News coverage on the UK’s vote to leave the EU has taken the nation by storm with numerous leaders speaking out on the damage or success the outcome will cause.
Peter Carter, former Royal College of Nursing (RCN) chief executive, is no different, voicing his concern that Brexit will be a “disaster for healthcare”.
Carter, who worked as the general secretary and chief executive of the RCN from 2007 to 2015, has never been shy about speaking out on issues. After all, his leadership established the College as a voice for nursing. Nursing in Practice was keen to know why exactly he thinks Brexit is such a cause for concern, and what he thinks the profession now faces in the challenging times ahead.
Q In the news, you have stated that leaving the EU would be a “disaster for healthcare”. Why?
A I think the Brexit people seriously misunderstood just how dependent we are on people from overseas to staff the health service. I personally believe the NHS and the country is a much better place for having all these people from the Caribbean, Malaysia, India, Sri Lanka – and I could go on.
In 2003 we were training 23,000 nurses a year. When the coalition government came into power, they got so preoccupied with Andrew Lansley’s reforms [Health and Social Care Act 2012] that many health authorities, in order to help balance their budgets, cut the training places for student nurses. Our training figures went down to 17,000. That went on for nearly three years. For example, in London they were training 2,000 a year. That got cut by 25%
Then, about two and a half years ago, the staffing crisis became so evident that suddenly they had this massive recruitment across Europe, capitalising on the financial crisis in countries like Spain, Portugal, the Republic of Ireland and Eastern Europe.
And so we have recruited thousands of nurses from Europe and are still recruiting thousands of nurses, predominantly from the old Commonwealth countries plus the Philippines. Then Brexit started up this business about ‘people coming over and taking our jobs’. Well, first of all, we are actively recruiting these folk because we need them. So forget any notion that we are going to stop recruiting nurses from overseas. We are going to depend on overseas recruitment for years to come.
And the claim that Brexit means £350 million a week is going to be put into the health service? I, like millions of other people, knew that was nonsense! So now we find ourselves in a hell of a mess, with Eastern Europe and our colleagues from Spain and Portugal, and everywhere, unnerved and worried.
Q You have said it would take years to stop recruiting from abroad. What do you think it would take for this to stop?
A There is a range of other things. If you up training places you will make a big impact within three years. Secondly, we should support the pilot to look at 1,000 nursing associates and see if that helps. Also, there are tens of thousands of nurses – I don’t know the exact figure – who are not working as nurses. The reason is that far too many employers have rigid employment policies. I would say, give me thousands of nurses that can work one, two, three days a week, one night a week or whatever. That’s a resource that is readily available.
I also think that, after six years of pay restraint, a half-decent pay rise would be very welcomed. This is an era when many other industries, starting from Parliament downwards, have not had pay restraint.
But a ward sister running a neonatal unit gets £34,000 a year. I think that is a pittance when you put it against comparable occupations, and look at the level of the responsibility.
Q What would you do personally about the staffing crisis?
A We need to train more nurses and for that we need investment. Now, friends of mine say: ‘Oh Peter, we cannot keep pouring money into the health service.’ But we do not pour money into the health service. We are spending 6% of our gross domestic product (GDP). All over Europe; France, Germany, Spain, Portugal, the Republic of Ireland, Italy, they spend more on their healthcare systems than we do.
So people say, ‘the country is broke’. It is not broke. We are the fifth largest economy in the world and we do have money; it depends where we want to spend it.
I accept the economy is under strain, but we have to decide what our priority is, and right now I would invest in that workforce.
Q The NHS is amending English requirements for applicants trained abroad. What do you think about this?
A I thought what they said was, while they want to ensure standards are high, they will allow people to retake the test. If nurses go off to night school or whatever and get up to speed, I do not see anything wrong with retaking the test. After all, people re-sit their A Levels or retake their driving test. There are very few areas in life where one strike means you are out. So I welcome people who persevere and get up to standard and pass.
Q Do you think nurses should play a greater role in commissioning?
A I think commissioning has been an absolute failure and I would scrap the market. We are in this really tough economic climate, and we have all of this commissioning and contracting infrastructure. That money could be much better spent on front-line patient care. They do not have the internal market in Scotland or Wales and nobody has particularly missed it. It is billions, not millions. I personally would question, in such tough economic times, whether we can justify spending that on the apparatus of managing the internal market. It is horrendous, and in times of austerity non-essential things should be cut. And that end of it continues to grow, while frontline clinical services continue to be squeezed. So that is what I would do; I would cut it out. If possible, of course you want nurse representation, but my view commissioning is unnecessary.
Q So if commissioning is a failure, how do you think it has impacted nurses?
A I think too many decisions have been made by people that are not tuned into the clinical end of things. You end up with ill-conceived cuts, which have stacked up problems. Let me give you an example from mental health services, child and adolescent services. They are low numbers but very high cost, right? We will accept that. But over the last decade and more, before the coalition because Labour have got their responsibilities for this, we have seen people thinking, ‘these services are very expensive’ – which they are. And so they have cut them. Now, a year last Christmas, a police officer in Devon was reduced to tweeting, saying, ‘We have got a 14-year-old girl in a police cell and we cannot find an adolescent bed anywhere in the country.’ Isn’t that a terrible indictment of our healthcare system that, in one of the wealthiest countries in the world, we have got children in police cells because we do not have the beds? So the private sector – and I do not criticise or blame them at all – is now providing those services, but is charging top dollar because the NHS hasn’t got an alternative. Now, if commissioning was working that would have never happened.
Q What would you say are the key things for the profession that need to change?
A Leadership needs to be more confident about taking on issues that are facing nursing and nurses.
I also think there are wonderful opportunities in nursing that we simply do not highlight. It is a wonderful way to earn your living. You have huge opportunities and, unlike so many other occupations, a nursing career can take you to lots of very different things all over the country. I speak to nurses that say things like, ‘I did six years in A&E and then five years in oncology, and I am now doing palliative care.’ That is something worth celebrating; that you are in an occupation where you can do diverse things. We also need to promote the value and worth of nurses. I certainly think politicians, senior civil servants could do so much more in this. Can I hasten to add, I am hugely encouraged by Simon Stevens, chief executive of NHS England because I think he is exactly what the NHS needs.
Q Why do you think Simon Stevens is exactly what we need?
A He is a visionary. He understands the need to get to the minutiae of the planning with his Five-Year Forward View. I liked that document; first of all, it’s written in plain English. We should get the politicians to take a step back and not try to get involved in the minutiae. Then we let Stevens get on with it. We’d have a much better chance of taking the NHS in England forward.
Q What do you think the future for nursing, in the current situation, really looks like in the UK?
A I think the future can be very bright if people talk and engage and work with the people that understand what is going on. The future will be very dull if we get initiatives that are not properly thought through.