How to End the Nursing Shortage
Caines, Eric, New Statesman (1996)
Eric Caines argues that we should abolish not just junior doctors but nurses as well
In the past month, the Department of Health, in an obvious attempt to make the most of the summer lull in health crises, has been releasing bits and pieces of news about how well its efforts to restock the NHS with nurses have been going. The department's principal claim is that its decision to increase the proposed number of "super-nurses" (or consultant nurses) to 5,000 has been good for recruitment. Not only, according to the department, has it enthused school leavers to sign up in droves for training, it has also convinced qualified nurses, now bringing up their children or working in other fields, to return to the N H S. ! hope these recruits will not be disappointed when they discover that their chances of becoming a [pounds]40,000-a-year super-nurse are around 100-1 against. I hope, too, that they will not ask too many questions about what this new cadre of nurses is going to do, since nobody seems as yet to have the faintest idea.
I would also note that, amid all the headlines about returners and new recruits, I saw no figures about how many nurses are still leaving the NHS.
I do not blame ministers for trying to make the most of whatever good news they think they have. But I think the advent of super-nurses raises deeper questions about the NHS and about the hospital workforce and its training. And we can see this if we look at some other items of news about the health service that emerged last month.
For example, at about the same time that ministers were hyping their recruitment successes, the Office of Health Economics released the 11th edition of its Compendium of Health Statistics - a snip at [pounds]300. What caught my eye was not the widely reported and unfavourable comparisons between Britain and other EU countries on such matters as coronary heart disease and health spending, but a set of figures showing the numbers of nurses and doctors employed by the NHS at various times since 1951. In that year there were 188,600 nurses and midwives. By 1987 that figure had risen to 514,600. Today there are 373,000, a reduction of more than 150,000 in a little over a decade. Graphically represented, that would give a curve rather like that of the Sugar Loaf Mountain.
The curve for hospital doctors and dentists over the same period, however, would be a straight incline, steepening towards the top. In 1951 there were only 14,777 hospital doctors and dentists. There are now almost five times that number, 66,800, with the greatest increase having occurred over the past decade- exactly the same period in which the nursing workforce has suffered its dramatic decline.
What accounts for this change in the balance between doctors and nurses? One explanation might be that doctors have been taking clinical work away from nurses. Or perhaps the division of labour between them has remained the same, while nurses have shed many non-clinical duties to ancillary staff, and doctors have taken on increasing workloads, including many new specialities. Or could it simply be that the NHS is chronically short of nurses? Manpower planning for nurses and doctors is carried out separately, and it is possible that economic pressures to reduce overall manpower have bitten far more deeply into the big battalion of nurses than into the smaller medical workforce.
All that is pure speculation, but it does raise questions about the policy that underpins the creation of 5,000 consultant nurse posts. …