Why David Cameron’s immigration rules will worsen nurse shortages

Original post from The Guardian


It takes time to train NHS nurses so in the meantime, trusts have to recruit from abroad

A scene from the opening ceremony of the 2012 London Olympic Games. There are thousands of vacant nursing posts. Photograph: KeystoneUSA-Zuma/Rex
A scene from the opening ceremony of the 2012 London Olympic Games. There are thousands of vacant nursing posts. Photograph: KeystoneUSA-Zuma/Rex

Recruiting skilled and motivated nurses is key to delivering good quality hospital services. So Newcastle upon Tyne hospital NHS foundation trust was delighted when it found its latest crop of new nursing staff, who, according to chief executive Sir Leonard Fenwick, were expected to become “part of the backbone” of its workforce. Trouble is those nurses are still sitting some 6,500 miles away in the Philippines after the trust’s applications to bring them into the country were rejected.

“It’s a frustration,” says Fenwick. “We have had a great success story with bringing in staff from the Philippines over the past decade. They have been fabulous – they have hit the ground running and they have become indispensable. This is about bringing to the UK calibre people who quickly become thoroughly engaged in our social fabric.”

The Newcastle trust’s problems – it has had three applications for a total of 85 certificates of sponsorship that non-EU staff need to enter the country refused between June and September – are just one example of an issue that NHS trusts say could put patient safety at risk. That’s why 10 hospital trusts, including Newcastle, last week signed up to a letter to the home secretary, Theresa May, calling for an easing of immigration rules. The NHS Employers organisation, which coordinated the letter, estimates that around 1,000 nurses from outside the EU have been rejected by the Home Office to date, with a further 1,000 applications expected over the next six months.

The Home Office disputes the figures and claims NHS trusts have been given more than 1,400 sponsorship certificates for nurses since April this year, but more than 600 of the places allocated to them in April and May this year had been returned unused.

In recent months, when places for Tier 2 visas for nursing and a number of other professions have been oversubscribed, priority has been given to shortage occupations.

“The independent Migration Advisory Committee, which took evidence from a number of NHS trusts and representative bodies from across the UK, recommended against adding nurses to the shortage occupation list earlier this year,” a Home Office spokesperson adds.

But NHS Employers’ chief executive, Danny Mortimer, says hospitals around the country are being affected and that until moves to train more nurses in the UK start to pay off, hospitals need to be able to recruit flexibly.

“There are two principal areas of concern, he says. “The first is if you can’t recruit permanent staff, whether from the UK, the EU or outside the EU, that drives demand for agency staff – and that comes at a premium.

“Then people are looking at their plans for winter and the need to expand capacity and thinking: ‘Gosh, how do we staff that?’ We are not given to the waving of shrouds but it does create a risk. We know the winter period is going to be pressured.”

As well as reconsidering the decision not to add nursing to the shortage occupation list, NHS Employers wants rules on the salary criteria for entry to be eased to reflect the fact that skilled health staff are not paid as much as, say, migrants offered jobs in financial services.

But the problem goes wider than nurses who are not able to enter the country to take up the jobs they are offered – it could also hit thousands already here. The Royal College of Nursing has warned that new rules requiring non-EU workers must be earning at least £35,000 before they are allowed to stay in the UK after six years could “cause chaos” in the NHS. According to RCN research, by 2020 some 6,620 nurses could be forced to leave, wasting almost £40m in recruitment costs.

Then there’s the impact of the tougher climate on care homes, which already find it more difficult than NHS trusts to recruit nurses. Analysis by consultancy Christie & Co suggests that adult social care has a 9% nurse vacancy rate, compared with 7% in the NHS.

“It takes time to train nurses so in the short term we have to get nurses who are already trained into the country,” says Michael Hodges, director of healthcare consultancy at Christie & Co. “Care homes really want to hire nurses from overseas, which in the past has been really successful. The tightening of the system and the fact that some could even be forced to return home doesn’t help matters at all.”

Dr Pete Calveley, chief executive of care home provider Barchester, says that with 15,000 nursing vacancies across the NHS and social care it’s a “nonsense” for nursing not to have official recognition as a shortage occupation. Despite the difficulties with securing their entry, Barchester has returned to trying to recruit nurses from outside the EU because of the shortage in the UK and the fact that EU nurses who join the care sector often move on quickly to the NHS.

“Last year we recruited 800 nurses but lost 1,000,” he says. “The cost of recruiting is absolutely huge. Yes, let’s train more nurses in the UK but let’s also recognise that nursing is hugely in demand and not make the search for them so inappropriately burdensome. Although there are thousands of vacant posts it’s not considered a shortage which seems bizarre.”

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NHS; Is it fit for Purpose?

NHS Scandal

Why has the caring stopped?

Over the last few months many problems with the NHS have become known, so therefore, are we now saying the NHS is not fit for purpose?  I believe there are some of us are saying YES, while others are saying NO and even others who are not sure. So lets try to find some answers. The NHS was created in 1948 and since that time has undergone many changes, some because the NHS wished to, some due to advances in technology and medical science and some inflicted upon it by successive governments.  But during all this time the fundamental principles of the NHS have not been changed. When created it was to be ‘free at point of delivery for all citizens of the UK’. This in most cases is still correct. So why are all these problems occurring? Lets start at its beginning.

  1. Every UK citizen was entitled to signup with a local general doctor, known as a General Practitioner (GP), it may have been the same doctor to whom they went to when ill in the past, but then they would have had to pay the doctor directly for this service.
  2. The NHS was born out of a long-held ideal that good healthcare should be available to all, regardless of wealth. At its launch by the then minister of health, Aneurin Bevan, on 5 July 1948, it had at its heart three core principles:
    • That it meet the needs of everyone
    • That it be free at the point of delivery
    • That it be based on clinical need, not ability to pay
  3. These three principles have guided the development of the NHS over more than half a century and remain. However, in July 2000, a full-scale modernisation programme was launched and new principles added.

    The main aims of the additional principles are that the NHS will:

    • Provide a comprehensive range of services
    • Shape its services around the needs and preferences of individual patients, their families and their carers
    • Respond to the different needs of different populations
    • Work continuously to improve the quality of services and to minimize errors
    • Support and value its staff
    • Use public funds for healthcare devoted solely to NHS patients
    • Work with others to ensure a seamless service for patients
    • Help to keep people healthy and work to reduce health inequalities
    • Respect the confidentiality of individual patients and provide open access to information about services, treatment and performance

Since then there have been the setting of targets by successive governments.

I do believe in having targets, but wish to call them standards. We have always had standards to maintain in the NHS, but these days in trying to run the hospitals as a business, finance as become the main factor instead of care. Before all else, care has to be the first priority.When the NHS was created in 1948, it was not envisaged that the population would increase in great numbers and that medical science would advance so quickly in both technology and treatments. To cater for this, our hospitals have had to increase in size to cope and this as left management abilities to flounder. We need to maintain standards, but not by tick boxes, use the technology in administration practices that have been created. All records are computerised, so all relevant information should be to hand from the computers, no additional staff in put required. Proper supervision of all staff needs to be reintroduced and all work as one team and that is to the betterment of care to the patient.

When the NHS is working well it can not be bettered and unfortunately, this is not deemed news worthy by the media. But many aspects of hospital care are wanting and an investigation should not just look at the present, but look to the past to see when this change for the worse occurred. Was it Government targets being introduced, withdrawal of Matrons, Sisters or charge nurses becoming more hands on, instead of managing the ward, the replacement of cottage hospitals with the large hospitals of today, aging population, emphasis on academic  nursing qualifications instead of the ability to care, influx of staff where English is not first language and understanding it is limited, changing from larger open wards to smaller units within the ward, increasing in technology and medical conditions, hospitals run as a business instead of a caring facility. The list is endless, just what is the answer, this has to be known before steps can be taken to improve them.

Alarm bells should be ringing, the NHS is provided with money from Government, from money raised from UK taxpayers, to be used to provided care for patients. Why is some of this money being used to gag people from letting the UK public know the truth.For one thing no one should be gagged for telling the truth, if the NHS is not fit for purpose then the public need to know.

What all employees in the NHS should realise is that by the source of the money for their salaries in coming from the public, it is the public who are effectively their employers, it is just that it has been sub-contracted to the Government and the NHS.

Image or Care, What is of most concern to the NHS?

It should be care, but who knows when you follow the current articles in the UK press.

How many More?

It makes you wonder how many other gagging orders are in operation and what is still left to be uncovered.

So it is not only Sir David Nicholson who is a fraud, but also his right hand , Dame Barbara Hakin. You will see both these persons have received Royal Honours, but for what, in these two it would appear to be for incompetence and lack of professionalism. If the people at the top of the NHS are not fit for purpose, what hope is there for the NHS. A clean sweep needs to be undertaken and this should start at the top and go as far down as possible until we find those who are fit for purpose. Hopefully there will be some.

It is time that every aspect of the NHS is given a full audit and every detail investigated. If staff are not up to the job, then they must go, but the facilities have to remain open. If the staff are not up to the job, then get staff who are, there would appear to be plenty qualified staff ready and waiting to be employed.

As I have said when the NHS is working well, it is excellent, as I have seen myself, by the care afforded to my own family from all aspects of the health service in Sheffield.

The creation of the National Health Service 1948 was a magnificent achievement, unfortunately, without the aid of a crystal ball, the founders could not have envisaged so much would be happening in the UK in so short a time. As stated successive previous governments have created target to be achieved and certainly at Stafford Hospital this is one reason for its failings. As it was concentrating to much on attaining these targets than maintaining its primary function of providing good quality care for its patients. Unfortunately, I believe more hospitals will have been found to fail for similar reasons as time goes on. Then as to gagging orders and payments made to gag NHS officials to stop then advising what is happening, how can this have been allowed to happen.  Not only is this diverting money needed for providing the care function, it is also being dishonest with the public, who are all contributing to the cost provided by them by paying their taxes.

Anyone responsible for misleading in this way should not be employed, certainly not within the NHS, more likely should be doing time in prison for, hopefully, what should be a criminal act.

The NHS should be fit for purpose and where this is not currently so, every effort needs to be made to make sure that it is. The NHS can not be left to fail, as it is an integral part of the UK and one that we should be proud of. All within the NHS need to work as a team, as no one individual can work without the support of the others.

Hopefully, in the very near future, we can all say that it is.

Nicholson still holding on to office

Nicholson should go and go now and so should any others of the same ilk. His right hand woman, Dame Barbara Hakin for a start.

To remove Sir David Nicholson sign the E-petition

The Blame Game

The NHS is safe in whose hands, all parties are to blame for the current situation, maybe some parties more than others.
But, surely, now is the time for unity to ensure all can be done to save the NHS where it is failing.

The NHS is an intergral part of the UK and can not be allowed to fail in any shape or form. Many of the problems have been successive government interference in creating bureaucracy to administer systems to keep to, what may have been welcome targets. But if an organisation is only concentrating in maintaining its operation into achieving certain targets, this could and most likely as, caused other non-targeted area to suffer. When you have an organisation based on care, no one area can be concentrated on, with the exclusion of some others. The management have to oversee the whole operation not selected parts.

It is for the reason to save the NHS, that all parties, be they in Government, opposition, NHS or any other areas, should work together for the common good for all in the UK