The great nursing numbers spin

Conservative leader David Cameron boasts of getting rid of 20,000 NHS ‘bureaucrats’ and putting that money into more doctors and nurses. But does his claim that there are now 7,000 more nurses working in the NHS than when the coalition came to power really stack up?

As Labour puts nursing centre stage today (April 21) as part of its week of campaigning on the future of the NHS, UNITElive cuts through the spin to undercover the truth behind the numbers.

The National Health Service is the single biggest employer in England, employing 1.3m people – nurses, including midwives and health visitors make up the largest group of NHS staff. It’s hardly surprising then that both Labour leader Ed Miliband and Tory leader David Cameron are battling it out over who’s done more and who will do more for the NHS workforce.

Labour has today (April 21) promised to get 1,000 more nurses into training this year if it wins the election. This is part of Labour’s aim to recruit 20,000 more NHS nurses. (BBC )

Recent figures show that between 2010-2014 the total nursing, midwifery and health visiting workforce increased by 6,434 from 311,000 in May 2010 to 317,000 in December 2014 – indeed, not far shy from Cameron’s 7,000 claim.

Fewer nurses

But the Royal College of Nursing (RCN) says in Frontline First: The fragile frontline there are in fact fewer nurses than in 2010 and that an already over-stretched workforce is being forced to carry out even more work, with serious implications for patient care and staff welfare.

RCN analysis of the workforce headcount shows that while the total number of posted has technically gone up by 6,434 the real increase in total nursing workforce is actually only 1,470 – excluding midwives, health visitors and school nurses.

The report also finds that while health visiting numbers have increased by 2,691 since May 2010, bringing the total to 10,783 by December 2014, this masks a worrying decline in community nursing more generally.

The community nursing workforce has been cut by over 3,300 since 2010 – 2,000 of which comes from district nursing, which provides specialist care. That’s an alarming 28 per cent less of caring for elderly and vulnerable patients.

Unite professional officer Ros Godson is equally worried about the loss of expertise across community nursing in recent years, as more highly qualified nursing staff are squeezed out and their jobs down-banded.

She explains, “Specialist health visitors and district nurses, trained to a Masters level in areas such as safeguarding, child protection, learning disabilities and public health, are being squeezed out.

“Experts in their fields they provide professional advice, training, supervision and leadership to people who need them locally. But their expertise is being lost in the relentless drive to cut costs. It’s yet another example of how this government seems intent on running down professionalism. Once this expertise is gone we won’t get it back easily – if ever.”

In the early days of the coalition, and despite its promises to protect the frontline, nursing numbers plummeted by over 6,000 in just two years, reaching a low of 304,000 in August 2012.

It was only after the publication of the Francis report in 2013, exposing the link between unsafe staffing levels and poor patient care at Mid Staffordshire, they started to rise.

Recruitment crisis

From 2013 Trusts embarked on a mass recruitment drive to increase the number of nurses on acute wards, pushing many already deeply indebted hospital trusts even further into the red.

The problem worsened as a chronic shortage of ‘home grown’ nurses forced hospitals to hire one in four nurses from abroad – and turn increasingly to private agencies for nursing staff at significant cost.

The annual bill for temporary staff has more than doubled since the coalition came to power, with trusts spending a massive £2.5bn on agency staff – last year alone.

Speaking on Radio’s 4 Today programme this morning Andy Burnham Labour health spokesperson vowed to get ‘the agency bill down.’

He said, “NHS trusts simply cannot recruit the staff that they need so they’re having to turn to private agencies. What we’ve seen is a huge increase – a billion pounds and more going to private agencies.”

Burnham added, “the NHS will not have a secure future until we break the grip these agencies have over NHS organisations.”

The RCN reportalso reveals big cuts in student nurse training, last year over 30,000 potential nursing students were turned away as over 50,000 people applied for just 21,205 places.

And as we have seen, the increase in the number of nurses in acute hospitals is off-set by deep cuts across community nursing, with the NHS in England losing nearly 4,000 mental health nurses and 1,500 learning disability nurses since 2010, according to the RCN.

For Joyce Still, a health visitor with 26 years’ experience and 42 years within the wider NHS, the coalition’s top-down reorganisation has been deeply damaging to the profession.

The increased marketisation and competition introduced by the Health and Social Care Act has shifted the focus away from patients to commissioners.

Still said, “Morale is at an all-time low. We are now completely targeted driven – we’re told we have to meet the targets and key performance indicators set by the commissioners. We can’t use our professional opinion – the patient or client is never ever mentioned.

“It’s all about the commissioners rather than what’s best for the patient. It’s not an NHS that I think is delivering a good quality service.”

Sharing her fears of another five years of a Tory government, Still added, “The NHS is at an all-time low. I think that if the Tories get another five years we are not going to have an NHS – it will be completely privatised and fragmented. If Nye Bevan was alive now to see what was happening, he would be turning in his grave.”