

“If we are spending so much time under pressure, it’s not attractive,” he said.

“The amount of time taken up with admin means we can only be in one place at a time. We are trying to do as many things as we can but it’s not possible to always do that.”

A series of reports by experts such as Sir Robert Francis and Sir Bruce Keogh have highlighted the vital importance of safe staffing, leading to desperate recruitment drives by trusts. However, cuts to nurse education placements in previous years have caught up with the NHS, causing a shortage of home grown nurses.

The RCN says the situation is likely to get worse, with student places still lower than they were in 2003, despite recent increases, combined with an ageing workforce - 46pc of nurses working in the NHS in England are now aged 45 or over.

The Norfolk and Norwich University Hospital’s spending on agency nurses rose by 63pc in a year to £2.17m in 2013/14.

Director of workforce Jeremy Over said: “We use agency nurses as a last resort to help ensure we have the right numbers of nurses on duty in addition to our own staff, of which we have just over 2,000 registered nurses with a vacancy rate of around 6pc which is a relatively small number considering the size of the hospital. We have recently interviewed for a number of nursing posts and have been delighted to offer a significant amount of positions to a number of UEA students to begin later in the year.”

Spending by the James Paget University Hospital fell by around £500,000 to just over £1m.

Liz Libiszewski, director of nursing, quality and patient experience, said the trust uses its own bank nurses and works with matrons and ward sisters to respond to fluctuations in demand for care.

She said: “The JPUH operates with few nursing vacancies and the use of external temporary nursing staff is only considered once all other options have been exhausted.” She added: “We are undergoing an extensive recruitment drive, including recent overseas visits to Portugal and the Philippines, to ensure that we are able to fill available nursing vacancies.”

The Queen Elizabeth Hospital, King’s Lynn hopes to recruit 60 nurses from the Philippines and 71 nurses from the EU this year and last month held a nursing recruitment event in Lynn. Further recruitment days will take place in March in Swaffham, Downham Market and Wisbech, dedicated to seeking registered nurses, physiotherapists and occupational therapists.

Catherine Morgan, director of nursing at the QEH, said: “Following the trust being placed in special measures, and issues which emerged from the Francis report around improving nursing levels, the decision was taken to secure more agency and bank staff in the short term whilst a skills mix review and recruitment programme was developed.

“The trust has since increased its number of nursing staff and is currently running a successful recruitment programme.”

The shortage of nurses is another pressure on an increasingly stretched NHS system. Winter demands have seen hospitals forced to cancel routine operations, while A&E waiting times have increased, and staff struggle to discharge patients due to a lack of suitable care in the community. Long turnaround times at hospitals have caused problems for the region’s ambulance service and hospitals have been full to capacity.

Statistics published this week show the James Paget University Hospital was 100pc full on 14 of the 22 days when its capacity was checked in January.

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