COVID has exposed a prolonged shortage of nurses that is putting NHS patients at risk

“Protect the NHS” has been a recurring message that has shaped the UK’s response to COVID-19. The danger that the pandemic could overwhelm the NHS has never been far from sight. As we approach the five-day relaxation of restrictions for Christmas, the question of whether the NHS will be able to cope is as pertinent now as it was in March.

What has become apparent is that the main limit to treatment capacity is not the number of hospital beds, not even the number of intensive care beds with ventilators, it is the number of properly trained nurses available to provide care. The pandemic has exposed an Achilles heel: a deficit in nursing.

This is not a new problem. About 10% of registered nurse positions in the NHS were vacant when the pandemic struck. Analysis by the charity The Health Foundation has found that over the past ten years, NHS activity (the number of patients seen and the care provided) has increased year over year, but without a corresponding increase in the nursing workforce. .

Between 2010 and 2017, the number of nurses on the NHS hardly changed. From 2017 to June 2020 there was a 4.8% increase, but the gap between the amount of work to be done and the number of nurses has continued to widen. As the shortage of registered nurses persists, the NHS has employed an increasing number of support staff, such as nurse aides and healthcare workers. Last year, the growth of support staff was twice that of registered nurses.

A dangerous situation

Research points to the risks of not having enough registered nurses on duty. A 2014 study of nine countries found that increasing a nurse’s workload on a patient increased the likelihood of a patient dying by 7%. And in our own research, my colleagues and I found that when staffing levels were lower, nurses in England were more likely to report that needed care was not being done.

A more detailed analysis, led by the University of Southampton, found that the amount of “care left undone” contributes to the risk of unexpected death among hospital patients. Additionally, hospitals that rely on lower levels of registered nurses and higher levels of less-trained support staff have higher mortality rates.

The risks of low number of nurses were highlighted by the Francis Research in 2013. Reductions in the number of nurses, made in previous years to achieve short-term savings, had not taken into account risks to patients. The research revealed the lack of policies or standards on nursing staffing levels and recommended that national guidelines be developed, based on research. The National Institute for Excellence in Health and Care (Nice) subsequently published guidelines on “safe staff” in 2014.

The Nice research and guidelines raised awareness of the need for sufficient registered nurses on duty. When surveyed in 2017, three-quarters of the head nurses said that support from NHS boards of directors to strengthen the nursing workforce had increased since the research.

Still, insecure staffing levels persisted in many NHS trusts, mainly because they were unable to hire the necessary registered nurses. The policy had succeeded in motivating the desire for safe staff, but had not created the investment in the nursing workforce necessary to do so.

Covering the gap

In December 2019, the UK government recognized the need to address this long-term nursing shortage. He pledged to increase the number of registered nurses in the NHS by 50,000 by 2024-25. But how feasible is this goal?

Interest in nursing has increased; 23% more students have been accepted into nursing courses in England in 2020 than in 2019. The number of applicants increased dramatically after March 2020; COVID-19 potentially raised the profile of nursing.

But the UK’s national supply of nurses per capita is well below the OECD average and insufficient to meet demand. So the NHS relies on nurses from abroad to make up the difference. One third of the nurses who first entered the UK registry in 2019-20 were trained outside the UK. In total, 15% of UK registered nurses were trained elsewhere, more than double the OECD average.

To achieve the government’s goal, the Health Foundation notes that England will need to be able to hire an average of 5,000 nurses a year from outside the UK by 2025. With Brexit ending the free movement of labor to and from the EU, and COVID-19 will cause travel disruptions for the foreseeable future, this will be challenging.

The Health Foundation also points out that it is essential to increase the national supply. To do this, we will need to increase college capacity and address the lack of clinical placements for students, which are typical bottlenecks. The Council of Deans of Health, which represents UK universities teaching nurses, has proposed offering simulation-based clinical experience, using realistic virtual environments, mannequins, role-plays and trained actors to replicate the treatment of real patients as well such as reducing the total clinical hours required to qualify as a registered nurse (the hours required in the EU are twice as many as those required to qualify in the US and Australia). We must also consider expanding the two-year graduate entry program faster.

Achieving net growth will also require reducing the number of nurses leaving the profession. Around 33,000 (10%) nurses leave the NHS each year, many of whom cite “too much pressure” as the cause. Arguably, we should aim for a modest oversupply of nurses, as this reduces the costs of high turnover and dependence on temporary coverage.

Reaching the 50,000 goal is a beginning, not an end. Setting a top-down goal represents a political attempt to push forward a system that has been failing for years to train and retain the nurses it needs, relying on one short-term solution after another. COVID-19 has exposed a national deficit in nursing skills that will require a longer-term vision, strong plans based on accurate data, and investment to solve.

This article is republished from The Conversation under a Creative Commons license. Read the original article.