Nursing on a ‘knife-edge’ RCN warn of intensifying staffing crisis

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A nurse on a protest demanding a 15 per cent pay rise has had enough of poor pay and conditions

NURSES’ unions have declared that World Patient Safety Day 2021 must be a ‘wake-up call’ to ministers to tackle – ‘urgently’ – the nursing workforce crisis which is ‘currently on a knife-edge’.

Nursing staff are relied on to deliver safe and effective care in hospitals, the community, care homes, GP surgeries and more, for millions of people every day. But with tens of thousands of nursing vacancies in the NHS alone, and no government-led workforce planning in place to recruit and retain staff, patient safety may be impacted.

Soaring numbers of Covid-19 cases, and ‘an ever-growing backlog’ of people requiring care and seasonal pressures mean the profession faces the prospect of ‘another’ knife-edge winter. Too few nursing staff means teams are under pressure, under-resourced and care can be left undone.

The most recent official NHS data show that the number of registered nursing vacancies in England had risen by more than 3,000 – to 38,952. It also showed that the NHS waiting list for routine treatment rose to a record 5.6 million in July.

The RCN (Royal College of Nursing) nurses’ union’s Chair of Council Carol Popplestone said: ‘This World Patient Safety Day should be a wake-up call for the UK government – nursing staff deserve to be able to go to work with enough staff on shift to care properly and safely for their patients.

‘That is what patients and their families deserve too. We will continue to campaign for safe nurse staffing and fair pay on behalf of our members until the UK government recognises their clinical expertise and knowledge, and makes the right political choice by properly investing in the nursing workforce.’

RCN President Dr Denise Chaffer added: ‘Our members continue to provide the best care they can for patients across the health and care system, under continuing difficult conditions.

‘This World Patient Safety Day, I’d like to extend my thanks to all nursing staff in the UK and across the globe, for their continued commitment to provide the safety-critical care their patients and families need.

‘I hope that nursing staff take time today to recognise their incredible contribution to the health and wellbeing of our communities, despite continued nursing staff shortages.’

Also to mark World Patient Safety Day, the RCN has released a new video featuring ‘Game of Thrones’ star and RCN ambassador Emilia Clarke, who is supporting its call for action.

In her message to nursing staff she said: ‘This day is a reminder of all you do to keep us safe and well, but I know you are still campaigning to get your work recognised by others, including with fairer pay levels and even safer workplaces. You have my full support, and I will always help to fight your corner.’

Supporting members to deliver safe and effective care is one of the RCN’s key priorities. The RCN’s Nursing Workforce Standards, published earlier this year, help all nursing staff understand what measures must be in place to support the delivery of safe and effective care – and challenge employers safely when they feel the standards are not being met.

Meanwhile – and in particular – combining the flu and Covid booster programme may not be ‘straightforward’ or even practical. Speaking in a televised briefing about the booster campaign on Monday, Professor Jonathan Van-Tam said that ‘giving the booster jabs with flu vaccines at the same time is ‘safe’ and ‘does not affect an individual’s immune response to either vaccine’.

But, while he said that ‘Covid-19 booster doses may be given at the same time as flu vaccines’, he added that this was not only ‘subject to availability of both products’, but also comes with practical considerations.

GP leaders told Pulse that while they would like to be able to co-administer the vaccines, it was wrong to leave it to GP practices ‘to sort out’ the practicalities.

JCVI (Joint Committee on Vaccination and Immunisation) guidance issued on Monday stated: ‘It is not the intention of the JCVI that the 2021 Covid-19 booster vaccine programme should disrupt or delay deployment of the annual influenza vaccination programme. Both of these programmes are important for individual and public health, especially over winter 2021 to 2022.

‘Where operationally expedient, Covid-19 and influenza vaccines may be co-administered.’

And in guidance just issued, NHS England said that GPs should ‘use their discretion’ to delay flu jabs for co-administration if this would boost uptake – especially ‘where it improves patient experience and uptake of both vaccines, reduces administrative burdens on services or to reduce health inequalities’.

Professor Van-Tam said: ‘MHRA (Medicines and Healthcare Products Regulatory Agency) has looked at the data from the trials on giving flu in one arm and Covid in the other at the same time, and the antibody response to both of those vaccines is not impaired by doing so, and the tolerability of doing that at the same time is also fine.’

However, he added: ‘I would add that there is a practical reality to add on top, which is for the NHS to consider in more detail, that it may not always be the case that it is possible to co-administer those two vaccines in every single patient.

‘Sometimes it will be possible, and we should, you know, gain efficiencies by doing that where we can. But remember that, if you’ve ever been for your flu jab, it’s quite a kind of rapid process to get down the line. There is a 15-minute waiting period with Covid-19 vaccines – an observation period – and meshing those two together, in practical terms, won’t always be straightforward.’

Therefore, he said ‘people need to understand’ that ‘if they are offered the chance of two together’ they should do so – but ‘by the same token they may not be, through practical realities’.

Kent LMC chair Dr Gaurav Gupta said: ‘The government should do everything it can to facilitate co-administration rather than put that burden again on general practice to try and make these difficult decisions.

‘Co-administering is absolutely preferable because these are the most vulnerable patients. We would not want vulnerable patients to have to come to practices twice because it increases the risk for them to get not just Covid but other infections as well.’

He also urged the Government to ‘support general practice’ which ‘is not happening at all at the moment’.

Dr Gupta said: ‘We need some urgent respite from NHS England from some of this work so we can get on with the most important work of seeing the country through the pandemic.’