Lesley Riddoch: Fears nursing shortage is hitting health care

Not being able to attract enough nurses because of poor pay and conditions has a knock-on effect, writes Lesley Riddoch

Care for patients across Scotlands National Health Service is being compromised by a shortage of nurses. Picture: Getty Images

Nurses fear staff shortage will lead to patient death.” It’s a headline we’re used to reading about hospitals south of the Border but it’s rare here in Scotland. It’s rarer still to have recent experience of the hospital involved.

But just before a whistleblower’s complaint about conditions at Perth Royal Infirmary was published in the Dundee Courier last week, I was in PRI for a hip replacement operation and could see the effect of nursing shortages at first hand.

Not, I hasten to add, because of any shortcomings in care, expertise or friendliness amongst the doctors, surgeons, nursing, physios and cleaning staff I encountered. They were, without exception, kind, patient and skilful people and the four days I spent in Ward 8 would revive the spirits of the most curmudgeonly soul.

But only I suspect, because the number of operations carried out and thus the number of beds occupied that week was well below the ward’s capacity – small enough to be managed by the under-strength pool of nurses available.

Or to put it another way, it seems elective surgery at PRI is being habitually cancelled because there are not enough nursing staff to cope with orthopaedic wards working at full tilt. It’s not a beds shortage but a nursing shortage.

For one thing, nurses are regularly drafted out of “elective” wards where procedures like hip and knee ops are (arguably) optional to help in relentlessly busy “medical” wards, where older patients with multiple health issues can’t be discharged because money still isn’t available to provide alterations for homes or occasional nursing and social support despite the creation of joint health and social care boards which seem to have done little so far except appoint well-paid managers.

Nursing pay is lousy and the 1 per cent rise “awarded” by the Scottish Government last week was sub-inflationary. According to the Royal College of Midwives, below inflation rises for the last seven years mean “midwives have seen their pay drop in value by over £6,000 since 2010”.

Now that all nurses must be graduates (perhaps with sizeable student loans) they expect far better.

As one Nursing Times reader commented; “When the Nursing and Midwifery Council decided to make nursing a degree level course, they neglected to take into consideration how higher education demands higher return.

“Nurses are highly-skilled professionals with many transferable skills. My advice is to transfer those skills into a role that pays a living wage.”

That is already happening.

The day I was admitted, I understand there were eight nursing vacancies across the two orthopaedic wards at PRI. As a result, I was the only patient from Ward 8 operated on, even though highly qualified surgeons and anaesthetists were on hand. I’ve tried to check this with Tayside Health Board but their official response was a general statement which says wards are quiet sometimes.

That doesn’t wash.

In pre-assessment examinations, patients are told to call at 6am on the day of admission to see if beds are available and warned that only half those scheduled for operation will be admitted. That warning is standard, printed on material for patients and handed out weeks, even months before admission – hardly necessary if problems only occur on busy days.

It’s stressful. Nurses are having to turn down disappointed patients including self-employed people like myself who’ve cancelled work for six weeks to allow for recuperation and folk with dependent relations who’ve been put (needlessly) into respite care.

My own admission was cancelled the day before the operation on the grounds there were “no beds” but reinstated an hour later. When I was finally admitted, I was astonished to find two-thirds of the beds in Ward Eight were empty for the duration of my four-day stay.

With empty beds galore, why are elective operations being cancelled? It seems that in this orthopaedic ward at least there is an ongoing shortage of nurses being disguised by constant reference to a shortage of beds.

This interpretation is backed up by last week’s newspaper article based on an anonymous letter from whistleblowing senior staff nurses who risked their careers to lay bare the problems in PRI.

They said: “Working conditions are atrocious. Many nurses are unable to go to the toilet, obtain a drink of water and meal breaks are regularly forsaken in an attempt to manage the workload. We do not have a magic wand but we are so angry that managers continue to cover up the true picture of the reality on these wards. The stark reality is that care is inadequate, unsafe and at times dangerous to the point that it is only a matter of time before a patient is fatally harmed.”

The nurses insist that qualified but inexperienced staff are being left in charge of wards, staff from unrelated specialisms are being drafted in to provide cover and patients are being given beds in other wards (boarded) due to lack of staff.

These severe problems may not be happening in non-medical wards – but they have an impact across the whole hospital when nurses from other wards are drafted in or patients are boarded out. Is this why so many beds in Ward 8 are empty – waiting for “overspill” patients from other medical wards?

Who knows?

On the one hand, RCN senior officer Bob McGlashan says: “There have been significant adjustments to the bed numbers in Wards 3 and 6 at PRI to alleviate patient safety concerns.”

On the other, Dr Alan Cook, NHS Tayside’s medical director, insists, “patients are being cared for in the safest environments following the introduction of “interim contingency measures”.

I hope this doesn’t induce worry in any patient heading for PRI – the point is that nursing numbers now seem to be constraining admissions so if you are admitted, the chances are you’ll be fine. But how many folk waiting in pain for hip, knee and other orthopaedic operations are quietly being turned away every day? How many other hospitals are managing nursing shortages the same way? And whilst NHS staff in Scotland don’t claim hospitals face the same crisis that exists in England, how can that be averted when problems of nursing recruitment are exacerbated by problems of retention?

We need an open debate about this – and the whistleblowers of PRI should be commended for kicking it off.