“The single biggest problem in the NHS at the moment is that we don’t have enough people wanting to work in it.”

As I said yesterday some may see this quote – from the chair of NHS Improvement  (NHSI) Lady Dido Harding – as a bit simplistic but actually it sums up the problem very well.

We do spend a lot of time looking at those we train in professional roles and argue about how many more there should be. And the usual conclusion is MORE.

But if they don’t want to work in the NHS, whilst training them may be good business for the Universities, it does nothing for patients (and spends public money on training that doesn’t produce more NHS staff). In 2017 3000 more nurses left the profession than came into it as a result of training and migration.

So the key issue is people wanting to work and stay in the NHS. Yesterday I commented on the number of European trained nurses that want to work in the NHS but may be prevented from doing so by Government migration policy. Before Brexit these people – who want to work – have had a big impact on NHS staffing levels. A third of nurses registered in 2015/6 had trained in the EEA.

It’s worth just stopping for a moment and thinking about this statistic . One third of all new registered nurses in 2015/6 came from the EU. If similar numbers are now deciding not to work in the British NHS we are facing a shortage of one third of new nurses. Simon Stevens was reported in the Evening Standard on 1/11 as suggesting that we should make our feelings known to European nurses about how much we care for them. And in the same report most London hospitals were offering to pay the £65 required for their EU staff to register to stay working in the UK.

Whilst I agree with this strategy I feel I should point out that what is true about the loss of EU nurses is also true about nurses in general..

To make Lady Harding’s point in stats. Too many nurses no longer want to work in the NHS.  The obvious truth is that even when they are qualified people don’t have work in the NHS if they don’t want to. Wanting to work in the NHS is the key determinant.

And the numbers are enormous.

In January 2018 more than 10% of nurses left the NHS in each of the last 3 years. Before people say, “well its an ageing profession” (every profession is ageing – in fact come to think of it every person is ageing so that doesn’t really explain very much) take note that more than half of the nurses who left in the last 3 years were under 40.

This is a lot of people deciding that they don’t want to work in the NHS – and given this is the biggest single threat to the quality of care – we really need to know why.

Over the last few months I have had a couple of friends and a loved one spending time in 3 different hospitals in London. And whilst the illnesses and organisation have been different, one of the universal experiences has been the amazing feedback that patients and relatives give the nurses who are looking after them. Every day, all of the time. There can’t be another job where the people you are serving are so grateful, and say it so often. Bless you nurse, thank you for your time and thoughtfulness, thanks for the care, is the soundtrack to a nurse’s work.  It’s amazing to witness it.

Apart from the experience of a few nurses working in A and E over weekends when the drunks are in, the real gratitude that patients and relatives feel and express is unlike any other job I have ever seen.

This must – and does – have an impact on job satisfaction. But this leads to a further underlining of Lady Harding’s point. If people experience this strong life-affirming patient feedback and STILL don’t want to work in the NHS – something is very badly wrong.

And what is wrong is the rest of the working environment. We know that the turnover rates in some health locations are two or three times that of the best. We know that the extra care provided for staffing some organisations – alongside the thanks from the public has a big impact on job satisfaction.

But in too many places staff do not feel valued by their organisations.

I was really pleased to hear the Chancellor announce a commitment to mental health nurses in every A and E department. Being a patient suffering mental health pressures in A and E is a really horrible experience – so this is a great policy. But it won’t mean anything without the mental health staff in the NHS to carry it out. And since we know 10% of mental health staff posts are currently vacant and that too many mental health nurses don’t want to work in the NHS, the announcement isn’t likely to mean very much.

So let’s be clear. If we cannot solve this problem, cannot persuade those that currently do not want to work in the NHS to change their minds, the long-term plan simply doesn’t matter.