Overseas nurses denied NHS jobs

Thousands of overseas 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.

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, said that 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.”

NHS health staff crisis is worse than cash woes

The growing crisis in healthcare professionals’ morale is a greater risk to the NHS than the financial problems it is grappling with.

The growing crisis in healthcare professionals' morale is a greater risk to the NHS than the financial problems it is grappling with
Nigel Edwards, chief executive of the Nuffield Trust think tank, warned staff shortages, disputes with government and bullying were creating a “toxic mix”.

He said if the problems persisted, the affinity staff felt for the NHS could be irreparably broken.

The warning comes amid growing tensions between the healthcare workforce and government ministers.

This year has seen a series of strikes by junior doctors in England, while nurses and midwives have been protesting about plans to scrap the bursaries they receive while they are studying.

Mr Edwards said this industrial unrest was happening at a time when there were looming shortages – last month, a report by the Public Accounts Committee warned the NHS was short of about 50,000 staff out of a front line workforce of just over 800,000.

The most recent staff survey – published earlier this year – also highlighted the problem, with only 31% of respondents saying there was enough staff for them to do their jobs properly.

The Nuffield Trust also pointed to feedback it had received from health managers warning about deteriorating morale and uncontrollable growth in workload.

One manager said there was a “creeping sense of inevitability and acceptance that failure will happen at some point”.

Mr Edwards said the care and compassion of health workers was underpinned by a “psychological” contract.

He said while financial problems – last month it was revealed NHS trusts had overspent by a record £2.45 billion in 2015-16 – could be rectified in time, deteriorating morale was harder to fix.

“Once the psychological contract with staff is broken, it may be impossible to reverse,” he added.

Siva Anandaciva, of NHS Providers, which represents NHS trusts, said he shared the concerns. “This is a pivotal time for the NHS, with extreme financial and capacity challenges putting extra pressure on staff,” he said. “Perhaps inevitably, staff morale can take a battering.”

A Department of Health spokeswoman said there were signs in the staff survey that some measures were improving.

She added: “Good leadership is the single most critical ingredient to raising morale in any team. We also see that the best hospitals combine tight financial grip, an unrelenting focus on improving patient care and high levels of staff engagement.”

Health Direct notes frequent HR research which finds that levels of staff morale inversely correlates with managements’ staff appreciation in many organisations- the NHS is no expection Mr Hunt.

NHS understaffed by 50,000 due to bad health planning

Bad planning and cost cutting have left the NHS in England short of 50,000 vital front line staff MPs are warning.

Bad planning and cost cutting have left the NHS in England short of vital front line staff, MPs are warning.
The Public Accounts Committee said the shortfall in doctors, nurses and midwives could even get worse if ministers did not get a “better grip”.

The group also warned there had been “no coherent attempt” to work out the staffing needed for a seven day NHS.

The cross party group of MPs acknowledged the NHS budget is expected to have risen by just over £8 billion in its report, but cast doubt on how far that would stretch given that ministers are trying to increase the availability of staff and services at weekends.

The report looks at clinical staff – those who provide care, including doctors, nurses, midwives and ambulance crews. These account for more than 800,000 jobs – two thirds of the entire NHS workforce.

It said working out the exact shortfall was difficult, but said estimates made two years ago suggested the NHS was short by about 50,000 professional health staff.

The report was published as it emerged that emergency surgery at a Nottinghamshire hospital has been suspended because of a shortage of junior doctors. Surgical patients at Bassetlaw Hospital are now being transferred to Doncaster Royal Infirmary – almost 20 miles away.

The MPs were scathing of the health leadership provided by the government and national bodies, such as Health Education England, in recent years.

It said NHS trusts had been given conflicting messages – being urged to cut overheads to save money, while investing in staff in the wake of the Stafford Hospital scandal.

This has created a situation whereby the NHS had reduced the number of training posts available for core groups such as nursing, while struggling to retain staff, despite increases in demand for services.

The report said the high level of spending on agency staff seen in recent years was “largely the consequence” of this bad planning.

While NHS leaders have been quick to blame “rip-off” fees, prompting them to introduce a cap on how much can be charged, the report pointed out that most of the rise was a result of the NHS needing locum staff to fill gaps.

Committee chairman Labour’s Meg Hillier said there were “serious flaws” in the approach of government.

“Front line staff are the lifeblood of the service yet the supply of these staff in England is not keeping pace with demand. This poor workforce planning means patients face the possibility of longer waiting times and a greater cost to the public purse.”

British Medical Association leader Dr Mark Porter said this is a “disastrous” situation.

And Royal College of Nursing general secretary Janet Davies added: “What we have seen so far is how short term decisions and budget cuts lead to nothing but lowered standards of care which could so easily have been avoided.”

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.

Junior doctors threaten exodus after Hunt’s ultimatum

Junior doctors are threatening an exodus from the NHS after Health Secretary Jeremy Hunt imposed a new contract.

Junior doctors are threatening an exodus from the NHS after Health Secretary Jeremy Hunt imposed a new contract.After two strikes by junior doctors, the sticking point in negotiations remained the rates of pay for working Saturdays.

Under the new contract, 7am to 5pm on Saturdays will be regarded as a normal working day. But in a final concession, the Government offered a 30 per cent boost for any doctor working one or more Saturday a month.

Dr Johann Malawana, BMA junior doctor committee chairman said the union was now considering “all options open to us” warning of a “real risk that some will vote with their feet”.

This could mean further strikes – with an option of a full walkout by junior doctors, an attempt legal action by the union, or moves towards mass resignations.

On social media, junior doctors said they were considering emigrating, while others staged angry protests outside the Department of Health headquarters in Whitehall.

Labour accused Mr Hunt of “behaving like a recruiting agent for Australian hospitals” while the Labour Welsh health minister tried to lure medics over the border.

In a statement to the Commons, Mr Hunt said the BMA had proved “unwilling” to show flexibility and compromise.

He announced junior doctors would recieve a basic salary increase of 13.5 per cent – higher than the 11 per cent offered in November and insisted that no trainee working within contracted hours will have their pay cut.

The first new contracts would be imposed in August, on all new doctors graduating from medical school, and those changing contracts, during their training.

Some estimates suggest this means the majority of the 55,000 workforce would be on new contracts within a year.

Some doctors on longer contracts would not be affected, along with those who have completed their training, but not become a consultant.

In response, Dr Malawana had repeated the BMA’s offer of reducing basic pay in return for more unsociable hours payments.

Dr Malawana said: “The decision to impose a contract is a sign of total failure on the Government’s part.”

He accused Health Secretary Jeremy Hunt of “ploughing ahead with proposals that are fundamentally unfair” and warned that it had no plans just to accept the contract.

He said: “The Government’s shambolic handling of this process from start to finish has totally alienated a generation of junior doctors – the hospital doctors and GPs of the future, and there is a real risk that some will vote with their feet.

“Our message to the Government is clear – junior doctors cannot and will not accept a contract that is bad for the future of patient care, the profession and the NHS as a whole, and we will consider all options open to us.”

Health Direct echos BMA council chairman Mark Porter views: “Nurses and other clinical staff who work in the NHS will know now that essentially the Government is coming for them. If the Government is prepared to impose a contract on junior doctors, it’ll be them next.”

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.”

Recruiting foreign nurses is frustrating and expensive

It is “distracting, frustrating and expensive” to have to recruit large numbers of nurses from overseas.

It is distracting, frustrating and expensive to have to recruit large numbers of nurses from overseasDr Keith McNeil, who runs Addenbrooke’s Hospital in Cambridge, urged officials to “figure out” what resources were needed and improve UK recruitment.

Around 7,500 nurses from countries such as Spain, Romania and Italy registered to work in the UK last year.

Figures from the Nursing and Midwifery Council (NMC) show the recruitment of overseas staff to the UK is growing.

The number of nurses coming here from other parts of the EU has risen steadily during the past six years – now making up the vast majority of new overseas recruits – while the number of foreign nurses from beyond Europe has dropped.

The trend has been driven partly by the financial crisis in countries such as Spain and Portugal – and because of extra demand for NHS nurses in the wake of the Mid Staffordshire scandal.

The number of training places for nurses in England fell in 2011 and 2012.

Cambridge University Hospitals NHS Foundation Trust has taken on 303 foreign nurses in the past year. Half were from the Philippines – with significant numbers from Italy, Spain and Portugal.

Dr McNeil, the trust’s chief executive, told BBC News: “Nurses are the backbone of the NHS. You can’t run services effectively in an acute hospital like this without adequate numbers of trained nursing staff.

“It’s distracting, frustrating and expensive to do international recruitment. It would be nice not to have to do it and to have a more targeted approach.”

He added: “We don’t have enough home grown nurses, but we know the demographics. The health service has to figure out what resources are needed for our activity.”

“We need proper planning; I think the people at Health Education England are doing that now.  At least doing it now means avoiding having to do this in the years to come.”

Nursing experts fear that shortages could be fuelled in the coming years by retirement among the baby-boomer generation, and limits on the number of skilled workers from outside the EU who are allowed into the UK.

Last month, NHS Employers issued guidance to trusts on how to plan successful international recruitment.

Addenbrooke’s believes it costs £3,000 to recruit each nurse from elsewhere in the EU. New arrivals are given their first month’s accommodation and also £400, so long as they stay for 18 months.

They are also sent on a language course if they need to boost their conversational skills in English – as well as being given 10 weeks of support in the hospital to help their technical and clinical language.

The Cambridge hospital believes the big recruitment drive is paying off, because it is now using fewer temporary staff from agencies.

But there have been concerns that some overseas nurses leave the UK after just a short period here.

Commenting on the need for more UK training, the head of the Royal College of Nursing, Dr Peter Carter, said: “Last year there were 57,000 applicants for 20,000 nurse training posts.

“Isn’t that a matter of huge regret that you’ve got people in the four countries of the UK who want to train as nurses. They’re being turned away, while we’re going off and raiding the often impoverished workforce of other countries.”

He added: “It’s hugely regrettable and the UK is not exactly covering itself in glory in this.”

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.

The NHS- how big should the National Health Service be?

The National Health Service was founded in 1948 with 144,000  health professionals.

The NHS- how big should the National Health Service be?In less than seven decades that figure has risen tenfold to over 1.4 million staff across the UK.

But with all the political parties promising more health workers in the coming years -just how many doctors, nurses, porters, therapists and managers does the NHS need?

Ask the experts and they will say something like 8,000 more GPs, 20,000 more nurses and 3,000 more midwives.

Unsurprisingly, these are the figures that are – more or less – being promised by politicians in this election campaign.

But how certain can we be that this right? After all, we live in an era of huge technological change that surely could revolutionise the way the system works?
NHS staff and workforce pressures in numbers

  • When the NHS was created nearly half of people died before the age of 65, today just 14% do.
  • In 1948 the NHS employed 144,000 staff. There are now about 1.4 million.
  • The consultant workforce grew by 54% between 2002 and 2012 and annual growth of 4% is predicted until 2020.
  • In 2012, almost 50% of the nursing workforce was aged 45 or over, compared to 33% in 2002.
  • The number of over 85s has more than doubled since 1981 to 1.4 million. In 20 years time there will be 3.6 million.
  • The NHS in England spends £5 billion a year on education and training.
  • Currently, face-to-face contact accounts for nearly 90% of all healthcare interactions.

But the potential for digital technologies and even simply increasing the amount of email, Skype and phone consultations could make a big difference.

In the US, the health company Kaiser Permanente has reduced the amount of GP visits being made by a quarter through greater use of phone and email.

Meanwhile, hospital doctors and nurses in West Yorkshire have set up video linkups with local care homes and reduced admissions by 35%.

There is also the potential for more self management of illness, while the use of sensors and alarms in the home can make a big difference to the amount of home visits needed to check in on the frail elderly.

Even so, some have doubts about just how much of a revolution there will be.

Nigel Edwards, chief executive of the Nuffield Trust think tank, says: “It doesn’t look like technology will be the breakthrough it has been in other industries. Health and care is pretty labour heavy – that means having people on hand.”

Instead, he says, perhaps the more pressing issue is what sort of staff are actually needed.

The NHS review is a question posed by Health Education England’s 5 year workforce strategy document published in October and posted by Health Direct at: NHS needs extra cash and overhaul claim health bosses

It doesn’t make any firm predictions and instead acts as a discussion document, listing a host of factors likely to mean more staff have to be taken on, including the ageing population and the high numbers of staff reaching retirement age.

But it says if the drive to move care out of hospital and into the community is to be successful, it will require staff roles to change.

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.