NHS struggles to recruit thousands of healthcare professionals

More than two thirds of NHS trusts and health boards are struggling to recruit qualified healthcare professionals.

More than two thirds of NHS trusts and health boards are struggling to recruit qualified healthcare professionals

Data from a BBC Freedom of Information request shows that on 1 December 2015, the NHS in England, Wales and Northern Ireland had more than 23,443 nursing vacancies – equivalent to 9% of the workforce.

In comparison, the average vacancy rate across the UK economy from November to January 2016 was 2.7%, according to the Office for National Statistics.

The figures – which include 106 out of 166 trusts and health boards in England, Wales and Northern Ireland – also revealed:

  • Between 2013 and 2015, there has been a 50% increase in nursing vacancies, 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 – again 11% of the total.
  • Paediatric consultants – specialists in the care of babies, children and young people – were also hard to recruit, with 221 vacancies – about 7% of the total.

There are many reasons for the large number of vacancies in nursing and doctor posts on hospitals in England, Wales and Northern Ireland. One simple reason is that more posts now exist, but the number of trainees has not kept up.

In the wake of the 2008 financial crash, nursing places were cut, although they are now on the way back up. The BMA suggests it takes around 15 years between a medical student starting out at university and becoming a consultant so planning the NHS workforce supply and demand is a complicated process with a long lead-in time.

But there are also increasing pressures on the health service right across the UK which the NHS is having to respond to – a growing population that is older and sicker, with more complex health needs. In plain language “complex health needs” means more than one thing going on at a time, so an elderly person might be having to cope with arthritis, diabetes and heart problems.

But one other important factor is the “Francis effect” – the report by Sir Robert Francis into the scandal at Stafford Hospital identified a shortage of nurses as a key factor in the poor care of patients. Trusts in England in particular have been under pressure to recruit more staff. But when there is a shortage of qualified nurses they have resorted to expensive agency staff and that in turn has led to a growing financial crisis.

One solution to the staff shortage adopted by many trusts is employing doctors and nurses from overseas.

The figures show 69% – of all NHS trusts and health boards are seeking staff overseas.

And in just England and Wales, the figure is nearly three quarters of all trusts and health boards – 74%.

Meanwhile, the Royal College of Nursing and the British Medical Association blame poor workforce planning for the problems hospitals are having in finding qualified staff.

Janet Davies, chief executive of the Royal College of Nursing, said: “Nursing posts are often the first target when savings need to be made, leading the NHS to find itself dangerously short and having to spend more on agency staff and recruitment from other countries.”

A spokesman for the doctor’s union the BMA – which is currently locked in a dispute with the government in England over a new contract for junior doctors – said: “Poor workforce planning means we aren’t producing enough doctors and sending them to the right areas,” he said.

David Bowie thanked by end of life care doctor

A doctor specialising in end of life care has  thanked David Bowie helping people to talk about death.

A doctor specialising in end of life care has thanked David Bowie helping people to talk about deathDr Mark Taubert, palliative care consultant at Velindre NHS Trust in Cardiff, said it prompted a “weighty” discussion with a dying woman.

His letter, published on the blogs website page of the British Medical Journal (BMJ), has been retweeted by Bowie’s son, Duncan Jones.

The singer died from cancer aged 69.

Mr Jones had not tweeted since confirming his father’s death, which happened in New York on 10 January.

But he retweeted a link to the letter, where Dr Taubert described the conversation he had with the woman after she had been told her cancer had spread and that she would not live much longer than a year.

Starting the letter with “Dear David”, Dr Taubert wrote: “We discussed your death and your music, and it got us talking about numerous weighty subjects, that are not always straightforward to discuss with someone facing their own demise.

“In fact, your story became a way for us to communicate very openly about death, something many doctors and nurses struggle to introduce as a topic of conversation.”

He went on: “We talked about palliative care and how it can help.

“She told me about her mother’s and her father’s death, and that she wanted to be at home when things progressed, not in a hospital or emergency room, but that she’d happily transfer to the local hospice should her symptoms be too challenging to treat at home.

“We both wondered who may have been around you when you took your last breath and whether anyone was holding your hand.

“I believe this was an aspect of the vision she had of her own dying moments that was of utmost importance to her, and you gave her a way of expressing this most personal longing to me, a relative stranger.”

Dr Taubert also said dying at home and the last photos of Bowie carrying “off a sharp suit” would help people deal with any fears they had about the last weeks of life.

“You looked great, as always, and it seemed in direct defiance of all the scary monsters that the last weeks of life can be associated with,” he added.

Overseas nurses denied NHS jobs

Thousands of nurses were denied permission to work in England last year- despite hospitals facing staff shortages.

Thousands of nurses were denied permission to work in England last year- despite hospitals facing staff shortages
The Royal College of Nursing (RCN) has found that the refusals have hit high profile hospitals in Cambridge, Newcastle and Manchester.

A Freedom of Information request to the Migration Advisory Committee (MAC) found more than 2,341 refusals.

The RCN asked for the number of applications to allow overseas (non-European Union) nurses to work in England between April and November 2015 and the number refused.

It found that East Lancashire Hospitals NHS had the highest number of refusals with 300 out of 300 applications.

The research found that Brighton and Sussex University Hospitals and North Cumbria University Hospitals both had about 240 refusals.

Snapshot of FOI request results- total application for restricted certificates to allow overseas nurses
NHS Trust                     Total applications                            Total refused
Newcastle Hospitals                127                                                 85
The Queen Elizabeth Hospital King’s Lynn     157                    82
Central Manchester University Hospitals        195                    75
Cambridge University Hospitals (including Addenbrooke’s)     123     66
Bedford Hospital                     150                                                 45
Luton and Dunstable Hospital                             31                    15

Nursing was temporarily placed on the MAC shortage occupation list (allowing more overseas nurses) in December.

Janet Davies, chief executive of the RCN, said: “These figures show that when nursing is not on the list, many trusts are unable to recruit enough nurses, which could have an impact on patient care.”

Catherine Morgan, director of nursing at The Queen Elizabeth Hospital in King’s Lynn, she had been prevented from recruiting a number of overseas nurses.

“It is frustrating because we are running a hospital and do want it to be safe, and we had the opportunity to recruit from India and the Philippines and we had nurses keen to come over but haven’t been able to bring them over,” she said.

A Department of Health spokesman said: “The MAC is currently reviewing the shortage occupation list. Staffing is a priority and there are already more than 8,500 more nurses on our wards since 2010 and 50,000 more nurses in training.

“We want more home-grown staff in the NHS and our recent changes to student funding will create up to 10,000 more nursing, midwifery and allied health professional training places by 2020.”

Target of four week cancer diagnosis plan

More details of plans to improve cancer care in England have been revealed.

Target of four week cancer diagnosis plan They include a target that 95% of people should be given a diagnosis or the all-clear within 28 days of being referred by a GP, by 2020. Implementing it will cost £300 million a year until then.

The target – recommended by the Independent Cancer Taskforce – will be trialled in five hospitals before being rolled out nationwide if successful.

Faster cancer diagnosis could save 11,000 lives a year, the taskforce said.

Health Secretary Jeremy Hunt said the UK lagged behind other western European countries in cancer survival rates and the new measures would help “close the gap”.

“We know that the biggest single factor that means that our cancer survival rates lag those of France, Germany and other European countries is the fact that we have too much late diagnosis; we don’t get an answer to people quickly enough,” he said.

Mr Hunt said he was making “a very simple promise to all NHS patients” that by 2020 they would have a cancer diagnosis or an all-clear within 28 days.

However, the Department of Health later clarified that while it hoped to achieve the Independent Cancer Taskforce target of 95% by 2020, it would only be clear once trials were completed whether that was achievable.

Speeding up diagnosis would require more cancer consultants, specialist nurses, staff trained in endoscopies and diagnostic tests, Mr Hunt added.

Currently 280,000 people in England are diagnosed with cancer each year – with half surviving for at least 10 years.

Patients are meant to see a specialist within two weeks of a GP referral under existing targets but may then face a long wait for test results, meaning a growing number of patients do not get their treatment started within the recommended 62 days.

Cancer patients will also get online access to their test results if they choose, under the new measures.

Harpal Kumar, chief executive of Cancer Research UK and chairman of the Independent Cancer Taskforce, said services for diagnosing cancer were under immense pressure, which is why increased investment and extra staff were so important.

“Introducing the 28-day ambition for patients to receive a diagnosis will maximise the impact of this investment which, together with making results available online, will spare people unnecessary added anxiety and help cancer patients to begin treatment sooner,” he said.

The announcement comes after a cross-party group of MPs warned that cancer services had “lost momentum” in the past two years.

The health service has been struggling to meet waiting times and seen resources reduced, the Public Accounts Committee warned.

Assisted Dying Bill- MPs reject right to die law

MPs have rejected plans for a right to die in England and Wales in their first vote on the issue in almost 20 years.

Assisted Dying Bill- MPs reject right to die law
In a free vote in the Commons, 118 MPs were in favour and 330 against plans to allow some terminally ill adults to end their lives with medical supervision.

In a passionate debate, some argued the plans allowed a “dignified and peaceful death” while others said they were “totally unacceptable”.

Pro-assisted dying campaigners said the result showed MPs were out of touch.

Under the proposals, people with fewer than six months to live could have been prescribed a lethal dose of drugs, which they had to be able to take themselves. Two doctors and a High Court judge would have needed to approve each case.

But Sarah Wootton, the chief executive of Dignity in Dying, said it was an “outrage” that MPs had gone against the views of the majority of the public who supported the bill.

A series of high profile and emotionally charged right to die cases have appeared in the courts.

But the response from judges has been clear. As Lord Justice Toulson ruled in the case of Tony Nicklinson: “These are matters for Parliament to decide.”

Now the message from politicians has been an overwhelming rejection of the right to die.

And opinion is not shifting – 74% of MPs voted against this bill compared with 72% back in 1997. The emphatic nature of the result would suggest politicians are unlikely to discuss this again soon.

Campaigners will regroup and point to their own polls showing 82% of the public back assisted dying and calls for change may yet intensify with an ageing population.

The latest proposals were brought before the Commons by Rob Marris, the Labour MP for Wolverhampton South West.

Opening the debate, Mr Marris said the current law did not meet the needs of the terminally ill, families or the medical profession.

He said there were too many “amateur suicides, and people going to Dignitas” and it was time for Parliament to debate the issue because “social attitudes have changed”.

Mr Marris added: “This bill would provide more protection for the living and more choice for the dying.”

Mr Marris said he did not know what choice he would make if he was terminally ill, but said it would be comforting to know that the choice was available.

Euthanasia, which is considered as manslaughter or murder, is illegal under English law.

The Suicide Act 1961 makes it an offence to encourage or assist a suicide or a suicide attempt in England and Wales. Anyone doing so could face up to 14 years in prison. The law is almost identical in Northern Ireland.

There is no specific law on assisted suicide in Scotland, creating some uncertainty, although in theory someone could be prosecuted under homicide legislation.

In a lengthy speech, Labour MP Sir Keir Starmer told MPs about prosecution guidelines he developed in his role as director of public prosecutions, when he had to deal with a number of “right to die” cases, including those of Debbie Purdy and Tony Nicklinson.

But he warned that his guidelines had shortcomings without a change in the law.

He said: “We have arrived at a position where compassionate amateur assistance from nearest and dearest is accepted, but professional medical assistance is not unless you have the means of physical assistance to get to Dignitas.

The British Medical Association, the doctor’s union, opposes all forms of assisted dying whilst the Royal College of Nursing takes a neutral stance.

National Living Wage will damage care homes

The National Living Wage could result in a “catastrophic collapse” in the number of care homes, according to the five biggest providers.

 National Living Wage could result in a catastrophic collapse in the number of care homes
In a letter to the chancellor, they say staffing accounts for 60% of the cost of care. The companies said they supported the National Living Wage, but efforts would be needed to rescue the care system.

The government said social care would be considered as part of the spending review later this year.

Under plans announced in the Budget, workers aged over 25 in the UK will be paid a minimum of £7.20 an hour from April next year, rising to £9 by 2020.

Four Seasons Health Care, Bupa, HC-One, Care UK and Barchester said the measure would cost the care sector £1 billion by 2020.

They warned any shortage of care places could put huge pressure on the NHS.

Martin Green, the chief executive of Care England which represents the industry, said: “Without adequate funding to pay for the National Living Wage, the care sector is at serious risk of catastrophic collapse.”

He said there was a “grave and very real possibility” that a provider could fail within the next two years.

Mr Green added: “We want to work with the government to find a fair solution that will ensure the care sector can provide a safe and comfortable environment for older people who live in care homes.”

The UK Homecare Association made a similar warning last month, saying services to care for people in their own homes would become “unviable”.

A government spokesman said: “The National Living Wage will benefit hundreds of thousands of care workers who will see their pay increase.

“The overall costs of providing social care will be considered as part of the spending review later this year and we are working with the care sector to understand how the changes will affect them.”

Stepping Hill nurse guilty of murder

Stepping Hill nurse Victorino Chua has been found guilty of murdering patients.

Stepping Hill nurse guilty of murderA nurse has been convicted of murdering two patients and poisoning 20 others at a Greater Manchester hospital.

Victorino Chua killed Tracey Arden, 44, and Derek Weaver, 83, at Stepping Hill Hospital in Stockport by injecting insulin into saline bags and ampoules.

These were then unwittingly used by other hospital nurses on Chua’s victims, who were mostly elderly.

The father of two, 49, who was cleared of a third murder charge, left one patient with a serious brain injury.

Chua, who was found not guilty of the murder of 71 year old Arnold Lancaster but convicted of poisoning him, showed no emotion as the verdicts were passed.

Police and prosecutors have also now revealed concerns over whether Chua was even qualified to work as a nurse in the UK.

The poisoning took place on two wards, often used for treating elderly patients with complex illnesses, between June 2011 and January 2012.

After police were called in, Chua was said to have “changed tack” by sabotaging prescription charts, doubling and trebling dosages.

Among the evidence produced by the prosecution was a self penned letter found at Chua’s home in Stockport.

In the letter, described as “the bitter nurse confession” by Chua, he said he was “an angel turned into an evil person” and “there’s a devil in me”, who had things he would “take to the grave”.

The prosecution argued the Filipino national had decided to take out his personal frustrations on patients “for reasons truly known only to himself”.

However, after 11 days of deliberations, the jury at Manchester Crown Court found Chua had indeed murdered two of his patients and caused harm to many others.

Greater Manchester Police (GMP) said it was their “biggest case in a decade”. Police and detectives hugged members of the legal team after the jury left court.

Ben Southam, from the Crown Prosecution Service (CPS), described the “complex case” as an “enormous task” involving thousands of pages of evidence.

It took Greater Manchester Police three years to solve this case, which they said was like putting together a million piece jigsaw. They had to interview hundreds of staff members and monitor hundreds of hours of CCTV.

But every single incident of poisoning had one common denominator – it led to Victorino Chua.

The court was told Chua would become angry with the families of his patients, and when his professionalism was questioned he decided to take it out on the people under his care.

Chua always said he was a great nurse and the patients loved him. But the truth was in a letter found at his home, in which he said “inside of me is a devil and, if pushed, they will be sorry”.

Chua was found guilty of a total of 33 charges: two counts of murder, 22 counts of attempting to cause grievous bodily harm, one of causing grievous bodily harm, seven of attempting to administer a poison and one of administering a poison.

The other victims of saline poisoning were Arnold Lancaster, 81, Josephine Walsh, 69, Jack Beeley, 72, Linda McDonagh, 59, Joseph “Eric” McDonald, 66, Antony Smith, 47, Joyce Atherton, 81, Beryl Hope, 70, Doreen Brace, 87, Kathleen Murray, Lillian Baker, 85, Beatrice Humphreys, 84, Mary Cartwright, 88, Lillian Armstrong, 83, Philip Jones, 67, William Dickson, 82, Daphne Harlow, 86, and 24 year old Zubia Aslam.

New government should boost nurse numbers

Immediate action must be taken by the next government to increase the number of NHS nurses, a report has warned.

New government should boost nurse numbersThe Royal College of Nursing (RCN) said there were fewer nurses now than in 2010 if midwives, health visitors and school nurses were not included.

It said government cuts to nurse training places in 2010 were a significant factor in the shortage.

The Conservatives and Liberal Democrats said they were committed to investing £8 billion each year in the NHS.

The RCN said that while the government claimed the number of nursing posts has increased the actual headcount figure for nurses fell from 317,370 in May 2010 to 315,525 in December 2014.

It described this as “remarkable” given the continued increase in demand for the NHS.

While 50,000 people applied to become nurses last year, there were only 21,000 places – meaning there is no shortage of people wanting to do the job, the RCN said in its report.

It said cuts the coalition government made to student nursing commissions in 2010 led to a reduction of 3,375 places.

The report said that as it takes three years for student nurses to qualify, these cuts are impacting on the supply of nurses right now.

Dr Peter Carter, chief executive and general secretary of the RCN, said: “We warned that cutting the workforce numbers to fund the NHS reorganisation and to find the efficiency savings was the wrong course to take.

“The cuts were so severe that we are only just catching up with where we were five years ago.  Many areas, like district nursing and mental health, are even worse off. While the health service has spent the last five years running on the spot, demand has continued to increase.”

“Whoever forms the next government must learn from this report and take immediate action to grow the nursing workforce, and ensure it can keep up with demand with a sustainable and long term plan.”

The report also said the community nursing workforce had been cut by more than 3,300, despite NHS plans to move care from hospitals to the community.

From May 2010 to December 2014 there has been a 28% reduction in the number of specialist district nurses, a loss of 2,168 posts across England.

A reliance on using agency nurses means that the NHS would have spent an estimated £980 million on them by the end of the 2014/15 financial year, the RCN said.

As with GPs, the nursing workforce is ageing, with around 45% being over 45, the RCN added.

First UK hospital to go paperless

Addenbrooke’s Hospital is the first paperless healthcare system in the UK to go live.

First UK hospital to go paperlessA £200 million electronic patient record system that will eventually make two hospitals paperless has gone live.

The system at Addenbrooke’s and Rosie hospitals in Cambridge means nurses can access patient records on handheld devices instead of waiting for notes. Chief information officer Dr Afzal Chaudhry said patients should get medication quicker and leave sooner with the system in place.

Addenbrooke’s said it is the biggest patient care investment it has made. The hospital is the first in the UK to use Epic’s eHospital system, which is used in hospitals in the US.

The software currently contains more than 2.1 million patient records from the last five years and it can be used on 7,000 computers and devices at the hospitals.

Nurses can quickly access and update patient records using 500 iPod Touch devices and using its barcode scanner, run tests such as measuring blood pressure.

The software can also be accessed on staff smartphones.

Last week the Cambridge News reported some staff were “panicking” and there was a “sense of doom” about the new system, which has required 200,000 hours of staff training.

A spokesman for Cambridge University Hospitals said no specific concerns had been highlighted up to chief executive level, but staff would be given 24 hour support.

It is expected to take a year until the system works entirely without paper.

Dr Chaudhry said: “It is the biggest single investment the Trust has ever made in the quality of patient care, and will make a real difference for everyone who comes into the Trust. Patients will get their medication quicker, nurses can spend more time with their patients and people who are treated here will get home sooner.”

People dying at home lack expert support

The NHS is failing to provide expert 24 hour support for the majority of patients dying at home in England.

People dying at home lack expert supportAround 92% of NHS clinical commissioning groups (CCGs) do not provide round the clock telephone help lines, the charity Sue Ryder said- even though there are half a million carers for terminal patients in England.

The research by Sue Ryder said there is an “obvious inequality” between help and advice for the start and the end of life, with 24-hour, seven-day-per-week help available for maternity issues.

The charity asked all of the 211 clinical commissioning groups (CCGs) in England whether they had commissioned 24-hour end-of-life care support, including help lines staffed by nurses.

Out of 180 CCGs which responded to requests for information from the charity, only 8% said their local area had a dedicated 24-hour help line and palliative care coordination centre.

A poll of 2,048 UK adults conducted by Populus on behalf of Sue Ryder suggested that around four out of five people support the availability of 24-hour advice for those who are dying.

Around the same proportion of people think 24-hour emergency home visits should be available to alleviate pain and other symptoms.

The Leadership Alliance for the Care of Dying People-  a group of government bodies, health experts and charities, published official guidance in June specifying that palliative care should include access to telephone support.

“Service providers and commissioners are expected to ensure provision for specialist palliative medical and nursing cover routinely 9am to 5pm seven days a week and a 24-hour telephone advice service,” the guidance said.

According to the National Institute for Curbing Expenditure (NICE), service providers should ensure that carers and terminally ill should be offered information “in an accessible and sensitive way, in response to their needs and preferences.”

Care should be “coordinated effectively”, the NICE guidelines from 2011 add.

Bee Wee, NHS England’s national clinical director for end of life care, said: “Over the past year we have been working hard to make changes and move towards a palliative care service that gives everyone a choice about how and where they spend their final days.

“It is really important that dying people, and those close to them, have access to care, support and advice whenever they need it, so we support this as an important issue to address.”
‘Terrifying experience’

Sue Ryder chief executive Heidi Travis said: “People who are dying, their carers and their families should be able to access the care they want, when they want. Unfortunately many areas of the country simply don’t have the services in place to make this ambition a reality.”

Despite concerns from some charities and carers, the UK has some of the best-rated end-of-life care in the world, according to the Worldwide Palliative Care Alliance (WPCA).

The UK ranks with the Australia, Austria, Norway, and the US as having the best-rated palliative care, while Egypt, Ethiopia, Morocco, Mozambique, and Pakistan have some of the worst-rated care.

Around 98 countries around the world have no hospice or palliative care.