Outside the marginals

a commentary on the politics that followed the UK 2010 & 2015 elections

Burnham’s New Army of Nurses

Labour’s plans to recruit 20,000 more nurses by 2020. Few would disagree with the problem, but does Labour’s prescription adequately address the problem?

We will train, recruit and pay new NHS staff: 20,000 more nurses, getting the basics right with safe staffing in hospitals, and providing personalised care outside hospital to families with the greatest needs;
Labour Party : Time to Care Fund (accessed 22 March 2015)

“To recruit 20,000 more nurses by 2020” is inevitably a slogan – that is unfortunately the currency of election campaigns. But can we unpack the problem and the proposed solution?

The symptoms are almost certainly observed correctly:

  • too few nurses
  • hospital wards under-staffed
  • community services sometimes non-existent

But the diagnosis is only partly correct

  • not recruiting enough nurses

but it omits:

  • not retaining nurses (often with a wealth of experience)
  • nurses being bogged down with bureaucracy (thanks to the political obsession with cutting anything not at the “front line”)
  • nurses becoming a “graduate profession” moved from “caring” (which is now the job of Heath Care Assistants in many hospitals) to “medically treating” (possibly to cover for lack of numbers and experience of doctors on many hospital wards)
  • a sometimes chaotic, sometimes criminal private care system

The prescription is generally along the right lines. But we need to ask is “recruit 20,000 more nurses” too simplistic a response?

Elsewhere we have learnt that unless you count the numbers leaving as well as the numbers coming in, you will not have effective control over the total number!

So we need to address why experienced nurses are leaving.

Do we want just 20,000 more “nurses” as currently defined?

The 15-minute visit : Community Care

“Modern nurses” will not do much to end “the scandal of 15-minute visits”. The reality is that the “15 minute” home visits are about enabling the infirm to get up, toilet themselves, wash, prepare and eat meals, and at the end of the day get back to bed. To assist the elderly to do these tasks adequately requires more than a series of 15 minute visits; carers should be under less time-pressure (“time to care”) which means flexibility of scheduling and more resource. But does it require a graduate nurse – and would modern nurses be willing to do this work – day in, day out?

We need to consider whether the “15 minute visit” or even a less pressured “three visits a day” regime does much more than address the physical needs of the infirm. If we want to enable people to “live at home”, what responsibility do we have for more than their physical needs?

For the housebound, we also need to consider how to best support them medically. If all physical care visits were done by modern nurses it would be possible to medically monitor the housebound at every visit. But is that an appropriate use of an expensive and rare resource?

With care visits the schedule is dictated by issues such as whether a bed needs to be made or completely changed, whether the patient needs a “cat’s lick and a promise” or a more complete wash – even whether the patient is upset after a bad night and just needs to be comforted for a few precious minutes.

Is the need to medically monitor actually a different task requiring say a regular visit from the likes of a district nurse somewhere between one and four times a fortnight – depending on the medical needs of the patient?

Hospitals

Within hospitals where is the evidence that continuing with the current structure of domestics / health care assistants / senior health care assistants / various grades of nurses / nurse practitioners – often with strict demarcation – is the right structure? Then within that such a structure, is 20,000 more nurses the appropriate change?

Is even a “net increase” (assumed to refer to England) of 20,000 enough? This  equates to about 38 per constituency to cover both community needs and also surgeries and hospitals some of which is 24/7 cover. Providing 24/7 cover almost quadruples the number required compared to single shift cover (after allowing for shifts, hand-overs, holidays, etc ).

Can we create nurses at this rate? With it being a graduate profession you need the time to do the university course, and also the time to get sufficient people with the necessary secondary education for entry into the nursing education and training.

We want this new generation of nurses to be home-grown and will offer young people a new ladder into the NHS
Andy Burnham reported in Julian Ware-Lane backs Labour’s plans for 20,000 extra nurses

If we can’t “grow” these nurses in England, will we continue to plunder other nations’ nursing services?

“Recruit 20,000 nurses” is an eye-catching slogan, but can it happen and will it bring about the claimed benefits?

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