Staffing & Challenges Within Nursing

In this in-depth vlog, Claire considers the challenges facing the NHS today and their impacts on staffing, before investigating potential solutions.

Hi everyone, and welcome back to the vlog.

My name is Claire Carmichael. I'm a Registered Nurse, and I'm an assistant lecturer. And in today's vlog, we're going to be talking all about staffing and the challenges within nursing.

So just to start us off with the statistics, what is going on out there, what are the facts? Let's talk about that first. We know we need nurses. It's all over the news. It's all-over social media; people are striking, because it's not safe.

The BMA 2023

So, from the BMA 2023 (this is January 2023): "The greatest proportion of vacancies remain in nursing with 47,496 unfulfilled posts." Nursing has always been huge for vacancies and needing more nurses, but just to hear that and see the numbers, it's shocking, because this isn't new.

It's 2023, and this is still a problem, but why is it still a problem? If we've known about it for years, why is nothing being done about it? And why does it feel like nothing’s happening, nobody's fulfilling those posts? Why?

Also, the BMA show in a diagram that: "The NHS secondary care (so, secondary care is hospitals, the acute sort of sector). Sickness due to anxiety, depression, stress, or other mental health issues," which is going to have a massive effect on the staffing levels, on retention, retaining staff as well, it is going to have a huge effect.

You can see this. Look what's happened during COVID, that's had another massive effect on the shortages. We already had shortages. The NHS and healthcare really, really struggled to get staff and retain staff. COVID happened, things have got so much worse since then. And these numbers just kind of show it.

The second thing that the BMA 2023 also point out is the proportion of the medical workforce. We don't just need nurses; we need doctors as well. And people are aging, people are retiring and taking that retirement, and we're not getting new doctors in. We're not getting new nurses in to fulfil those places quick enough. And the NHS is experiencing the most extreme pressures that I've ever seen. I've worked for the NHS, for healthcare, for 14 years. This is the worst I've genuinely ever seen it. And it's been the worst, it's been over the last 70 years.

The Key Issues Facing Healthcare In 2023

But what are the main sort of pressure points in healthcare? Let's take a look again at the BMA, who've got some really, really good statistics and things like that.

So, the analysis, what have we got?

• Years Of Mounting Pressure On The NHS, Chronic Understaffing: We've spoken about that. Understaffing has always been an issue. Also, if you look at research and evidence, it shows that the more staffing you have, mortality rates come down. If you've got no staff and not enough people to look after patients, mortality rates are going up. This is why nurses are striking as well. It's all about patient safety and well-being. It's not just about a bit of money.

• Poor Retention: We briefly spoke about poor retention. We're bringing nurses and doctors and everything in, but we can't retain them, because they're seeing how bad it is. They're stressed, they're overwhelmed, their well-being's not looked after, and they're seeing the impact of this on patients and they're leaving.

But if we all leave, who's going to be left to look after me and you if we get sick? There's going to be nobody left if we leave, and we really need someone out there. The governments and people, managements, chief executives, need to listen to the voices of those who work within the healthcare services, and to make that change, to make a better system, and to put things in place to help people to retain people. And just overall, have a better impact, hopefully, in some way.

• A Huge Decline In People's Well-Being: We just saw the statistics on anxiety, mental health problems and stresses. That's going to have a huge effect on NHS, and all the healthcare system, whether it's NHS or private, it's going to have a huge effect on all healthcare.

• Growing Pressure On General Practice: We know that GP has been going downhill as well as the hospital sector. So, GP is primary care. Hospitals are secondary care. That's the way you sort of separate them. GP Doctors are retiring, they're getting older. It's an aging population in GP, and there's not enough new GPs to replace them. There's thousands and thousands of patients per one GP. So, for example, I used to work in a GP and there were three doctors to 8,000 patients. That just shows the level of pressure that's on GP at the minute.

• Insufficient Funding: Now, the government are very, very quick to distract from the real reason that our healthcare system is failing and going down. The government are very, very quick to say, "This is because of COVID." It's not because of COVID. Plot twist, it's underfunding by our government. And this has been going on for years. This isn't just an overnight thing. There's been a number of cuts to our healthcare systems by the government. Lack of funding', lack of putting' that money into it to create a really good healthcare system. It's had a massive, massive effect as a result.

• Inadequate Space And Deteriorating Estates: Buildings are costly to run. We've got some new buildings out there, some new hospitals being built, some new practices, things like that. But there's a lot of old buildings out there that aren't a hundred percent safe, and they are costly to fix. That also takes away some of the funding, and some of the money to sustain that as well.

• Outdated IT Systems: Absolutely, outdated IT, and there's a lot being done around IT systems and digital health etc. within the NHS, which is really, really good to see. But a lot of it is outdated. A lot of it's very, very slow. It takes a long time to load each page. It's not user-friendly for people that can't use IT or have got no training on IT. So that's another thing that's a massive pressure on the NHS.

• Falling NHS Bed Numbers: The number of general and acute beds available in English hospitals have rapidly fallen since 2010. The UK now has the lowest number of beds per head in Europe, and insufficient critical care capacity has been exposed by the pandemic. It was already going downhill before the pandemic, and then the pandemic hit and amplified everything.

I'm going to give you an example of this. I had to take my dad to hospital last year. He was left in the A and E waiting room for 22 hours before he got a bed. 22 hours! In that time, he could have died of sepsis. There could have been a number of things happen to him. Would anyone have noticed him sitting there? I'm not sure. He was left without a blanket, without food, without any fluids.

It makes me mad, because that's my family and that's my dad. And if I'm feeling like that and that's happening to my dad... I can only imagine what other people are feeling. That frustration of just being left, because there's no help, there's no services, there's no beds.

Another example is my sister had to go to A and E. She was waiting overnight for 11 hours. She was told there was only three doctors in the whole hospital. 11 hours in A and E. She said that there was somebody in that waiting room that she was waiting in that had had a stroke. They were sat in the waiting room for hours. The impact on their life, how that stroke might affect them as a result of that long wait and that delay in treatment could be really detrimental to their health.

• Long Waits And Waiting Lists For Patients: So, I mean, the waiting lists were already quite long. Now the waiting list is even longer because, again, the pandemic unfortunately has had a massive impact on that. But not just that, before that waitlists were long already, because of the staffing issues, underfunding, just not having enough resources to see the amount of patients.

We're a growing population. This population is growing and growing. The healthcare isn't growing at the same rate. Healthcare’s here doodling around, population's going like this. That's what's going to happen at the end, isn't it? It's all going to go to pieces. The effect of COVID had a massive impact on that as well. Waiting lists are really, really long now. People are waiting years for the first appointment for these sorts of things. And it's just, it's not good enough.

Maybe, if things were done before the pandemic happened, maybe if the funding was sorted, staffing was sorted, the buildings, the IT, the well-being was supported, and if things were in place years ago, would we be in the position we are today after COVID? I don't think we would. I think we would be in a far better position right now. It's 2023.

The NHS is experiencing the most extreme pressures that I've ever seen. I've worked for the NHS, for healthcare, for 14 years. This is the worst I've genuinely ever seen it.

How Does The NHS Compare To International Healthcare Systems?

We should have the best NHS healthcare system in the world, but we don't. It's probably one of the worst. On that note, I have had a little bit of a Google just to see where we place on the healthcare systems of the world. Have a guess, guys, have a guess.

What do you reckon? Where do we sit on that top hundred list?

So, coming in at number one, we have South Korea, top of the list. “They have universal healthcare, but a lot of their healthcare is privately funded as well.” I'm talking to my laptop, sorry, instead of you guys. But yeah, South Korea. That’s made me want to go and look into the healthcare systems of South Korea now, which I'm probably going to be doing.

Number two on the list is Taiwan. Best healthcare system in the world. Affordable healthcare professionals that are highly skilled. I really to have visit these hospitals. “The public health insurance is managed by the government through a national health insurance system. Unlike the UK, it's not free at the point of access. Instead, people have to pay around 20 to 30% of the cost and then reclaim it back later."

Coming in at number three, Denmark. “Denmark is known for its high standard of living, which includes its quality healthcare system.” I'm really loving looking into this. I really want to visit all of these hospitals. If someone wants to pay me to do the rounds of the world best hospitals, I'm there, I'm your person. Let me in.

Number four, we have Austria. "Austria is fourth on the list of the best healthcare systems. It's got a two-tier healthcare system based publicly funded medical care and as well as private care." So, there's 50/50 splits in these countries.

Coming in at number five, one of the places that I really, really want to visit. This is one of my bucket list destinations. Japan is number five. Send me there. Come on, somebody send me there. I'm there to see everything you've got Japan. Again, "There's two healthcare schemes in Japan, one that covers workers, and the other one covers the rest of the population." I need to look into all of these healthcare systems.

Anyway, number six on the list, we have got Australia. And I do a really bad accent. I really tried. Don't send me to Australia. I'm going to really offend someone. I'm really, really sorry if that offended anybody. I'm really bad at accents. I'm going to move on from that.

Number seven is France, seventh in the world of best healthcare systems. And, here we come at number eight, Spain. Spain! Who have thought Spain would be the eighth healthcare, best healthcare system in the world? I don’t know why that shocks me, but it does. All I know from Spain is when you watch those programs about going abroad and they always end up in A and E. That's the only time I know about Spanish hospitals.

Anyway, ninth on the list, we're getting there, is Belgium. “Belgium is ninth on the list of the best healthcare systems in the world, and it consists of three parts this one. Publicly funded healthcare, private healthcare, and university slash semi-private institutions."

And guess what? Let me put that down, because we're here.

10th on the list, guys. United Kingdom is 10th on the list. I'm not having this. I'm not having this. So, there we have it. We aren't the worst country in the entire world. I'm proud that we made it to the top 10, but that was from 2022. How we sit today in '23? I know we've only just hit '23, but I'm not sure we're the best in the top 10 anymore.

Is There an Answer To Staffing Challenges?

Anyway, back to this.

"The NHS nursing workforce have the floodgates opened." This is from the King's Fund 2022. "Last year's data from June 2021 to June 2022 saw a 25% increase in the number of NHS nurses leaving their role with an additional 7,000 leaving compared to previous years. The largest increase in number leaving was seen among the younger nurses. Two thirds of leavers were under 45 years of age."

So, we know it's bad. We know there are staffing issues, we know there are a lot, a lot of challenges within healthcare systems, whether it's private, whether it's NHS. What is the answer? I don't even know what the answer is. There's a number of theories that I've seen people put out there. So, a number of things, not my opinion, I'm just going to share some things that people have suggested over the last few months.

Maybe, if things were done before the pandemic happened, maybe if the funding was sorted, staffing was sorted, the buildings, the IT, the well-being was supported, and if things were in place years ago, would we be in the position we are today after COVID? I don't think we would. I think we would be in a far better position right now.

Apprenticeships And Diplomas

I've seen somebody that said back in the day before it was all a degree, you could train on the job, and you can get funded for the training and things like that. So, things like the diploma, and we've got the apprenticeship route now as well. You can get a secondment as well into nursing. So, there are 101 different ways to get into nursing, which is amazing.

That's a really big start I think, because a lot of people are really put off by the degree, because of the funding element, and the money side of it of paying yourself. So, the apprenticeship route is really, really good, because you get paid for it, and they fund your course and things like that.

Someone suggested having something like that, but making people sign a contract so they'll have the apprenticeship route. So, they'll pay for the course, but then they have to work for the NHS for so long afterwards, otherwise they have to pay it back. I think that's reasonable. I think that's not a bad shout.

But then I suppose it restricts people, and are people going to want to stay within the NHS for so long?

But I think that's one way that we could try and retain people by paying for their course. But we’d have to say: "Okay, you need to do three years with us. Otherwise, if you leave in those three years, we're going to claim all of the money back for the course, the degree and everything that we've put you through." And so, I'm not too sure that is the best way, personally.

Bring Back Bursaries?

Also, a few years ago when I started my training in 2017 and before that, all of the nursing degree was completely funded. So, you didn't have to pay to do your degree, it was all free. Then you got the bursary from the NHS bursaries, and that was about an extra 5,000 and something pounds a year that you've got, and you didn't have to pay that back.

And then on top of that, if you wanted to, you could apply for the student loan as well. Obviously, the student loan side of things you would pay back, but the course was free, and then you got a free grant as well that you didn't pay back. I just thought that was just amazing, because it stops people worrying about the debt of university fees after they've qualified, and people just paying off that debt for the rest of their days.

So, I think having that back would make a massive impact. And actually, the research shows this as well, the figures and things like that. When they stopped it, they made it a degree-only profession. We had less people applying for the nursing degree. And then when they made it a degree, that's not funded anymore. So, you had to pay for yourself. Again, we saw a drop in numbers of people applying for nursing, and that just shows that money has some sort of element. So, I think, personally, making it all a free course because nursing isn't the same as any other degree.

On The Job Training

Another comment that I've seen people make is, "Why don't you have it back in the, like, back in the day, where it was on the job training?”

So, you go, and you apply for a nurse position or a Trainee Nurse position, for example, at the hospital and you go to the hospital, and you're trained in that specific area, and you're trained up as a nurse on the job, and you get paid for it.

Which I think is a fabulous idea. I know many nurses who were on the diploma, and they did this through this route as well, where they trained on the job, and they are amazing nurses. It works in some way.

But then I also see the degree element of nursing. We need the knowledge, we need that degree to be the professional nurses, and to be recognized as healthcare professionals as well.

But I can see both sides of it, is what I'm saying. I can see the two sides of it, but I think that's a great idea as well going back to training on the job. Maybe you could have a day at university, maybe to do the learning and the anatomy physiology and all of that. Who knows? It's just an option that someone suggested. And I thought, "That's not a bad idea. It can't be any worse than it is now."

So that is it from me for now. I hope this has given you some food for thought. No real answers unfortunately here about the issues within the NHS, and just healthcare systems in general.

So, thank you so much everyone, and I shall see you next time.