Shortages of staff are widespread within the NHS and exist across all disciplines.
To protect the patients the NHS must have the right number and mix of staff, with the right level of education, qualification and experience. Numerous studies show that low nurse staffing levels were associated with higher rates of falls and deaths. The Keogh review into hospital mortality rates found inadequate numbers of nursing staff in a number of ward areas, particularly at night and at the weekend. The Berwick review into patient safety found that inadequate staffing levels are an early warning sign of poor quality and safety problems. The review also found that general medical or surgical wards with fewer than one nurse to eight patients, plus the nurse in charge, may increase safety risks substantially.
The Guardian (13 Dec 2017) reported that the shortages are now so acute that:
• The NHS is short of 42,000 nurses, midwives, physiotherapists and occupational therapists. Health Education England, the NHS’s staffing agency, also warns that the health service workforce will need to increase by 190,000 by 2027 unless the rise in illness recedes.
• A widespread lack of nurses is most severe in London, where 15% of posts are vacant, and lowest at 8% in the north-east.
• There are 1,674 (26%) fewer district nurses and 842 fewer learning disability nurses than in 2012.
• GP numbers have fallen by 1% over the last five years despite a key government pledge to increase the total by 5,000 between 2015 and 2020.
• Almost one in three paramedic jobs are vacant across England.
• The number of nurses leaving the profession rose from 7.1% in 2011-12 to 8.7% last year.
In February 2016 the BBC reported figures on vacancy rates across England, Wales and Northern Ireland obtained from freedom of information requests. The research found that: between 2013 and 2015, nursing vacancies rose by 50%, from 12,513 to 18,714; for doctors, the number of vacancies went from 2,907 to 4,669 – an increase of roughly 60%; in England and Wales, there were 1,265 vacancies for registered nurses in emergency departments – about 11% of the total; for consultants in emergency medicine there were 243 vacancies – 11% of the total; and for Paediatric consultants – 221 vacancies – about 7% of the total.
Such is the problem of staff recruitment and retention that there are new examples almost weekly of trusts struggling to find staff and having to close beds or suspend services and CQC reports highlighting problems with staffing and recruitment, this is just a selection that got reported in March 2016:
- North Staffordshire Combined Healthcare NHS Trust was given an official warning about community mental health services for young people, after inspectors found there were not enough staff to provide quality care. In this case there were not enough nurses, consultant psychiatrists, psychologists or therapists;
- Norfolk and Norwich University Hospitals NHS Foundation Trust were told by the CQC to address serious nursing staff shortages, after inspectors found poor staffing levels were affecting patient care;
- A local MP highlighted that the CQC had identified serious concerns about staffing levels following inspections in 2014 and 2015 at Mid Yorkshire Hospitals NHS Trust;
- Barnet, Enfield and Haringey Mental Health NHS Trust was told by the CQC that it “requires improvement”, especially the need to solve a “substantial problem” with recruitment.
A shortage of nurses
There is a major issue with nurse recruitment and retention. Although the overall number of nurses employed in the NHS has increased, in the face of increased demand there is still a shortage of nurses. According to Government figures there are an estimated 12,500 full-time equivalent nurse vacancies. A 2016 survey from the NHS Employers organisation found that 93% of trusts had a shortage of nurses.
In March 2016 the independent Migration Advisory Committee criticised the Department of Health, Health Education England and NHS trusts noting that the nationwide shortage of nurses has been driven by a desire from the government to save money. The report also noted that these organisations did not recognise obvious warning signs over a number of years and highlighted that similar financially driven decisions were being made again. The committee revealed that Health Education England would have commissioned 3,000 extra nurse training places for 2016-17, but financial cuts following November’s spending review meant it commissioned only 331 extra places.
As trusts have such difficulties finding permanent staff they have been forced to spend vast sums on agency staff. In an effort to counter this cost, at the end of 2015 the Government imposed caps on hourly rates of pay for agency nurses. However by March 2016 acute trusts in England had overridden these pay caps more than 60,000 times, according to an investigation by Nursing Times.
Not enough midwives
There is a serious issue in the NHS with the shortage of midwives. According to the October 2015 survey of Heads of Midwivery (HoMs) carried out by the Royal College of Midwives (RCM), staff shortages are leading to unit closures, reduced services, and large sums being spent on agency staff. Well over a quarter of HoMs – 29.5% in 2014 and 29.6% in 2015 – reported that they simply did not have enough midwives. The shortage of midwives in England remains critical with the country still short of 2600 full-time midwives.
As a result of staff shortages and increased demand temporary unit closures are common – 32.8% in 2014 and 41.5% in 2015 – with units closing their doors on average on 6.6 separate occasions in 2014 and 4.8 separate occasions in 2015. The most times a single unit closed in a year was 33 times (2014) and 23 times (2015). In addition, staff shortages, as well as inadequate funding, is leading to a reduction in services. A tenth of HoMs – 10.9% in 2014 and 11.0% 2015 – reported that they had to reduce services in the last year. This included reductions in specialist midwives, fewer parent classes and less bereavement and breast feeding support.
One consequence of the shortage of midwives is the increased use of agency staff. A report published by the RCM in January 2016 concluded that the “costs of agency staff are spiralling out of control”. The report based on freedom of information requests sent to trusts around the country, produced some shocking statistics: the spend on agency midwives increased almost 76% from 2012 to 2014; there were eleven trusts that spent over £1 million on agency midwives in the three year period with one trust spending £4,482,432 on agency midwives between 2012-2014; and the spend per hour of £49.01 on an agency midwife is more than 2.7 times the amount for a permanently employed midwife and more than 1.8 times the amount of paying overtime.
A lack of GPs
There are widespread problems with both the training and recruitment of new GPs and the retention of current GPs. In 2014 the Government promised 5,000 extra GPs by 2020, however it is highly unlikely that anywhere near this number will be added to the workforce. In March 2016 an analysis by Pulse found that not even half that number will be added to the workforce. Pulse calculated that, unless there are some drastic changes, the Government is on course for “increasing the workforce by 2,100 in the best case scenario.” The GPC stated that it showed the Government’s pledge to be “wholly unrealistic”.
Over the last three years the GP sector has been characterised by practice closures and increasing difficulties of recruiting staff. Figures compiled in May 2015 by Pulse show that in England, Scotland and Wales, 61 practices have closed since April 2013 which has forced more than 160,000 people to register somewhere new. Whilst data released by the Government in 2014 showed that more than 500 practices had closed between 2009 and mid-2014. These also include practices lost through mergers and takeovers. Since these figures were released the situation has got steadily worse. In February 2016, a survey of GP practices in London found that almost one million people in London could lose their GP in the next three years. In April 2016, a survey found that almost 90% of GP practices are struggling to find locums to cover shifts. In the BMA survey of almost 3,000 GP practices it was found that just one in ten GP practices in England is able to get by without locum cover.
To make matters worse almost one-third of GP training places remain vacant after the first round of recruitment in 2016. The final figures after the first round of recruitment for August 2016 showed that 2,296 of places were filled across the UK – 70% of all places.
Too few hospital doctors
There are problems in the recruitment of all levels of hospital doctor. The current situation with the junior doctor contract will inevitably lead to junior doctors leaving the NHS. It was reported that the number of doctors who applied for documentation to work abroad surged by over 1000% the day Jeremy Hunt announced he would force a new contract on them: 300 doctors applied for Certificates of Good Standing on Thursday 11 February – up from an average of 26 a day in February before the announcement.
Data from the Royal College of Physicians (RCP) in March 2016 revealed that hospitals are facing such chronic shortages of medical personnel that 40% of senior doctors’ posts remained vacant. NHS hospital trusts are finding it impossible to fill key posts because of a lack of consultants equipped to do the job, according to the RCP’s latest annual audit of doctors working in hospitals. In addition, the shortage of trainee doctors is so serious that one in five members of the RCP, believes that patient care is compromised.
Problems recruiting A&E consultants has led Scarborough Hospital, run by York Teaching Hospital Foundation Trust, to consider running an A&E department without consultants in order for its service to be sustainable. In April 2016 it was revealed that Lancashire Teaching Hospitals Foundation Trust had to downgrade one of its A&E departments due to a crisis in locum doctor recruitment.
Not enough mental health professionals
Mental health services are experiencing staff shortages across the board – nurses, therapists and psychiatrists. According to a report leaked to The Guardian in February 2016, overseen by Paul Farmer, chief executive of the mental health charity Mind, staff shortages are a serious issue in mental health services. In some parts of the country, more than 10% of children seeking help are having appointments with specialists cancelled as a result of staff shortages, yet one in 10 children and young people have a diagnosable mental health problem. Under-18s in particular have been badly hit, with the numbers arriving at A&E departments with psychiatric conditions rising to nearly 20,000 a year –more than double the number four years ago. The chief cause is an absence of out-of-hours community care for vulnerable under-18s, with children being advised to attend A&E after 5pm.
In March 2016, North Staffordshire Combined Healthcare NHS Trust was given an official warning about community mental health services for young people, after inspectors found there were not enough staff to provide quality care. In this case there were not enough nurses, consultant psychiatrists, psychologists or therapists.