Our nurses are being cast into a perfect Brexit storm

https://www.theguardian.com/commentisfree/2016/oct/24/nurses-brexit-cuts-eu-staff-nhs-crisis

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Hardly anything in Britain is untouched by the Brexit vote. With the country angrily wrenched apart, this has caused the greatest political, social and cultural rift of our life-time. But in few places is the hurt felt more deeply than inside the NHS.

More than 55,000 EU nationals work as doctors and nurses in a health service that would collapse without them. In the midst of a severe nursing crisis, what inexplicable stupidity not to give a cast-iron guarantee that all those working in the NHS can stay for ever, welcoming any more who wish to come. What kind of “bargaining card” is the threat to throw out people we absolutely cannot do without?

Companies that recruit abroad on behalf of NHS trusts are full of anxiety. Take TFS Healthcare, which recruits nurses for UK hospitals from Spain, Portugal, Romania, Poland and Italy. Ben Cambage, the managing director, says his company is “already seeing the impact of the Brexit vote. A lot of nurses from these countries have now been put off coming to the UK.” He says it’s “even more concerning” that nurses already placed in UK hospitals are seriously considering leaving as they no longer feel wanted or welcome. Many feel very passionately about the racially aggravated crimes since the referendum vote. “Tensions are high,” he says, and “one of our international consultants had to convince one of her Romanian nurses not to lead a mass walk-out of EU staff at her hospital.” Add to that a far more stringent language test now to be imposed on foreign nurses, and many fewer may come.

The reason we need so many foreign nurses is that after 2010, the number of UK nurse training places was cut, with the gap filled from abroad. Jeremy Hunt boasts of 10,000 extra nurses employed under his government, but that’s thanks to importing nurses to cover for training cuts. In 2015 Health Education England was training 3,100 fewer nurses than a decade ago, a 19% cut. The public accounts committee was told that 2015 saw the lowest output of qualified nurses in recent times. Add to that the attrition rate: only 60% of the newly trained enter the NHS, as the long-enforced 1% pay cap means they can earn more in other occupations.

Since 2010 nurses’ workloads have risen steeply: there are 31% more hospital admissions, 45% more procedures and 22% more patients in A&E. But the number of nurses has only risen by 9%. After pay, the other reason nurses cite for leaving is the pressure of work due to lack of staff, a self-perpetuating downward spiral. HEE finds a shortfall of 7.2% nurses, midwives and health visitors; their failure to train enough has left the NHS relying on foreign recruits.

The John Radcliffe hospital in Oxford is just one of many struggling with the nursing crisis. Mark Power, its director of human resources, has written a detailed report warning his board that the present 10% vacancy rate in the Thames Valley area may worsen following the Brexit vote. In 2015 his hospital brought in 448 EU nurses who are now “concerned and uncertain” about their future. Inability to recruit and retain EU staff has become “a significant strategic risk”. It cost the trust £1.4m last year to recruit from the EU, so why risk them leaving now? His report calls for “prompt action at a national level” to stop them leaving.

Now add to this crisis the abolition next year of bursaries for nurses in training. Like other students, they will have to take out loans and accumulate large debts. The government claims this would allow universities to create some 10,000 more training places: currently they are turning away 37,000 applicants. But the fear all through the NHS is that instead new trainees will be deterred.

The John Radcliffe’s chief nurse, Prof Catherine Stoddart, fears many will be discouraged. “I worry about the older ones, as a third of our trainees are healthcare assistants who train up for a full nursing qualification. They have to give up their pay while they train as it is, and they will be reluctant to take on debts as well when they have families and high living costs in this area. Those with experience are the most valuable recruits and we can’t afford to lose them.”

Another inexplicable act of vandalism is new deep cuts – up to 45% - in nurses’ post-registration specialist training. A report by the Council of Deans of Health warns how much worse this “short-sighted” closure of courses will make already acute shortages in specialisms, such as A&E, intensive care, diabetes, cancer and palliative nursing. Professor Stoddart says for her hospital, offering specialist training is what helps keep good nurses.

As trusts plunge deeper into debt, they have also been reproved by their regulator for the rising pay bill

Ask her about her EU nurses and the way she brims with extravagant praise betrays her anxiety following the referendum: “They make a huge contribution with very strong skills that lift the standard of our own. Our best nurses have worked all over the world.” They’re worried, she says. “Since the vote, we have organised special lunches for them to reassure them and say how much we want them to stay. There’s a risk they will go home in the present climate. Our patients worry too, asking them: ‘Where are you from and are you going home?’”

Hospitals are caught in a crunch: the Care Quality Commission has pressed them to increase the numbers of nurses on each ward ever since the 2013 Francis report into the deaths of more than 400 people who received poor care in Mid Staffordshire. On the day I visited, the CQC suddenly descended for an unannounced inspection. Yet, as trusts plunge deeper into debt, they have also been reproved by their regulator, NHS Improvement, for the rising pay bill. Last week the Health Service Journal asked Hunt how trusts can square this impossible circle between safe staffing and balancing the books. He gave one of his famous magical replies: trusts need to look beyond that “binary choice”, he said. How? No one knows.

He could at least demand that the three Brexiteer ministers immediately embrace all EU health service staff; tell them they will always be welcome here before they up sticks and go home, or follow the trail of British-trained nurses already heading to better paid, less stressful jobs in the US and Australia.

The alternative is a nursing shortage, caused directly by government cuts and strategic failure, turning into another perfect Brexit storm.