It’s officially the year of the nurse – what better time to reverse 10 years of bad care? | Polly Toynbee | Opinion

By a grim irony, this is the World Health Organization’s year of the nurse and the midwife – and so it has turned out to be, as the pandemic makes harsher demands on the profession than ever. The Health Service Journal’s latest analysis of deaths shows 106 dead: 35 nurses, 27 health care assistants, two midwives, 18 doctors and 10 in social care, along with others – and a high proportion from ethnic minorities. One nurse, at Witney Community hospital in Oxfordshire, was Margaret Tapley, who died of the virus while still in service at the age of 84.

Before anyone gets carried away by Boris Johnson’s eulogy for his life-saving angels, the facts of nursing life are brutal and it’s worth recounting them in detail. In recent years, leavers have outnumbered joiners by up to 3,000 and the more nurses quit, the harder it becomes for those who stay in understaffed wards. Remember this epidemic began with the highest ever number of nurse vacancies: 44,000 in February. But, says Anne Marie Rafferty, the president of the Royal College of Nursing and professor of nursing policy at King’s College London, that’s not a true reflection: “Those vacancies run on affordability. That’s only the number of nurses they can pay for, not the number needed.” Even the 10,000 retired nurses who have returned to help out in the crisis, mostly not on the frontline, don’t cover those lost since 2010, she says.

Nurse training was an early casualty of George Osborne’s axe-swinging 2010 budget. Despite recent efforts, numbers are still down on 2010, though the decade saw a huge increase in patients, who are far sicker in a population with 25% more over-65s. After the 2016 cavalier removal of nursing bursaries, applicants fell by 24%: although the government has restored the £5,000 maintenance grants, fees at £9,000 a year are impossible for many healthcare assistants seeking to upgrade with families to support. The King’s Fund expects the nurse shortage to rise steeply to 100,000 over the next eight years. The UK has fewer nurses per head of the population than countries such as France, Denmark, Germany and Ireland – hence the growing tendency to substitute assistants for trained nurses.

Any hope the government takes this seriously enough is blown away by the sheer insanity of charging non-EU medical staff £624 a year for each member of their family for their right to be treated by the health service they support. It looks like a deliberate policy to deter those we most need. Besides, nurses’ pay starts at £18,000, well below the high bar of £25,600 set for the right to work here. Brexit saw the departure of thousands of EU staff.

This week a survey of 2,600 nurses by a group of universities and the RCN found an alarming state of anxiety, stress and fear about their own safety and their families’ and a lack of training before being plunged into new roles: a third of them reported severe depression. More than half worked longer than their contracted shifts, mostly unpaid, and only about half had the correct amount of personal protective equipment.

During the austerity years nursing was seen as disposable, often first to be cut. Before this crisis wards were running hot, with a dangerous 95% or more beds filled. The ratio of nurses to very sick patients keeps rising, as does the average age of nurses, now at 47. The government talks breezily of more care in the community, getting people out of hospital beds faster, but that’s where the nurse shortage is gravest: district nurses have almost vanished, cut by 43% since 2010. Many have caseloads of 400, with just one for every 14,000 people in England – and nearly half are due to retire or leave in the next six years.

There is nothing insoluble about any of this. Encouraging and keeping nurses is not difficult. Pay them decently, give them as clear a career path ahead as doctors enjoy, and see what happens. As it is, the usual graduate premium for most occupations doesn’t apply to nurses’ meagre lifetime earnings. Housing for key workers would help. There used to be good accommodation for nurses, vital in high-cost areas, but the old nurses’ homes were sold off in one of Margaret Thatcher’s cost-cutting Rayner Scrutinies.

Where nurses are treated as precious commodities and given maximum flexibility in their shift times, a few hospitals buck the trend and hold on to them, says Rafferty. As everyone reaches for some good to emerge from this catastrophe, she tells of a surgeon she just met, reassigned to an intensive care unit, “amazed” at the expertise of those specialist nurses – and humbled to find himself relegated to assisting. “But of course, they are still paid around a third of his salary,” she adds.

So when next week’s clap for the NHS comes, join in out of gratitude but also out of anger – anger at how depleted the nursing workforce has become and how badly the successive Conservative governments have treated the profession.

Polly Toynbee is a Guardian columnist

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