The fall in nursing numbers is a complete disaster

Without swift work to rectify this problem, patient care will suffer.

Following recent reports regarding a significant rise in emergency hospital admissions and higher patient mortality rates over the weekend due to a lack of senior doctors, we are now faced with the abysmal fact of fewer training nurses. Research by Nursing Times (NT) earlier this month revealed that nurse training places have been cut by more than 2,500 in the past three years. Professor David Green, Vice Chancellor and Chief Executive of the University of Worcester commented: "We are heading straight for a national disaster in two to three years’ time." Worse still, Strategic Health Authority figures obtained by NT showed that there were over two thousand more nurses opting to work in a community based setting as opposed to acute care.   

During my time in the NHS I have worked in primary and secondary care with the latter including time spent in acute medical, high dependency and intensive care environments. And I have witnessed first-hand the considerable strain placed on the nursing profession. In an acute medical setting for example, a nurse would be typically responsible for at least four to six patients, sometimes even more. And in the acute setting, a patient’s clinical state can change at any moment. As doctors, following initial patient assessment, we put plans in place from a management perspective to ensure recovery. But due to large patient numbers and demands from outpatient clinics it is difficult to be on the shop floor monitoring each patient around the clock - a sad fact but unfortunately true.

In a high dependency or intensive care setting, the situation however is very different. Doctors are always present and patients benefit from one to one nursing allowing for effective patient assessment. You may argue that these types of patients obviously need a more advanced and rigid monitoring regime and you are probably right. But ward patients also rely heavily on nurses to be their eyes and ears, alerting doctors to any concern they or of course the nurse may have.

An afternoon ward based scenario to help illustrate my point; a four patient bay being manned by one nurse.

Patient A has been admitted with chest pain which initially settled but has now recurred and is more severe in nature. The nurse must do a new set of observations, namely blood pressure, heart rate and oxygen saturations, as well as an electrocardiogram (ECG), give pain relief which has been previously prescribed and alert the doctor responsible for that patient about the change in clinical state.

Patient B, a chronic alcoholic admitted following an alcohol binge, starts to vomit large amounts of blood. He feels faint, his blood pressure is falling and he is at risk of cardio respiratory arrest. The nurse, in addition to recording new observations, will need to insert a cannula and start intravenous fluids if the doctor responsible for this patient is busy and unable to reach the patient straight away.

Patient C has been admitted with renal failure due to not eating and drinking. He has a history of severe depression and is refusing to take his medication. He has been referred to the on call psychiatrist but while waiting for a review is threatening to kill himself and other patients on the ward.

And Patient D, who has been admitted following a fall at home but is now suitable for discharge. He is becoming frustrated by the time it has taken to receive his discharge paperwork and medications. It has been two hours now and he wants to make an urgent complaint about the care he has received, or lack of, to the Patient Advice and Liaison Service (PALS).

You may find it hard to believe but the above ward scenario is certainly not far from the truth.

Not only are nurses expected to respond to changing patient conditions they are also responsible for patients’ personal needs, administering appropriate medication, referring patients to other multidisciplinary staff such as a physiotherapist or occupational therapist and for facilitating discharge to name but a few.

With falling nursing numbers, the government should take heed and put concrete plans in place to ensure this situation is rectified and done so quickly. The workforce is already stretched and I for one fail to see how patient care will not be grossly affected.

Neel Sharma is a Medical Doctor and Honorary Clinical Lecturer at the Centre for Medical Education, Barts and the London School of Medicine and Dentistry

Great Ormond Street Hospital nurses perform during the Olympic opening ceremony. Photograph: Getty Images
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Zac Goldsmith to quit as Tory MP after Heathrow decision announced

The environmentalist is expected to stand as an independent candidate.

Zac Goldsmith, the MP for Richmond Park and North Kingston, and a committed environmentalist, has announced his resignation after the government backed a third runway at Heathrow. 

He has told his local Conservative association of the decision, according to The Huffington Post. The group has reportedly agreed to back him as an independent in a by-election.

Goldsmith tweeted: "Following the Government's catastrophic Heathrow announcement, I will be meeting my constituents later today before making a statement."

Goldsmith had previously pledged to resign if the government went ahead with the decision. By quitting, he will trigger a by-election, in which he is expected to stand as an independent candidate. 

Speaking in the Commons, he said the project was "doomed" and would be a "millstone" around the government's neck. He said: "The complexities, the cost, the legal complications mean this project is almost certainly not going to be delivered."


However, there is no guarantee it is a by-election he will win. Here's Stephen Bush on why a Richmond Park and Kingston by-election could be good news for the Lib Dems.

After years of speculation, the government announced on Tuesday it was plumping for Heathrow instead of Gatwick. Transport secretary Chris Grayling called it a "momentous" decision.

The announcement will please business groups, but anger environmentalists, and MPs representing west London constituencies already affected by the noise pollution. 

In a recent post on his constituency website, Goldsmith highlighted the noise levels, the risk of flying so many planes over densely-populated areas, and the political fallout. He declared: "I promised voters I would step down and hold a by-election if Heathrow gets the go-ahead and I will stand by that pledge."

Once a Tory "nice boy" pin up, Goldsmith's reputation has suffered in the past year due to his campaigning tactics when he ran against Sadiq Khan for London mayor. Advised by strategist Lynton Crosby, Goldsmith tried to play on racial divisions and accused Khan of links to extremists. Despite enjoying support from London's Evening Standard, he lost.

The former mayor of London, Boris Johnson, once declared he would lie down "in front of those bulldozers" but has toned down his objections since becoming foreign secretary.

Green MP Caroline Lucas urged him to follow Goldsmith and resign, so he could team up with her in opposing the extension at Heathrow.

Labour, in contrast, has welcomed the decision. The shadow Transport secretary Andy McDonald said: “We welcome any decision that will finally give certainty on airport expansion, much needed in terms of investment and growth in our country." He urged the government to provide more detail on the proposals.

But London's Labour mayor Sadiq Khan accused the government of "running roughshod" over Londoners' views. He said: "Heathrow expansion is the wrong decision for London, and the wrong decision for the whole of Britain."

Julia Rampen is the editor of The Staggers, The New Statesman's online rolling politics blog. She was previously deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines.