And then there were two

Labour swept back to power in May on a platform of reform for public services, and specifically the National Health Service. Cynics might suggest that the government fought an effective campaign in an area where the population could still be feasibly encouraged to lay blame on eighteen years of Tory rule, but the nation’s desire for an efficient, reliable health service was amply demonstrated by the landslide Labour enjoyed. Mr Blair has since pledged to bring an extra 20,000 nurses into the NHS by 2005, pin-pointing the solving of the crisis in nurse recruitment as a fundamental pre-cursor to a reliable Health Service. The question that has yet to be addressed properly though is this, where are these nurses going to come from and what is going to make them stay? The status of the nurse in society has suffered over the last twenty years, falling victim to the same association of wealth with worth that was the result of the Thatcher era. Nursing is now the profession whose practitioners are most likely to suffer violent attack during the course of their work, and yet they often earn less than an average administrative assistant. Issues of pay are fundamental to the problem of recruiting nurses and this is borne out by the areas in which the problem is worst, the big cities and London in particular. The capital provides the starkest example of a public service system close to meltdown. The housing market in London is now so inflated that a report by Battersea and Wandsworth Trades Union Council claimed that workers earning less than £29,000 had no chance of stepping on to the property ladder. Geoff Martin, its head, claimed "This economic apartheid against people on low-to-average earnings is tearing the heart out of London. If this isn't tackled soon, there will be a complete meltdown in our health, education, social services and transport systems." The NHS and the government should be very grateful for the wanderlust of antipodean youth because without the Aussie and Kiwi nurses willing to live in shared housing in the poorer areas of London the meltdown may already have happened in healthcare. The nurse vacancy rate has fallen over the past year, standing at 3.4 per cent in March, 0.5 per cent lower than in March 2000. But many of the nurses coming into the service have had to be drafted in from other countries, leading to concerns about standards and even that the government is irreparably damaging the healthcare infrastructure of the developing world. Bringing in nurses from overseas will certainly address the problem temporarily but it is a long term solution that must be the priority. The Chancellor has recently reconfirmed that the NHS in England is to get an extra £135 million over three years to boost recruitment and retention of staff, mostly nurses. The money will undoubtedly help and was welcomed by the Royal College of Nursing but Christine Hancock, general secretary of the RCN, urged the treasury to look beyond just increasing wages for existing nurses, saying "Pay is still a key factor in improving nurse recruitment. We know one in five nursing students never join the nursing workforce. Using this money to increase student bursaries would help to ensure that not a single student leaves their course because of financial hardship." So with low pay and low status seemingly welded to the profession of nursing, what can be done? Well there is certainly a desire to nurse still out there. Apocryphal stories abound of former nurses who have returned to the profession after being made rich by other means, claiming that they always wanted to nurse but couldn’t afford to do so, and undoubtedly the non-monetary rewards of nursing remain as powerful a motivator as ever. The government claims that nearly 3,000 nurses and midwives have been attracted back into nursing since April following a recruitment campaign, but separate reports indicate that there are still 4,500 jobs in acute hospitals still vacant in the capital alone. The "golden hello", a £1,000 grant to help towards child care costs during the three-month training period has helped and the government has provided £170 million to improve child care facilities in hospitals in its effort to recruit nurses and retain those already working. But the upshot of both of these measures and all the other provisions the government has planned still won’t solve the crisis, only dilute it. There needs to be a fundamental effort to redress the erosion of the position of the nurse in contemporary society, both in terms of remuneration and status. How this is to be achieved after nearly two decades of neglect is a question that money won’t solve but long term education and short term legislation might. Nurses and other vital public servants need to be given advantages that will encourage others to look at the profession enviously. In Japan for example, many public servants are given huge discounts on apartments in the city, and this can be a huge bonus to the kind of young people the government wants to attract. Imagine the lure of an apartment in cosmopolitan Islington or fashionable Fulham to an 18 year old contemplating a variety of careers. Whatever the government’s eventual solution it needs to be creative, quick and sustainable as throwing money at the problem might win elections but won’t address fundamental flaws in the NHS.