Chronic understaffing in the health service!

Junior doctors on the picket line during their strike in 2016 against an unfair and unsafe contract
Junior doctors on the picket line during their strike in 2016 against an unfair and unsafe contract

ALMOST half of NHS workers on the front line of patient care say there are not enough staff on their shift to ensure patients are treated safely and with compassion, a new survey published by the union Unison reveals.

The study illustrates the effect of chronic understaffing in the health service, with unfilled posts and uncertainty about the future status of many workers having an impact on patients. The snapshot survey Just Another Day examined attitudes and experiences for staff across the UK during one working day – the 24 hours of Tuesday 18 September 2018.

The aim is to paint a picture of how staff felt about the pressures they were under. The public service union, which represents hundreds of thousands of people in a range of health professions, is warning the government it must pump significant funds into the NHS to fix the problems caused by years of austerity.

In addition, ministers must put a greater focus on apprenticeships to usher more people into healthcare professions. Almost half (45%) of the respondents who were directly involved with patient care (6,778 out of 15,134 respondents) said there were not enough staff on their shift to deliver a safe, dignified and compassionate service. Some departments were more severely affected than others.

Hardest hit were those in acute inpatients where almost three in five (59%; 1,381 out of 2,345) said staffing was insufficient. It was also a serious issue for those in mental health (45%; 996 of 2,203), primary care (41%; 777 of 1,893) and community health (36%; 642 of 1,794).

Concerns about staffing levels come despite the number of bank or agency staff being used on the day. Nearly half of respondents (47%) said their service relied on bank staff on the day of the survey, mainly to fill nursing roles but also healthcare assistant posts, administration and a variety of other positions.

Unison’s survey also raises other serious concerns. One in seven (14%) of respondents rated the quality of care as ‘compromised’ and one in six (15%) said patient safety was compromised on the day of the survey.

The findings are based on responses from more than 18,000 healthcare staff from across the UK including nurses, healthcare assistants and support workers, students, ambulance service staff, cleaners and porters. The vast majority (90%) worked in the NHS, the remainder from the private and voluntary sector.

Other findings of the report include:

  • Almost two fifths of respondents (38%) worked longer than their scheduled hours, in many cases unpaid • Nearly one in six (16%) were subjected to violence, aggression and/or verbal abuse during their shift
  • More than a quarter (26%) reported extremely high stress levels.

The desperate state of staffing is illustrated by the most recent figures for the NHS in England, issued in November 2018. These indicated the service was short of almost 41,000 nurses (nearly 12% of the entire nursing workforce), with the total number of vacancies for all occupations close to 103,000.

Unison outlines a number of specific recommendations to the government in its report. These include:

  • The NHS must be given a significant increase in funding to tackle the serious cuts to the service brought about by the squeeze on funding. Current resource pledges are not enough to meet patients’ needs • Legislation must be introduced for mandatory safe-staffing levels in England and Northern Ireland, building on the lead of Wales and Scotland
  • A renewed focus is needed on apprenticeship schemes as a way to improve access routes into healthcare professions • Changes to healthcare student finances are also essential to encourage training and recruitment to the service • The investment in improving pay and rewards must be continued in order to attract and retain health service staff. Stress and violence must be tackled to improve the working environment.

Unison head of health Sara Gorton said: ‘This survey shows the extent to which crisis level staffing has become normal across the whole NHS. ‘These are long-term, systemic factors not being properly addressed. ‘The government must give the system the funding needed to tackle these issues. ‘But hearteningly it also shows the dedication and compassion these hard-working committed staff continue to show at the most trying times.’

Despite the enormous pressures, the report shows staff continue to go the extra mile to help their patients: • ‘I dyed an elderly lady’s hair after my shift (not including the hour I stayed late doing extra clinical work),’ said a registered nurse from Golders Green, north London

• ‘I gave a crying baby a cuddle for 15 minutes, taken out of my break on a night shift, so a tired first-time mummy could close her eyes for a few minutes,’ said a registered nurse from Accrington, Lancashire • ‘A patient could see me struggling, took my hand and told me how great I had been and how good my care was. That meant so much to me,’ said a registered nurse, in Birmingham.

Dame Donna Kinnair, Acting Chief Executive and General Secretary of the Royal College of Nursing, responding to the Unison survey, said: ‘Politicians cannot ignore this warning from thousands of NHS professionals. ‘Nursing staff feel pushed to the brink but it is patients who pay a high price when we can’t provide the care they need.

‘Promises to tackle the systemic workforce issue in England haven’t yet materialised.

‘This is a further reminder of the urgent need to bring tens of thousands more people into nursing with real investment and agree a new law in England on safe staffing levels.’

Meanwhile, in a historic move, the RCN has unanimously agreed its Jersey Branch can ballot members on taking strike action. RCN members working at The States Health and Community Services Department will be balloted on taking strike action over pay if mediation by Jersey Advisory and Conciliation Service (JACS) with the States Employment Board doesn’t urgently result in an improved pay offer. 

This is the first time in its history the RCN has authorised a strike ballot, and if members walk out, it will be the first time RCN members have gone on strike anywhere. RCN members have taken this decision after years of unfair treatment and a below-inflation pay offer. 

The RCN will be working with the Jersey Nurses Association whose members also rejected a ‘final’ pay offer from the States. Lindsay Meeks, Regional Director of RCN South East, said: ‘This historic decision has come after years of poor pay and a desultory offer from the States’ Government.

‘It reflects the strength of feeling among our members, after years of unequal pay which is driving people away from the island, and ultimately risks safe patient care as nurse numbers dwindle.  ‘But first and foremost, nurses’ responsibility is to their patients and should the strike go ahead, members will take every precaution to ensure treatment and care remains safe.


‘Our members want this situation resolved, and the RCN will continue to negotiate through the mediation service. ‘We hope it doesn’t come to a walk-out, but the States should be in no doubt our members will not be ignored again.’