J.Meirion Thomas is a former Professor of Surgery and Consultant Surgeon in the NHS.
One of this week’s big news stories is that the NHS will need to recruit tens of thousands of nurses from abroad over the next five years to plug holes at ward level in our hospitals.
From a patient’s perspective, nurses are the caring face of the NHS: they work compassionately at the front-line. In addition to the increasingly complex and skillful clinical tasks they perform, nurses have the opportunity to provide words of comfort and reassurance to patients when at their most vulnerable, as well as an explanation of the possibly bewildering treatment plans being carried out. They are true professionals, but sadly not sufficiently respected.
Until fairly recently, nursing was a sought-after profession for school leavers and mature students but, sadly, its appeal and reputation has been eroded. As with teachers, society has failed to understand the vital role that these increasingly unglamorous professions contribute to our national well-being. We neglect them at our peril.
Nursing morale has suffered because of low pay, an expanding workload, insufficient staff numbers and, perhaps especially, anti-social hours. There is a large attrition rate of nurses after graduation and only 60 per cent of nurses apply for work in the NHS.
The body blow for the nursing profession in UK was the decision to abolish bursaries for the training of nurses and midwives as of September 2017. From that date, nursing students, like other graduate students, would have to pay annual tuition fees of £9,000, increasing with inflation. Repayment of loans would begin when they earn more than £21,000 per year.
The reason given for this change was that the money saved could be used to train an additional 10,000 nurses. The opposite has happened! The Royal College of Nursing has described the abolition of nursing bursaries as “a disaster”, and have reported a fall of one third in nursing applications over the past two years. Nursing also attracts mature students who may be especially disadvantaged if they already have expenses relating to an established family or other commitments. Previously, nurses and midwives were entitled to non-repayable bursaries of up to £4,191 with maintenance loans up to £3,263. All tuition fees were paid by government. The change was massive body blow to the profession.
That was no way to treat a workforce that should be valued and respected, and whose professional reputation needed encouragement rather than a gigantic disincentive. Also, little has been said about encouraging nurses back to work after child-rearing and arranging family-friendly work scheduling.
As a direct consequence of this neglect and mismanagement, we are now told that the Government will need to recruit tens of thousands of foreign nurses over the next five years to plug holes in nursing care. As with doctors, they will mostly be poached from lower income countries where they have usually been trained at public expense and where their services are sorely needed. This serial practice has a moral and ethical dimension which we and Government need to address.
Recently, I uncovered the fact that in 2018, the UK had imported more doctors than it had trained. To be exact, of new registrants with the General Medical Council in that year, 8115 had trained abroad (54 per cent of the total) and 7186 were home grown. I have confidently predicted that this figure will rise to 60 per cent within two years as a consequence of the abolition of the Tier 2 visa cap in June 2018.
I believe that the NHS is approaching an existential crisis with so many unattended and unsolved problems, two of which are described in this article. Are we sleep-walking towards a healthcare disaster in the UK and approaching the point of no return as the Department of Health oversees a process of managed decline?