Cap in hand...

Comment & Opinion

Joan Pons Laplana, RGN, Telehealth FLO Clinical Lead NHS Arden & Greater East Midlands Commissioning Support Unit.

and Proud Nurse, NHS Change Day Hubbie and Care Maker

How many ears must the NHS have
Before he can hear staff cry?

Yes, and how many vacancies will it take 'til he knows
That too many staff have gone?

The answer, my friend, is blowing in the wind
The answer is blowing in the wind.

A cap on agency fees are long overdue but if that's all that the government is going to do I fear for our NHS.

Jeremy Hunt has helpfully reminded the NHS that £22 billion in efficiency savings are expected In particular, he has singled out the £3.3 billion spent on agency doctors and nurses. Hunt said it is ‘totally unacceptable’ that the unit cost of nursing has increased by as much as 42 per cent since the Francis Report into Mid Staffs was released in 2013.

But the real problem is that trusts are finding it difficult to fill vacancies and at the same time there has been an increase of the number of nursing posts required to meet activity pressures and the newly defined safe staffing levels.

Because we have a growing vacancy rate due to effective pay cuts for years, higher pressures, greater workload, increased expectations and scrutiny, staff are leaving the NHS to work for agencies. Why wouldn't you leave the NHS if you can do the same or less work sometimes paid four times more than the regular staff.

The double impact of the current pay freeze alongside rising inflation is seriously affecting the living standards of nurses across the UK. That, in my opinion, is what initially triggered the mass exodus of nurses to agencies. The pay freeze has backfired and now is costing an exorbitant amount of money.

Once again the government is pointing the fingers to the wrong place. We need to treat the cause, not the symptom. Unless the NHS starts caring properly for their own staff, the dependency on agencies will keep growing. As Richard Branson says, the secret is to train the staff well that they can leave and then treat them well enough that they don’t want to.

There is clear evidence that nurse staffing levels make a difference to patient outcomes and the quality of care they receive but the link between staffing levels and outcomes also depends on having a highly trained and motivated workforce.

We need to act now!! If you put together the fact that places for pre-registration nursing has fallen by nearly nine per cent from 2010/11 to 2011/12 and that 12 per cent of the nursing workforce is aged 55 or over and a quarter is aged 50 or over means that the problem is only going to get bigger.  The NHS future is on the balance.

The answer Mr Hunt, is to invest in frontline staff.

We are feeling persistently threatened with overwhelming workloads and our ability to care and show consistent compassion is compromised – when our threat and drive systems are out of balance with our safety (soothing) system we over produce adrenaline, cortisol and testosterone and under produce oxytocin. As a result we may lose the capacity to maintain empathy and to respond flexibly to respond to individual need (both our own and others)

So many of us are moving too fast without time to reflect, pause, take a breath and connect with each other. Fast-paced clinical caring environments create conditions in which those who are giving the care may themselves become unwell suffering with stress and burnout.

The NHS cannot deliver care without our staff and depends on having a healthy and productive workforce. Staff stress is believed to account for over 30 per cent of sickness absence in the NHS, costing the service £300-400 million per year.

Health and wellbeing must be part of the NHS long-term strategy to improve the productivity, engagement and health care of staff.

The Chartered Institute of Personnel and Development (CIPD) listed some of the essential factors leading to organisational and personal well-being. These are the following:

  1. values-based working environment and management style
  2. open communication and dialogue
  3. team working and co-operation
  4. clarity and unity of purpose
  5. flexibility, discretion and support for reasonable risk-taking
  6. a balance between work and personal life
  7. the ability to negotiate workload and work pace without fear of reprisals or punishment
  8. being fairly compensated in terms of salary and benefits


In my opinion at present our work environment doesn’t promote staff well-being. To be able to care for others, staff need to be cared for. It’s not rocket science, its common sense. Happy staff= Happy patients and I will add that in a long term also saves money.