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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Harriet Harman: “Theresa May is a woman, but she is no sister”

The former deputy leader of the Labour Party urged women to unite across the divided party.

The day-long women's conference is usually the friendliest place at Labour party conference. Not only does it have a creche and a very clear emphasis on accessibility, but everybody who attends starts from a place of fundamental agreement before the sessions have even begun. For that reason, it's often ignored by political hacks in search of a juicy splits story (especially since it takes place on Saturday, before the "real" conference action really gets underway). But with the party divided and the abuse of women on and off social media a big concern, there was a lot to say.

This year, kick off was delayed because of the announcement of Jeremy Corbyn's victory in the leadership election. The cheer for the renewed leader in the packed women's conference hall was far bigger than that in the main hall, although not everybody was clapping. After a sombre tribute to the murdered Labour MP and former chair of the Labour Women's Network Jo Cox, Harriet Harman took to the stage.

As a long-time campaigner for women's rights, veteran MP and former deputy leader of the Labour Party, Harman is always popular with women's conference - even if her position on the current leadership and her status as a former Blairite minister places her out of sync with some of the audience. Rather than merely introducing the first speaker as the agenda suggested, Harman took the opportunity to make a coded dig at Corbyn by doing a little opposition of her own.

"Theresa May is a woman, but she is no sister," she declared, going on to describe the way that May, as shadow spokesperson for women and equalities under William Hague, had been a "drag anchor" on Harman's own efforts to enact pro-women reforms while Labour were in government. The Thatcher comparison for May is ubiquitous already, but Harman made it specific, saying that like Thatcher, Theresa May is a woman prime minister who is no friend to women.

Harman then turned her attention to internal Labour party affairs, reassuring the assembled women that a divided party didn't have to mean that no advances could be made. She gestured towards the turmoil in Labour in the 1980s, saying that "no matter what positions women were taking elsewhere in the party, we worked together for progress". Her intervention chimes with the recent moves by high profile former frontbenchers like Chuka Umunna and Yvette Cooper to seek select committee positions, and Andy Burnham's campaign to become mayor of Greater Manchester.

Harman's message to women's conference was clear: the time for opposition to Corbyn is over now - we have to live with this leadership, but we can't let the equalities legacy of the Blair years be subsumed in the meantime. She ended by saying that "we have many leaders in the Labour party," pointing to Jess Phillips, the chair of the women's PLP, and Angela Rayner, shadow minister for education, women and equalities. Like Burnham, Cooper et al, Harman has clearly decided that Corbyn can't be unseated, so ways must be found to work around him.

Rayner followed Harman onto the stage. As one of Corbyn's shadow ministerial team, Rayner is far from in agreement with Harman on everything, and rather than speak about any specific policy aims, she addressed women's conference on the subject of her personal journey to the front bench. She described how her mother was "born on the largest council estate in Europe and was one of twelve children" and "never felt loved and didn’t know how to love, because hugs, cuddles and any signs of affection just wasn’t the norm". She went on to say "mum won't mind me saying this - to this day she cannot read and write". Her mother was in the audience, attending her first Labour conference.

As a former care worker who became a mother herself when she was just 16, Rayner is a rarity at the top of Labour politics. She told the Guardian in 2012 that she is used to being underestimated because of her youth, her gender and her northern accent: "I'm a pretty young woman, lots of red hair, and everyone expects me to be stupid when I walk into a meeting for the first time. I'm not stupid and most people know that now, but I still like to be underestimated because it gives me an edge. It gives me a bit of stealth."

The mass shadow cabinet resignations in June propelled Rayner to the top sooner than an MP only elected in 2015 might have expected, and she has yet to really prove her mettle on the grind of parliamentary opposition and policy detail. But if Labour is ever to win back the seats in the north where Ukip and Brexit are now strong, it's the likes of Rayner that will do it. As Harriet Harman herself shows, the women and equalities brief is a good place to start - for even in turbulent, divided times for Labour, women's conference is still a place where people can find common ground.

Caroline Crampton is assistant editor of the New Statesman.