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The King’s Speech is the “last chance” to fix the NHS staffing crisis before the next election according to the Royal College of Nursing which is not ruling out further strike action.
Professor Nicola Ranger, chief nurse at the union, told i on the eve of the state opening of Parliament that the problems, which led to nurses voting for industrial action a year ago sparking a cascade of industrial action across the heath service, are yet to be fixed.
Although a second round of strikes was narrowly avoided earlier this year the main bone of contention the RCN had with the Government over safe staffing levels remains, with the College leadership not ruling out a return to the picket lines. Any further strike action would not take place before 2024 but could resume in the run up to the next general election.
Asked if the NHS is in a better place than a year ago when nurses were preparing to walkout at hospitals in England, Professor Ranger said: “Sadly not. Of course, there has been a small increase in pay but clearly not what we think our members are worth. And certainly not enough money to make any difference to recruitment and retention.”
The Government struck a pay deal after the RCN and other health unions entered collective negotiations over the summer. One million NHS staff, including nurses and paramedics, received a 5 per cent pay rise worth at least £1,065 to full-time staff as well as two one-off payments worth at least £1,655. Although RCN members rejected the offer, a majority of health unions supported it and the deal was passed by the NHS Staff Council.
The College asked its members to support another six-month round of strikes but the ballot failed to reach the required 50 per cent legal threshold. Some 84 per cent of the 122,008 RCN members who voted in favour did so in favour of strike action.
“The main issue for staff was about safe staffing and sadly that is no better,” Professor Ranger said, pointing out that high levels of discontent among nurses looks set to remain ahead of a general election expected next year.
“We asked the Government for key things we wanted it to work on around safe staffing, so we’ll wait and see what happens. But I think, particularly going into winter, nurses are not silly.
“They are still under pressure and worried about their profession. So is this [industrial action] completely over? Sadly not. Let’s properly value nurses and nursing and then we will see a difference when we can focus on our patients.”
The RCN wants a maximum patient/nurse ratio established in every care setting, from acute wards to community hospitals and mental health units. Will the College rule out another ballot if that is not forthcoming?
Professor Ranger, who has been chief nurse at several NHS trusts, including King’s College Hospital, London, and Brighton and Sussex University Hospitals, said: “We are a member organisation and our job as leaders is to listen to our half a million members. They will let us know if they still feel where things are not where they need to be. Our members will guide us.
“We do eventually want safe staffing levels set out in legislation – as they do in Australia and California – but that can take time. That doesn’t stop us from defining what we think safe staffing levels should be and working towards that. The evidence shows that when you start defining safe staffing levels you make a difference in recruitment and retention. You start to see hope.
“In childcare you can only look after a certain amount of children. Even in a zoo you can only look after a certain number of animals, but in healthcare… I think the public would be shocked that there is no maximum number of patients that any one nurse has to look after.
“They know it in intensive care where it’s very clear: one nurse, one patient. We want the correct ratio in every setting. We know this won’t be solved overnight. It has taken us 10-15 years to get into this mess and it will take several years to get out. We just want a sense of hope that we’re listened to and that there’s a trajectory for improvement.”
The NHS has been stuck in a cycle of crises for years due to huge numbers of vacancies, which currently stand at 112,000 – nearly one in 10 of the total workforce. Officials said that the growing and ageing population, coupled with new treatments and therapies, means that without action, the gap could grow up to 360,000 by 2037.
Earlier this year the Government finally published its long-term workforce strategy for the NHS in England setting out how an extra 300,000 staff will be recruited over the next 15 years. The number of nurse training places will almost double, with 24,000 more nurse and midwife training places a year. However, only funding for the next five years has been allocated to boost the workforce.
Professor Ranger said although the plan offers “a bit of a roadmap” towards safe staffing levels it has “no funding behind it” to turn that into a reality and that it does nothing to help retention.
“I do feel there is a lack of genuine commitment to nursing in an overt way that stops people leaving the profession,” she said.
With no major health and social care announcements expected, Professor Ranger said Tuesday’s King’s Speech will be a “missed opportunity” for the Government to make a difference to NHS and social care before the next election. Rishi Sunak must call an election by the end of January 2025.
“If there is nothing mentioned to give the NHS and social care any sense the Government is concerned about patients as the staff are is a missed opportunity. The public know the state of the NHS – they are experiencing it. The staff know it.”
Professor Ranger described recent Government announcements, including a ban on trans patients from single-sex wards and asking NHS managers to stop recruiting diversity and inclusion managers, as “complete distractions” from the issues that matter to staff and patients. Ministers should be investing in “improving the culture of the NHS, not fuelling a culture war,” she said.
“Some of our trans patients are our most vulnerable patients. We want everybody to come forward and that the NHS will be there for them whatever their circumstances and needs. And when it comes to hiring EDI [equality, diversity and inclusion] managers, one in five of our nurses are internationally educated because we have had such a poor domestic plan for staff.
“So when you have nurses from all different cultures and ways of working, if they’re going to coalesce in one team around the patient, how are we going to do that without some investment in inclusion and equity and being one team?
“It has nothing to do with political correctness. They are absolutely essential to ensure that everybody feels safe to practice and we become one team around the patient. If you don’t want EDI managers don’t be reliant on one in five nurses coming from overseas.”
Rishi Sunak has blamed striking NHS staff for rising waiting lists, reaching a record high of 7.7 million people in England, which is given short shrift by Professor Ranger.
“It’s just further distraction. I’m old enough to remember when A&E performance was 98 per cent [of patients admitted, transferred, or discharged within four hours – the 95 per cent target has not been achieved since 2015] and it was an almost sackable offence to have a 12-hour breach.
“We don’t want people to be scared when they come to hospital and staff will do all that they can, but there won’t be a nurse in this country that knows someone who has gone into hospital and their first though is: ‘I hope they’re going to be OK’.
“That’s always my first instinct – not because of any criticism of staff, but because they are under such pressure that you immediately have that feeling. It’s not a good place to be.”
The Department of Health and Social Care has been approached for comment.