Where have all the nurses gone?

A localised pay system keeps their wages down, but their skills are in greater demand than ever. And they are disappearing

At last it's official. The health service has too few nurses. We are facing a recruitment crisis that could stretch well into the next century. After two years reminiscent of television's The X-Files, during which the Government denied all knowledge, it now admits that we have a problem.

Nurses have warned of it for some time. A survey released today by the Royal College of Nursing proves it. By the year 2000 a quarter of all registered nurses will have reached retirement age, while the number of nursing students has dropped by 39 per cent in eight years.

Yet demand for nurses is rising sharply. Although NHS demand has remained relatively unchanged, there has been a massive increase from independent providers such as nursing homes. They employ 26 per cent of all registered nurses. Ten years ago this figure was only 8 per cent. In the NHS, too, demand is now expected to start rising.

The facts about nursing shortages speak for themselves. We all know of someone whose operation has been cancelled, someone who has been waiting on a list for years, or has been turned away from hospital because a bed can't be found. Roughly translated, that means there aren't enough nurses.

What has the Government done so far to alleviate the shortages? First, it denied the shortages. Next, it began to reinstate some of the lost training places for nurses. But its main contribution was to introduce a system of local pay which forces nurses to negotiate with their managers .This year, nurses were awarded a national increase of 2 per cent. The Government said it had high hopes that this would be topped up locally.

In fact, only a tiny percentage has received anything more than 2 per cent. Doctors, meanwhile, received 6 per cent and MPs will get 26 per cent. Both have national awards. Nursing's pay review body, unlike that of the MPs, has not considered the consequences for the nation's health of a prolonged recruitment crisis. Nor has it considered the amount nurses receive compared with other professions.

Nurses still lag well behind all comparable professions. While a newly qualified staff nurse earns less than pounds 12,000 a year, a police constable gets pounds 14,500. Meanwhile, a ward sister with several years' experience often earns pounds 6,000 less than a police sergeant. Two-thirds of nurses questioned in today's survey believe that they would be paid more for less effort if they left nursing altogether. And last year 6 per cent did just that.

The Government has forgotten what Mrs Thatcher knew. She established the review body to avoid unrest. She was reluctant to continue a war with nurses because she knew the enormous public support that nursing enjoys.

She was right. Looking ahead to the next election, if we go by today's opinion polls, then the Labour Party should now learn from the Government's mistakes. The RCN has never been in a situation in which it has opened up so much clear water between the parties. By demanding a national award for nurses set by an independent review body, we have distanced ourselves from the Government. Ironically, at the same time, New Labour is reluctant to make any commitment.

If the Labour Party wants peaceful, constructive relationships with the largest professional group in health care to ensure the highest standards of patient care, it should commit itself to a national award for nurses. Not out of old-fashioned principle, nor because we have a National Health Service, but because it makes sense to treat nursing as a national professional group.

For other health service employees, local pay and local labour markets may make sense. But nurses and similar professionals receive intensive training for three years or more. A growing number are graduates. You can't attract more people into nursing at the drop of a hat, nor by offering them a few more pounds that they have to negotiate for.

Nurses are a valuable national asset, trained to the same high standards throughout the country. A national perspective on the recruitment and retention of nurses must now go hand-in-hand with a system of national pay.

Today, nurses everywhere are taking on new roles and responsibilities. In hospitals, nurses are working alongside surgeons where it makes sense. Reports of nurses carrying out minor operations have not led to howls of protest from patients, because, frankly, patients feel safer when there's a registered nurse around. In the community, many nurses are working in partnership with GPs, taking on such tasks as vaccinations, intensive home nursing care, and running well-women and well-men clinics.

We have to ensure that there are enough nurses to deliver these services. This will never be achieved through local pay. Today's survey shows that nurses who have left nursing or who intend to leave blame local pay for their decision.

Nurses want a commitment to a system of national pay. Nothing else will do. If we don't get it, anger and unrest might be among the least of the Government's problems.

Some trusts are already looking at alternative arrangements because they can't get enough nurses. We have seen attempts to train other health workers - including cleaners - to carry out nursing duties. The nightmare of calling for a nurse and being attended to by a cleaner has understandably unsettled patients and the public.

Such initiatives do signal a move towards lowest-common-denominator health care. Yet today, some nurses are undertaking part of their training with doctors and therapists. Nurses and doctors are now beginning to understand which treatments work and why. This knowledge is crucial. If we are to provide the best cost-effective care in the future we cannot put these innovations at risk.

As we approach the general election, might I suggest a slogan that will mean something to the public? It is this: "Whenever you need it, you will be cared for by a registered nurse". I guarantee you will get a reaction - not least from more than half a million nurses, as well as the families and patients who depend on them.

The writer is general secretary of the Royal College of Nursing