THE NHS RECRUITMENT GAP: a special investigation by Marlborough News Online - Part Three: Watch out - there are statistics about
Beware NHS statistics, especially as an election approaches. It is difficult to know what many numbers about the NHS that are quoted by politicians and headlined by newspapers really mean. A few zeros make figures look big. But they may simply be hiding a more complex and more important truth.
Part of the problem is that staffing levels have been thrust into the 'patient safety' debate following the Francis report on the Mid Staffordshire scandal - and quite understandably so. And part of the problems is that many politicians seem blind to the pressures on the NHS and keep denying there are shortages or recruitment problems.
Doctors have been vocal in their reaction to coalition health minister Dr Dan Poulter's denial that there is a shortage of GPs. Recruitment of doctors and nurses is difficult for local practices: "We shouldn't underestimate the problem in primary care - it's getting rapidly worse," Dr Toby Davies told the Wiltshire CCG board last month.
A local politician's recent newspaper column smoothed over any talk of shortages by claiming: "We have 17,000 more clinical staff since 2010 including 8,000 more doctors, 6,000 more nurses, 1,200 more A&E doctors and 400 more A&E consultants." (Those doctors, of course, started their training before 2010 and while there may be 'more', some of them may well be working outside England's NHS.)
And then just days later the Department of Health trumped those figures by announcing: "Since May 2010, we already have nearly 8,000 more nurses on our wards". (Treat this one with care as the policy of the moment is to keep patients out of wards and send nurses to look after them in - or closer to - their homes. So some of those 'more nurses' are no longer working 'on our wards' at all.)
What does '6,000 more nurses' or 'nearly 8000 more nurses' mean? No mention there of need - increased population and elderly patients requiring increasingly complex nursing. How do those figures stack up against the recruitment of foreign nurses?
In September 2014, ITV News, using Freedom of Information enquiries, found that 77 per cent of the hospital trusts that replied to them had recruited from EU countries since 2010. And in those hospitals 31 per cent of all their nurses had foreign nationality.
Official figures tell us that in the twelve months to September 2014, the NHS in England recruited 5,778 nurses from overseas - mainly from EU countries. Does that mean that the NHS has only found 6,000 minus 5,778 = 212 'more nurses' who were trained in the UK - of course not. As in many other fields, workforce statistics are very complex - and the more complex they are the easier it is bend them.
To cap it all, earlier this month, official workforce figures revealed the NHS in England had more nurses than ever before - with 3,047 more added between September and October 2014. But at the end of 2014 there were said to be 8,000 nursing vacancies in London hospitals alone. And still there is a shortage. You only have to look at hospital overspends on agency nurses to see that.
Recently, the Royal College of Nursing's research indicated that NHS spending on agency nurses by 168 NHS trusts in England had risen from £327million in 2012-2013 to £485million in 2013-2014 - and this year could reach £714million. And, if you can bear another statistic, the Daily Mirror reckons the NHS in England is spending £1,200 a minute on agency nurses.
Where can 'more nurses' be found? Since 2010, training places for nurses have fallen - one estimate is that during the coalition years 10,000 training places have been lost. (Coincidentally, '10,000 more nurses over the next Parliament' is Labour's latest NHS promise.)
We do know for sure what recent training place numbers have been:
2010-2011 20,829 (i.e. decided by the last government)
Why did coalition ministers allow that fall in numbers? Were they swayed by the red-top newspapers' campaign that nurses with degrees were 'too posh to wash'? Did they not know that demands on the NHS were growing fast as the population rises and the proportion of very elderly and often very frail people increases?
Into this soup of statistics comes a reported cut of 4,000 in the number of community mental health nurses. Has their work gone to some other part of the Lansley wood? Have they been re-designated as community-something-elses? Or have they taken the marginally easier option of re-training as health visitors? It is virtually impossible to find out - and the number of Freedom of Information requests journalists and researchers make about the NHS attests to that.
The NHS workforce - especially where it concerns nurses - is a moveable feast. The Francis Report meant that 'more nurses' were needed to achieve the new eight-patients-to-one-nurse guidance. In addition, new ways of working such as an emphasis on community services, means that 'more -nurses' with slightly different skills were needed.
When Wiltshire CCG's director of finance, Simon Truelove, pointed to the risk staff shortages posed for the successful delivery of their ambitious plans, he was chiefly concerned about the CCG's new reliance on community health staff and nurses.
The CCG'S prime aim is, in chief officer Debbie Fielding's words: "Keeping people in the right place - close to home." Treating people, especially the frail and old, away from hospital is key to their long-term plan and is also central to the Better Care Plan that starts in earnest - and very expensively - in April.
However well trained a nurse recruited in Spain may be, she cannot be expected to get off the plane and morph instantly into a community nurse, jump into a car and whizz round Wiltshire's treacherous lanes or a labyrinthine housing estate treating old people.
Some 'tutting' was heard at the last CCG board meeting that not enough community nurses were being found to meet the CCG's desire to expand adult community health services across the county.
Fine words describing new health care policies and programmes do not on their own automatically implement changes. You cannot talk a new care programme into being. Putting new schemes in place that require more staff with different skills takes training time - or should do so if patient safety is still top of the agenda.
It reminds us of the American Presidential candidate who, after a utopian speech full of ambitious "Love y'all" promises, was told by his campaign manager: "If you're promising motherhood and apple pie, check first to make sure all the mothers haven't run off with their tennis coaches and the apple harvest hasn't failed."