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The incompatible left and right hands

My loyalty and defence of the NHS has been lifelong.  So why am I so embarrassed, confused and dissatisfied with it at the present time?

Governments of all parties have done damage in an attempt to make the NHS better.  But for nursing, it appears that within the present government the left hand does not know what the right is doing; there seems to be little joined up thinking and scant strategic planning.

The most incredible example is when the Home Office immigration bosses did not liaise with the Department of Health (DH) bosses when establishing that from April 2016 nurses from outside the EU must earn more than £35,000 after six years in the UK to avoid being deported. They have set £35,000 as the level for essential professionals that we should keep - yet most band 5 and 6 nurses never earn this. Are they unaware that overseas nurses have been essential to plug the gap caused by a dangerous shortage of British nurses? The country risks losing well over 3,000 overseas nurses. The loss of those with training and experience who are estimated to have cost £20 million to recruit, is beyond belief.

David Cameron made patient safety a top priority after numerous hospital and nursing home scandals were linked to poor staffing levels, standards and skills. Elongated and expensive inquiries have undisputedly identified the nursing workforce as key to patient safety and public confidence. Don't government legislators heed the public's concerns and messages from the professions - or consult with each other?

Now, in a high profile media move, 200 trust nursing directors have vented their frustration in a letter to The Times in August regarding the threat to patient safety if overseas nurses are expelled for not meeting new immigration rules. 75% of trusts have recruited nurses from overseas, and for some they make up 15% of the nursing workforce. Nursing directors are charged with meeting government implemented patient/nurse ratios and their organisations criticised keenly and publically for failure.  Hospital nursing ratios fail because there are not enough nurses in the UK now. It's clear why there are not enough of us:

1. Not enough nurses trained.

2. Cost-saving cuts to nursing posts.

3. An exodus of burned out experienced nurses taking well-deserved early retirement.

The DH is awash with bodies that have good intentions but often appear confused and uninformed with poor planning. Recently, the financial regulator, Monitor, advised trusts to avoid agency spending by only filling 'essential' vacancies, risking nurses having to take on more roles; they then outlined permitted breaches of agency spending caps to maintain essential patient safety nursing ratios. Unexpectedly, the chief nurse has taken over from NICE to determine safe nursing ratios, the CQC regulates on the ratio of agency staff used and Monitor is about to decree the maximum hourly rate for temporary nurses and select 'suitable' agencies. So many rules, responsibilities, regulations, rulers and regulators - do they really create safer services if we cannot secure enough nurses. Illogical, clumsy decision making has knocked my faith in the government to take the NHS through tough times of rising demand and austerity. Yet they have rightly challenged traditional, self-interested healthcare attitudes and cumbersome boundaries that were not in the public's best interest. As nurses are trying hard to maintain confidence and engender cooperation in the new world - will the government please try harder too.