Planning ahead

by Feb 13, 2012 No Comments

Are we training enough nurses?

Last month, the Scottish Government announced plans to cut next year’s nursing and midwifery student intake by ten per cent. This cut – 2430 students compared with 2700 last year – comes on the heels of a 12 per cent cut this year, which according to the Royal College of Nursing (RCN) Scotland means the total intake numbers will be at their lowest for 15 years.

Ellen Hudson, RCN Scotland associate director, says it is “staggering” that these cuts come at a time when demand for services is growing.

“We know this is at a time when the demand for health services is increasing. We have an ageing population with increasingly complex needs who will need expert care whether they are in hospital, home or in the community,” she says.

The number of people aged 65 and over is expected to increase by 62 per cent by 2031 and for those aged 85 and over by 144 per cent.

However, while people are living longer, healthy life expectancy is not increasing at the same rate.

Two in five people in Scotland, many of whom are elderly, live with a long-term condition and so as our population ages, we will also see growing numbers of people living with multiple conditions and complex needs.

Hudson says they have “real concerns” that these year-on-year cuts to student intakes risks there not being enough professionally qualified nurses graduating to meet the demand for health services in the future and to deliver the safe, effective and high-quality health care that Scotland deserves.

However, in announcing the student nurse and midwife intake for 2012/13 the Scottish Government argued that the reduction reflects changing patterns of care and service delivery, as well as improvements in student attrition that have resulted in the number of students in training reaching an “all time high” of 10,384.

Health Secretary Nicola Sturgeon called the reductions a “sensible way forward”.

“The intake sets a balance between ensuring the right number of nurses and midwives for the future while also minimising the risk of oversupply and graduate unemployment,” she said.

“Any savings made from this reduced intake will be reinvested in measures to support student and newly qualified nurses and midwives. In particular, it will help us support the internship scheme that guarantees newly qualified nurses and midwives with employment when they graduate.” The NHS is changing, Sturgeon added, with the balance of care shifting towards community settings.

“The shape and size of the workforce reflects that transition and it is only right that student intake must reflect this,” she said.

However, Scottish Labour’s shadow Health Secretary Jackie Baillie, warns these cuts can’t be seen in isolation.

“I go on and on about the cuts in staffing because I think it is just so difficult for those left behind who are struggling to make sure that they do everything they can do, but when you’ve got 4,000 fewer staff in the last two years, more than 2,000 fewer nurses and midwives, nobody can tell me that that doesn’t have an impact on frontline care.” That is now, she says. But looking ahead, Baillie is also “worried” that these cuts underestimate the requirement for nurses in the future.

“Those who are more cynical than I might suggest this is so they aren’t accused of training nurses for the dole. The reality is, I think, our requirement for nurses extends well beyond health boards and actually, increasingly, is into the community and therefore, I think, this is a very retrograde step – particularly when you consider the time it takes to train a nurse, the experience they will build up over those years and the fact that we face a glut of people retiring, the baby boomer generation, all coming together.

“So I think the reality is they are taking a very short-term view and adding to the problems that we are starting to see emerge in the NHS.” Despite the SNP’s pledge to do everything in its power to protect frontline services, Baillie argues that nurses, and therefore patients, have been hit particularly hard by cuts, which she says is becoming apparent in increases in the rates of cancelled operations, readmissions and reporting of unsafe practices by nurses and other staff.

“I think what the government and health boards have done is they’ve gone for their payroll because the reality is that is where they will make the biggest savings quickly. The unfortunate thing is when you take a nurse away from a ward or a community setting there isn’t really anybody to pick up the pieces. It falls to other members of staff who are already hard pushed and therefore, I think, we are starting to see the signs of the service beginning to creak a little bit.” However, while RCN Scotland strongly opposes the 10 per cent cut and has called on the Scottish Government to reconsider, BMA Scotland actually called for an “urgent” reduction in undergraduate medical students in its 2011 election manifesto, warning that the country may be left with large numbers of unemployed doctors unless medical student places are cut.

“The BMA believes that there is a severe danger that Scotland’s medical schools are producing too many medical graduates,” Dr Brian Keighley, chairman of the BMA in Scotland, explains.

“A reduction in trainee requirements in the NHS, taken together with the significant increase in overall UK medical graduate output in recent years, has led the Scottish Government health directorates to forecast an oversupply of doctors in Scotland. In view of this, BMA Scotland has been calling for prompt action to reduce the medical undergraduate intake target, in order to prevent medical unemployment.

He adds that the BMA therefore supports the Scottish Government’s decision to reduce medical student intake from 2011 onward, as part of wider medical workforce planning.

However, Hudson maintains that when it comes to nurses and midwives, the current workforce planning process is “flawed” and doesn’t reflect the long-term demands for the NHS or wider sector.

“Currently these projections are based on what health boards are saying are going to be their requirements for the future. At the moment they are saying they need fewer nurses, but in reality it is not so much a question of supply exceeding demand that is actually leading to what you may consider to be graduate unemployment, it is actually many health boards are cutting available nursing posts simply because they have to balance the books and they are not taking into account the increasing pressures on the health services. They are looking very much at the short-term.” Instead, she insists our focus should be firmly on what the long-term impact on patient care will be if we don’t get the workforce right.

“Our concern is actually more about what the impact is on patient care and outcomes. If you have a workforce that is being increasingly stretched, how can they deliver the best care possible? … How can you possibly deliver a quality service on a shoestring by cutting the numbers of those who are professionally qualified and registered to do specific tasks?” she asks.

It is not just about being protective of the nursing profession, but about getting the balance right so as to protect the quality of patient care, she adds.

“You do need that balance between the right number of registered nurses and healthcare assistants who are so, so important, but getting the right skill mix and the right number is so important to meet patient needs. They are the ones who let us know whether their care is good or not and that is why it is so important that we train them well, we have a good education system and we manage to retain them.”

Katie Mackintosh Katie Mackintosh

Katie is Holyrood magazine's Health Correspondent and has been with the magazine since 2005. She has an MA in Sociology with Gender from Edinburgh University and a post graduate diploma in Journalism from Napier University. Katie has twice been named PPA Scotland Feature Writer of the Year, in 2008 and again in 2009, and was shortlisted for magazine writer of the year at the Scottish Press Awards in 2012. She is an Aberdonian by birth, a Glaswegian by nature, who now lives in Fife with her husband and young...

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