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Choices, choices...

Posted on 12/08/2016 by Jay Sihota

The recent article in the Nursing Times “National nursing shortage could continue beyond 2020” 1 now points to closing the gap between what is deliverable and the demand. This is the inevitable result of resigning ourselves to the idea that we will never have enough nurses and doctors in the system, and shifting the focus to reducing services provided. This until now has been taboo as the UK prides itself on its "free healthcare for all" no matter the situation. Although if your poor health involves your teeth we seem to accept that it won’t be free, merely subsidised. It’s looking like our NHS hospitals / acute services will probably have to follow the same model as dentistry and to some degree the Self Directed Care model that elderly care is moving to.

This doesn't reduce the demand though, it merely reduces the costs. Demand for services is almost impossible to reduce as our population grows along with life expectancy and the ageing demographic we have in the UK. So ultimately we may be able to shift costs to users but this still doesn't address the need for more nurses and doctors. Even if the NHS had five times the budget it has now, there just isn't the number of nurses needed…nor is there enough in the education pipeline. The outlook looks bleak when you combine this with the frankly farcical immigration rules, the uncertainty of Brexit, cutting of bursaries, and the higher English requirement since January for non-UK nurses to obtain a NMC PIN which has seen a massive reduction of nurses coming into the UK.

As if the landscape wasn't challenging enough, we now have the Government trying to go against the economic laws of supply and demand by capping pay rates and agency rates. This may bring some budgetary breathing space but it’s basically a dam made from balsa wood, eventually it will break (its currently leaking badly) and the financial pressure will be back. 

In the meantime it makes nursing more unattractive and thus fewer are choosing it as an option to study. The new graduates we do have are under-utilised as hospitals are crying out for experience and don't have the funds, or time, to invest in them. 

We haven't even looked at the retirement and burn out rates yet! The issues have been batted around by politicians to win elections as the NHS is so dear to the British population, but in reality everyone knows that no 4-5 year government term will solve our healthcare problems. The truth rarely wins an election, so what is to be done? Isn't about time we take the bitter pill and realise we can’t have it all? Choices need to be made. 

As a nation we need to accept that we will have to do without some things if we want the NHS to be well funded and capable of providing free services at the point of care. These questions are being faced by many countries who face similar nursing shortages along with funding issues.

The question is what are we willing to give up to protect the nation’s health? Forget Brexit, that's a referendum question if there ever was!  

1 http://www.nursingtimes.net/news/workforce/national-nursing-shortage-could-continue-beyond-2020/7009797.fullarticle

Jay Sihota 
Operations Director