The nursing profession in the UK is desperately grappling with a shortage crisis because of the complex combination of increasing industry demands, proposed changes to nursing student funding and the impact on employment after Britain’s exit from the European Union – or Brexit.

Adding to problems is the recently leaked new plans that revealed up to 7,000 nurse posts could be axed from National Health Service (NHS) hospitals across the country despite a surging Accident & Emergency crisis. The forecasts by Health Service Journal also disclose that the plans rely on a dramatic reversal in trends which have seen casualty units under unprecedented pressure.

Shortage crisis has multiple causes

The main factor causing increased demand of nurses is higher levels of hospital admittance due to an ever-aging population and more pressure on A&E services, especially during the winter months. Additionally, a scandal at Stratford Hospital in 2013 has resulted in a safe staffing recommendation issued to all hospitals.

The scandal found that between 400 and 1,200 patients had died as a result of poor care between January 2005 and March 2009. Although the recommendation does not specify a staff-to-patient ratio, it does suggest that patients are at increased risk if the attending nurse has to care of more than eight patients in a ward.

A rapidly decreasing workforce that cannot be easily replaced is the second part of the problem. Excessive work pressure, disillusionment with the profession and long schedules mean that huge numbers of qualified nurses are simply leaving; taking up other jobs and careers. Additionally, The Royal College of Nursing found that 50% of nurses are aged 45 or over and eligible to retire within ten years.

However, while A&E attendances across England have actually risen by 4.5% and emergency admissions by 3.5% in the past year, the plans rely on a 4.2% fall in attendances, and a 0.8% drop in admissions.

Proposed solutions and their setbacks

Posts that cannot be filled by permanent staff are filled with expensive, temporary agency staff and recruitment from overseas. However, Brexit has generated fears that the supply of nurses will cease, prompting the government to relax rules and grant 15,000 visas for European nurses, over the next three years.

Nursing is now on the Migration Advisory Committee’s Shortage Occupation List meaning, international professionals can be recruited to meet the deficiency. The NHS is therefore recruiting nurses and other healthcare workers from India and the Philippines. Currently, foreign nurses make up 40% of new nurses.

Last year, the government took steps to implement a plan to replace bursaries given to nursing students, with a loan and the announcement was met with much criticism. More than 20 charities and professional bodies sent an open letter to former Prime Minister David Cameron voicing their opposition and called the move reckless. Should it be implemented, nurses will begin work with debts of more than £50,000, which will only serve to further reduce the number of individuals applying to become nurses.

Supply and demand balance yet to be found

Ian Cumming Chief Executive of Health Education England has stated, “We are predicting that we will have supply and demand right for nurses for the NHS by about 2019/2020, but it does leave us with a gap between now and then.

Training to be a nurse takes more than three years, so when demand rises significantly and quickly, the supply of trained nurses available cannot respond at the same rate.

Using agencies is very expensive and last year cost the NHS £23.5 million. Marilyn Eveleigh, nurse advisor and trainer, suggests that nurses could return to fill shortages, if they are provided with adequate incentives.

She suggests redirecting the money spent on international recruitment and agencies into financial incentives such as paying for relocation costs and student loans. Eveleigh also advocates for recognition that 90% of nurses are female is important because they have caring responsibilities and flexible working schedules are therefore necessary. The government funded return-to-practice initiative between 1999 and 2004 resulted in 18,500 former nurses returning to work.

Nigel Edwards, chief executive of think tank the Nuffield trust, suggested the plans were unrealistic.

“Demand has been going up by around 4% a year for around two decades and the demography of the next three to five years is characterised by the population ageing rapidly and growing - with a bulge in the group that uses healthcare most,” he said.

With more than 23 hospital trusts and 20 hospitals announcing a black alert last week because they could not deal with the vast number of patients safely, the government and NHS might do well to consider trying all options to save the UK’s public health service. MIMS

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