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28 October 2021

Why we need a new deal for nurses

Unless ministers act now, the nursing crisis will only deepen, says the chief executive of the Royal College of Nursing.

By Pat Cullen

The government announced its plan for getting the country through the winter with much fanfare in September. The Prime Minister outlined Plan A, which meant expanding the Covid-19 vaccination programme and relying on that programme to stop the NHS from becoming overwhelmed in the coming months. 

We cautiously welcomed the measures, saying that they would be key to getting us through the “knife-edge” winter that nursing staff all fear. But we expressed concerns that Boris Johnson made no reference to the reality currently facing those staff – that there simply aren’t enough in our health and care services. 

There are nearly 40,000 registered nurse vacancies in the NHS in England alone. These vacancies, coupled with everything else nursing staff are facing – including delivering an expanded Covid-19 vaccine programme and the country’s biggest-ever flu vaccination programme – means our members are under huge pressure.  

We recently presented this case even more plainly, with figures we have analysed showing that the NHS in England recorded more than 18 per cent more sick days among nurses and health visitors in May 2021 compared with May 2019.  

We are also concerned that large-scale sickness absence will expose how short-staffed many services are, and the risk this poses to patient safety as nursing is a safety-critical profession.

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Our analysis shows that staff are more at risk of mental health problems, chest and respiratory problems and migraines, than before the pandemic. Since May 2019 the number of full-time equivalent (FTE) days lost for mental health reasons has increased by 31.4 per cent. Days lost due to chest and respiratory problems rose by 52.5 per cent and headaches or migraine rose by 51.9 per cent.

Anxiety, stress or depression remains the most common reason for staff sickness. As a proportion of all days lost, it has increased by 3.3 per cent throughout the pandemic (May 2020 to May 2021 data).

We want employers to work with us to make sure staff can get the vaccines they’re eligible for, are rested and have breaks, and look after themselves so they can look after patients better. It is vital that the necessary support is available where and when it is needed and that managers encourage and support staff to seek help.   

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Do we think that Plan A is enough? Put simply, no. The elephant in the room is the nursing workforce crisis, which this government has repeatedly ignored. Since 2016, when Brexit dominated the headlines, the government has failed to act on 21 warnings about this issue

But the nursing workforce crisis can be ignored no longer – and there are several ways in which we believe it can be addressed today. The first is by paying nursing staff fairly. Salaries for experienced nurses are now 12.6 per cent lower than if NHS pay awards had reflected the rising cost of living and inflation over the last ten years. 

A fair pay rise would be in recognition of nursing staff as highly-trained professionals, who fulfil complex, safety-critical roles. It is also needed to retain experienced nursing staff who are feeling burnt out and exhausted. Health and care services cannot afford to lose these experienced, senior nurses. 

Ultimately, fair pay will help ensure there are enough of the right nursing staff, in the right place, at the right time to provide safe and effective care for all patients by attracting and retaining highly skilled professionals.

Finally, the Health and Care Bill passing through parliament provides an opportunity for the government to come up with a long-term plan to address chronic workforce shortages. But this is an opportunity it is in danger of passing up.  As the bill stands, it goes nowhere near far enough to address the workforce crisis sustainably. But there is time to change this – it just needs political will.  

I recently gave evidence in parliament in relation to the bill, reiterating our call for the Health Secretary to be made legally accountable for delivering a fully-funded workforce plan based on population need.  

The RCN view is that for any health and social care reforms to succeed, the voice of nursing must be represented at the table. That is why we are also demanding that a director of nursing sit on the board of the new local healthcare organisations, Integrated Care Boards.

There will be immense pressure on health and care services this winter and services can’t afford to lose safety-critical professionals to avoidable illnesses on top of tens of thousands of registered nurse vacancies. The risk to our patients is too high to do nothing.   

Nursing staff will not stand back while patients cannot get the care and treatment they need – the care that nurses and nursing support workers wish to provide. 


Pat Cullen is general secretary and chief executive of the Royal College of Nursing 

This article originally appeared in our Spotlight policy report on healthcare. To read the full supplement click here.