Andrew Lansley’s legacy of crisis in NHS nursing care, and nurse’s pay in NI…

I’m probably not the best person to be writing about nurses’ pay. They have something akin to special category status in our family. My late mother was certified as a state registered nurse by the City Hospital in Belfast in 1943 after four years of intense study and practical work on the wards.

In that time, she had (literally) been blooded as a student in the makeshift morgues hurriedly convened in the city’s swimming pools during the Blitz two years earlier. Student nurses then, as now, were paid a pittance whilst training and working towards their qualifications.

So in his column yesterday Newton Emerson caused a bit of a stink by picking up on a snippet from the Mail on Sunday suggesting that ‘roughly ten to 12 nurses’ were taking up the offer of ‘working weekends’ involving a 360-mile round trip from Northern Ireland to Sunderland.

Of course there is a much broader context to this issue barely alluded to in the Mail piece. It has its roots in Andrew Lansley’s haste to convert NHS Trusts across England into Foundation Trusts, in part to facilitate the smoother working of his radical 2012 reforms.

Trusts preparing to undertake the transformation had to sign up to a Tripartite Formal Agreement (TFA), which included a set of commitments around financial control. Faced with such a tight timetable one of the first things that many trusts did was to cut recruitment.

The knock on effect on training and graduation has quickly developed into a wicked problem of under training and under recruitment. In the West Midlands, for instance, a 17 per cent drop in commissioned places for standard nurses was reported in the very early stages.

Initially English Trusts relied on agency nurses to plug the growing gap. But that gave way to a new initiative at the end of 2013. At the end of 2014 three quarters of NHS hospitals were forced to look elsewhere to recruit almost 6,000 overseas nurses in just 12 months.

RCN spokespeople warned even at that point that the recruitment issue was a ticking timebomb. Then last October the government added nursing to the Shortage Occupation List on an interim basis, which for now at least allows Trusts to recruit beyond the EU.

None of this speaks for a moment to the high turnover of such recruits or the difficulties experienced both by incoming and established staff in tackling the cultural and linguistic issues which arise in what are already highly challenging work situations.

During this time of cuts in training and recruitment the trend for referrals and admissions in the English NHS has been on the same steady upward curve as before, making it pretty obvious that this crisis originates within the management (or rather mismanagement) of the system.

What the Mail and other mainstream media miss in stories like the one about a dozen nurses from Belfast going to Sunderland to dig the local Trust out of what we must presume is a deep structural hole is the self inflicted nature of this mess at government level.

As for RCN’s campaign for the local Health Minister to implement a modest 1% pay rise, well the figures quoted by Newton do suggest nurses here are paid marginally better than those in the south (who have been going through their own series of structural crises).

But here the last UK government made a nursing degree an entry level qualification. Osborne now plans to remove the bursary (which replaced the Student Nurses’ salary) forcing them to pay for their own third level education. Not a problem if you become a nurse manager, Sister or Matron.

But who exactly needs to pay for a degree level education on £20k+ salary?  You’d almost be tempted to believe this was a scenario setup to fail. For the record, health expenditure in the UK was 8.46% of GDP in 2013, compared to 16.43% in the USA, 10.98% for Germany and 8.77% in Italy.

For his part, the NI Health Minister Simon Hamilton is not the author of this crisis. Nor has he made up his mind on whether or not to pass on the pay rise. Certainly NI has not yet seen the levels of chaos seen in almost every trust in England, although I suspect some of it may be coming shortly.

We know from the Mid Staffs investigation just how crucial it is to have a functioning and well provisioned nursing care. I don’t know if a 1% pay rise is too much. I do know there are no fat cats in nursing. And yet there may be better calls on that money here.

In truth we rely on the majority of registered nursing staff who work at the base of the pay scale to make the whole NHS thing work when resources are cut. We owe it to them and ourselves to admit there’s a much bigger problem here at play.
But then again, I would say that, wouldn’t I?

Mick is founding editor of Slugger. He has written papers on the impacts of the Internet on politics and the wider media and is a regular guest and speaking events across Ireland, the UK and Europe. Twitter: @MickFealty

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