After more than a decade of underfunding in the NHS, overworked frontline staff at the Bristol Royal Infirmary and Southmead hospital spoke to Bristol Live about the difficulties they face at work at a time when the staffing shortage has reached a crisis point. Across the country, the unions representing NHS workers are balloting members, who could go on strike over pay later this year.
Although the government has recently increased pay, it has not been enough to keep up with inflation and Healthcare Assistants in Bristol are still earning below the national living wage. While nurses spoke of working more than 13 hours without a break, HCAs are frequently having to dress wounds and cannulate veins while getting a similar rate of pay to supermarket workers in Aldi.
Deep cuts in social care and mental health alongside a growing ageing population with more complex medical needs, mean that nurses and assistants are not always able to carry out the necessary level of care, which has left many feeling demoralised.
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Healthcare assistants in Bristol earn less than their colleagues in Manchester, who recently were rebanded after Unison won a campaign which highlighted the work being done above their pay grade. HCAs in Bristol earn £10.37, below the living wage which is now £.10.90, whereas their colleagues in Manchester will now earn at least £11.11 per hour.
Mary* who was previously employed as a HCA in Southmead Hospital said that she has seen many colleagues leave the job soon after starting, as they can earn a similar wage in retail and bar jobs which are less stressful and don’t require long night shifts. Although HCAs are not required to to dress wounds, when Mary first started, she found herself carrying out such tasks due to the lack of nursing staff on hand.
She said: “When I first started one of the top nurses called me because she was so desperate for someone to help change the dressing on an amputated leg. You see dead people, it’s just not easy, some new people, see that and they just go. People are not stupid, when they can get a job in a bar, serve drinks and get some tips on top why would they stay to clean up poo and wee and see dead people?
“The only reason I stay is because it satisfies me mentally, I love people and it’s rewarding when you’re helping people. I see many people leave and go for a better paid job where they don’t have to do night shifts. where you’re fighting to stay awake and it’s usually cold.
“It’s the same for nurses, many of them are leaving, even though they’re on better pay than us, with everything going up, they can’t save anything, they can’t build a future, there’s just no hope. We won't get anywhere with the NHS like this, it needs a huge investment.”
Rowan*, a nurse at the British Royal Infirmary said that in other safety-critical professions workers would not be expected to work long shifts without breaks and that, although underfunding has caused problems for sometime, in the last year it has reached “a tipping point”. In addition, the increased workload caused by staff shortages and lack of community healthcare services makes it increasingly difficult for nurses to carry out the necessary level of care.
Rowan said: “It’s always been a struggle especially in winter, there’s been problems with staffing and not enough beds most of the time. At the moment people are pretty fed up, I think people have reached the end of their tether now.
“With the last 10 years or more there being less and less community services so we can’t discharge people, less funding for the NHS in real terms so we’re not able to do what we should be able to do.
“I think with the height of Covid and all the talk of key workers and clapping for the carers to then have real terms pay cuts year after year, people are just exhausted. It’s very common that people just can’t give the care that they want to and it’s really demoralising.
“We’ve had lots of new starters that have left pretty quickly. New starters and students have had a pretty tough time over the last few years because of Covid and the staffing crisis reaching a tipping point - there's just nobody there to support them.
“There needs to be more of a focus on what they can do to retain staff because the process of training staff is expensive. All of us have probably had moments where we don’t want to carry on, there’s been a lot of times when I’ve been angry for feeling undervalued and being undervalued.
“We’re taking on more and more responsibilities as nurses which isn’t being reflected in our pay or in the level of respect we’re getting from the government or management. It’s not just nice things that you would like to do that you can’t do, unfortunately sometimes it’s really important things that you just aren’t able to do despite the fact that you might be skipping your breaks and leaving late.
“When I started, very commonly you would work 13 hours and skip your breaks so you could leave on time. But now you're skipping your breaks, leaving late and you’re not getting all the work done that you would like to, it all adds up and becomes incredibly exhausting.
“We’re skilled professionals doing a safety critical job and if we were truck drivers or pilots there would be no way that you would be going 13 hours without a break. We don’t get paid for breaks so we’re actually at work for 12.5 or 13 hours, people are working through unpaid breaks and doing unpaid overtime.
“Nurses get a lot of attention but everyone in the NHS from cleaners to porters to admin staff are really important and work bloody hard. People would be surprised at what Healthcare assistants do; they’re checking blood, doing vital observations and they are the ones who are spending the most time with patients.”
James* who works as a HCA at Southmead /hospital spoke of the staffing strain being exacerbated by wider problems in the community. He felt there was a disconnect between decision making and frontline staff involved in the day-to-day running of the wards.
James said: “Our ward is run by young women in their 20s who basically run the whole ship. But bigger decisions by management over resources that impact us are out of our hands
“Because you’re understaffed, one nurse on a night shift has to fit in the medications and all the observations in a very short period of time before the handover at 7am. They might have to wake a patient up at 5am for an observation and then the patient doesn't get enough sleep.
“Often patients feel like they're in a prison when they are in hospital for two or three months with nothing for them to do and without resources. You just feel like you should spend time with patients, especially those in palliative care who don’t have family around them and it could be the last two or three days of their life but then other things come up.
“These kinds of things harden you and you feel like you have to distance yourself from your feelings, which is not nice. You still have empathy but you often don’t have the capacity and after a twelve and a half hour shift you’re knackered.
“We have a lot of working class patients who are medically fit but the family has broken down, social services have broken down and in some cases they are homeless. You could discharge them but they would be alone at home, social care is fragile at the moment.
“Society is in a quite bad spot at the moment when it comes to taking care of the vulnerable. There is a push from management to get these people out quicker but they don’t have the care out there and they might come back in a few weeks.”
Emma Hallam who works as a nurse at Southmead Hospital and represents the Royal College of Nursing union members across the south west said that stress and anxiety have now overtaken back pain as the leading cause of sickness among nurses. She said that the limited support available for student nurses alongside the stripping back of bursary support means that there is a very high ‘dropout rate’.
Ms Hallam said: “Nursing has always been a tough job and it’s always been a mainly female job so has been historically under paid. It’s never been a well-paid job but it’s got to the point now where our members are using food banks.
“In years gone by, it used to be a second income for a family because it was a women’s job. Women would have children and come in and out of it, which stopped progression. The world doesn’t work like that anymore and a lot of the time the nurses’ income is often the primary income in a family, supporting a lot of people.
“The pay is just not keeping up with inflation. What the RCN is saying is that in order to just break even we should be getting five per cent above inflation. When it goes well, nursing, it’s the best profession ever, you’re giving care and there’s a lot of people that would love to be doing it but they’ve left because they can’t afford to do it and then people aren’t coming in because they can’t afford to do it either.
“Nurses at the moment are taking themselves out of their pension scheme because they just can’t afford it. Often nurses will take on a level of stress, which I wonder if other people in society could manage. What we’re seeing now is that they break. The main reason for sickness in the NHS is now anxiety and stress.”
The Department of Health and Social Care announced in March this year that it was 'on track' to delivering 50,000 nurses by 2024 and that the government's progress report showed that overall nurse numbers were higher in 2021 than 2019. "The government is focused on recruiting and retaining nurses to compensate for those retiring, reducing their hours or leaving the NHS," the government spokesperson added.
A spokesperson from the DHSC said: “We have given over one million NHS workers, including nurses, a pay rise of at least £1,400 this year, as recommended by the independent NHS Pay Review Body. Compared to 2021/2022 pay scales, the lowest earners such as porters and cleaners have seen a 9.3 per cent increase in their basic pay this year and new nurses have seen a 5.5 per cent increase.
"These awards strike a careful balance between recognising the vital importance of public sector workers whilst minimising inflationary pressures and managing the country’s debt. "
North Bristol NHS Trust’s chief nursing officer professor Steve Hams, said: “Like other trusts across the country, we are facing challenging staffing pressures. The safety of our patients remains our priority and we encourage our staff to raise any concerns.
“We are committed to supporting the health and wellbeing of our staff with a comprehensive wellbeing package and are focused on recruiting more healthcare staff to support the demands on our services.”
University Hospitals Bristol NHS Foundation Trust has been approached for comment.
*Names have been changed.
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