FOCUS: HEALTHCARE - Trying to find a cure for the NHS. Moves are afoot to tackle the mammoth problems of understaffing, low wages and poor morale which are dogging the NHS. By Lexie Goddard

The National Health Service has just received the biggest cash injection in its 50-year history. In case you missed the headlines, the sum was pounds 21 billion, a large chunk of which will be spent on employing more doctors and nurses between 1999 and the year 2002.

The National Health Service has just received the biggest cash

injection in its 50-year history. In case you missed the headlines, the

sum was pounds 21 billion, a large chunk of which will be spent on

employing more doctors and nurses between 1999 and the year 2002.

Health Secretary Frank Dobson announced during the 50th anniversary

celebrations that the Government intends to provide for an extra 15,000

nurses and 7,000 doctors who will treat an extra three million patients

and shared his predictions of a modern health service full of ’well

qualified and highly motivated staff’. There are just two problems;

where will he find them and how can he hold on to them?

The number of nurses in training has dropped by over 8,000 - a decline

of 15 per cent - in the past four years according to the annual report

of the English National Board for Nursing, Midwifery and Health


The Royal College of Nursing (RCN) predicts the worst crisis in nurse

shortages for 25 years. Recruitment, however, is only half the


The Government needs to address its retention record. Low pay and stress

due to an increased workload are just two of the reasons why nurses are

leaving and not coming back.

The Department of Health (DoH) has been aware of the crisis for some

time and has just come to the end of a two-year pounds 2.5 million

publicity campaign to boost recruitment. The programme, called ’Nursing,

have you got what it takes?’ was intended to dispel the old fashioned

’mops and bedpans’ image of nursing and midwifery by promoting these as

challenging and rewarding careers. Saatchi and Saatchi’s hard-hitting

ER-style press and radio advertising drive ran alongside a national PR

campaign. Publicity kits containing videos, posters and information on

nursing were distributed to schools and colleges in a bid to attract

young people into the profession.

The other 50 per cent of the campaign focused on retention.

The results were positive. A total of 16,000 people called a recruitment

phone line in 1997 and 12,000 have phoned this year to get more

information on nursing. However the DoH says it can’t give a figure of

the actual number who have signed up to train or the number of ex-nurses

who have returned to the profession. There are also no plans ’at the

moment’ for another major recruitment and retention drive until the

results from this one have been fully assessed.

The RCN, whose members include three-quarters of all NHS nurses, was

involved in the DoH’s publicity campaign but is also about to launch its

own long term PR and lobbying drive to highlight the ’value’ of


Key to the campaign, which starts later this year, is the link between

investment in nursing and improvements in standards of patient care.

However, according to Stephen Griffin, the RCN’s director of labour

relations, while it is important to develop the image of nursing as a

profession and to focus on the need for ’family-friendly’ policies, what

many fail to recognise is that the RCN represents the existing

workforce, and that currently pay and reward is the main reason they are


’We need to stem the flow of nurses leaving the NHS, and therefore we

are pressing the Government to make significant changes to their pay and

reward scheme. There is a wide disparity between starting levels for

nurses and comparible professions such as teaching.’

Jane Keep is policy adviser for human resource issues at the NHS

Confederation, the organisation which promotes NHS policy to the media

and wider health community. She feels all the media coverage about

nurses being underpaid and overworked is sending a ’poor message’ to

potential nurses. ’The situation seems dire,’ says Keep of the coverage.

’We have to put forward the positive side of nursing. There is a

recruitment and retention problem but the ’hard done by’ stuff has been

done so much.’

Keep feels the DoH campaign was a good start but needs to be followed up

with an equally effective programme and that individual organisations

should stop ’scrabbling around’ and perhaps strengthen the message with

a joint campaign.

It is understood the NHS Executive will release a report next month

outlining a human resource strategy to address these problems. A career

advice service will also be launched next April with information and

guidance on all jobs in the NHS. The service will be aimed primarily at

nurses, health visitors and midwives but will later be extended to all

staff falling under the Professions Allied to Medicine (PAMs) such as

chiropodists, dieticians or speech therapists.

Some hospitals, like Guys and St Thomas’, are finding their own local PR

and human resource solutions to recruitment and retention such as

rotational schemes, where nurses are given a taste of nursing in

different departments and regular senior nursing conferences where

personal development is discussed.

Open days are held to encourage new recruits and attract back ex-nurses

or those who entered the private sector and exit interviews conducted to

find out why staff are leaving.

It’s not just the nursing profession which is suffering from staff


Medical courses receive three times as many well-qualified A level

candidates as there are places so there is no shortage of potential

doctors, but there is a retention problem.

According to the British Medical Association there are 1,000 vacancies

in general practice. BMA deputy head of public affairs Fiona Simpson

says ’morale is at an all time low’ among the UK’s 100,000 doctors due

to a number of reasons. Junior doctors are finding long hours gruelling

and work pressures intolerably high as they have to treat more


GPs, too, are overworked, conducting an average 10,300 consultations

each year. As 62 per cent of doctors are women, many want to take a

career break to start a family and both male and female are less willing

to ’eat, breathe and sleep medicine.’

They are also despondent about the future of the NHS according to a MORI

poll conducted in June for Reader’s, based on 200 face-to-face

interviews with GPs. Eighty- four per cent of GPs are worried about the

possibility of new administrative charges. Sixty-one per cent believe

public satisfaction with the NHS will go down and 47 per cent say

waiting lists for operations will get worse.

Whereas the Conservative Government’s PR efforts like the ’listening

tour’ of GPs’ surgeries were greeted with some cynicism, this Government

is no better at co-ordinating itself to communicate directly with

doctors about what NHS changes will mean to them and giving

morale-boosting messages.

’There is no particular desire to reassure doctors they are doing a good

job,’ says Simpson. The BMA’s 16-strong public affairs and press

relations team has lobbied for years on behalf of doctors on issues such

as reducing working hours and increasing medical school intakes. It

scored a long-awaited victory earlier this year when the Government

agreed to train another 1,000 students a year. Simpson and her

colleagues are now pushing to improve recruitment and retention and

expand the number of consultant’s posts to 4,000.

’Lobbying doesn’t stop when the decision you want is announced,’ says

Simpson. ’You’ve got to keep up the pressure.’

RECRUITMENT: Creating an appealing future for nurses

Royal Hospitals’ NHS Trust’s communications team is working with both

human resources and the nursing directorate to find local solutions to

the recruitment and retaining crisis.

The trust covers four hospitals: the Royal London, St Bartholomew’s, the

London Chest Hospital and Queen Elizabeth’s Children’s Hospital, with a

combined nursing staff of 2,000. The trust has been hit especially hard

by staff shortages partly because it is a teaching hospital. It has a

high turnover of young nurses on their first job and many cannot afford

the high cost of living in London on a salary of around pounds


One of its first steps was to review its recruitment advertising

material which head of communications Sara Moseley describes as ’too

conservative’ and to design a brochure as part of a package to be sent

to nurses who apply for jobs or potential applicants. The trust has also

produced a video on the role of the nurse, featuring six of its nurses

in different stages of their careers.

A key tactic is to attract recruits from the local ethnic minorities of

Tower Hamlets either as fully-fledged nurses or support workers who can

be trained with the help of bursaries. It held a recruitment fair in

partnership with community and voluntary groups in July which attracted

around 1,000 people.

Staff have also visited local schools and colleges as well as nursing

colleges to give talks on nursing at the trust. It is also now

developing partnerships with local housing associations to find cheaper,

quality accommodation.

Lack of career development and support is known to be one of the main

reasons why nurses leave, so the trust has produced a magazine called

Nursing Progress which enables its senior specialist nurses to showcase

their research work. The trust is also pushing for more creche

facilities and flexible working patterns. ’We are trying to keep staff

up to date with developments for the future so they have a stake in it,’

says Moseley.

’It is very much a priority for us to get people through the door (as

well as) making sure there is long term career progression so they want

to stay.’

PERIPHERAL PROFESSIONS: Who cares for the carers?

’Anyone would think the NHS is entirely staffed by doctors and nurses

like something out of a Carry On film,’ says Scott Davidson, public

affairs manager of the Chartered Society of Physiotherapy (CSP). ’In

fact there are 70,000 PAMs in the NHS.’

PAMs stands for the Professions Allied to Medicine and covers eight

professions including chiropodists, dieticians, physiotherapists,

occupational therapists and speech and language therapists. Many in the

field feel that because they are so much lower in numbers compared to

nurses (300,000) issues like its own staffing crisis does not receive as

much Government attention.

Like medicine, most PAMs courses are oversubscribed but there is a

massive retention problem. Pay and career prospects are limited.

Physiotherapists can get stuck on a pounds 22,000-a-year ceiling, as

there are few management posts available. As a result many go into

related areas like occupational health units in big companies or are

tempted abroad. Vacancy rates in physiotherapy are running twice as high

as in nursing.

In February this year, five of the groups joined together to form the

Alliance for Health Professionals, consisting of 60,000 professionals,

to enable to maximise the impact in terms of campaigning and


Meanwhile individual organisations are busy with their own

profile-raising tactics. Davidson is keen to develop ’grass roots’

lobbying on behalf of physiotherapists. The organisation encouraged over

50 per cent of NHS physiotherapists to write to Tony Blair in protest at

the decision to take a pay award back in February.

Aside from pay, the CSP is lobbying for a review of career structures,

support of continued professional career development and, as 90 per cent

of physiotherapists are women, more family-friendly employment. The

College of Occupational Therapists recently launched an advertising and

PR campaign to both explain their value to the general public and show

GPs how occupational therapists can contribute to patient care.

Co-ordinator of the college’s advisory service Mary Crawford is hoping

the campaign will draw the attention of Government and media attention

away from doctors and nurses.

’The problem is that we are not seen as the ’sexy, life-saving’ bit of

the NHS. The public is not necessarily interested if someone gets home

and manages independently after an occupational therapy programme,’ she


STAFF HEALTH: Why work is making employees sick

One of the most serious obstacles to staff retention in the NHS is,

ironically, ill-health, according to independent health scene observer,

the Nuffield Trust.

Just as Frank Dobson was voicing his commitment to a better health

service earlier this year, the trust commissioned a ground-breaking

report into the health of NHS staff. It revealed ’worrying levels of

psychological disturbance ranging from emotional exhaustion to suicide’

among doctors, nurses and other medical staff, which was costing money

and endangering the quality of patient care.

Reports over the past few years have raised concern over the health of

NHS staff, but none have been sufficiently comprehensive to allow for

any concrete conclusions to be made.

In January this year the Nuffield Trust decided to take up the cause by

convening a working group known as The Partnership, which represents key

organisations with a stakeholding in the NHS, including the Department

of Health, British Medical Association, the Royal College of Nursing,

and General Medical Council. The group commissioned an extensive survey

of data on the health of NHS staff, which drew together for the first

time all the scientific research available into a single review. The

damning results have led to a set of recommendations which have been

hailed as the most effective structural response to the problem of

ill-health in the NHS workforce to date.

Charles Barker Healthcare was hired by the Nuffield Trust to co-ordinate

a press conference in March, which coincided with the publication of the

report and was designed to persuade health authorities to take action in

light of the findings. The report won extensive national and regional

media coverage, reaching an estimated 10 million readers . This was

followed in June by a conference attended by 200 delegates from the

Government, health authorities and medical profession.

The report’s recommendations were formulated into a ten-point action

plan aimed at improving physical and psychological health, work

attendance and organisational efficiency among NHS staff. The plan,

which encourages better communication among staff as a way of promoting

teamwork and staff involvement, was designed to complement the

Government’s tone of openness and co-operation laid out in this year’s

new NHS white paper.

The Government was persuaded to take up the cause, which resulted in

Minister for Health Alan Milburn making a keynote address at the June

conference and pledging the Government’s commitment to the plan.

’The results revealed worrying levels of ill-health among all grades of

staff, and the highly sensitive nature of the report’s findings required

extremely careful handling,’ said Charles Barker/BSMG director of

healthcare, Rachel Dalton. The agency is now helping the trust to plan a

programme of activities to help implement the report’s


Nicola Tyrrell.

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