The NHS staffing crisis is killing people – and this winter it will be even worse

NHS politics tends to focus on easily measured inputs: how many beds have been cut as a result of austerity, how many nurses’ and doctors’ posts are empty, the lack of ambulances, MRI scanners and hospital repairs. But the ultimate output measure is how many people die needlessly as a result of these things.

An alarming number of excess deaths among people who were not suffering from Covid-19, analysed this week by the Financial Times, suggests the sheer magnitude of the current NHS crisis. The analysis finds that 2,047 more people died this year in the week ending 12 November than during the same period between 2015 and 2019, but only 1,197 of those people had Covid-19 on their death certificates. That’s just one week. This “raises the possibility that since the summer more people have been losing their lives as a result of the strains on the NHS or lack of early diagnosis of serious illness”. Cardiovascular disease and strokes are the most frequent causes of extra deaths, where every minute counts.

Put that together with last week’s Royal College of Emergency Medicine’s report. Desperate in tone, this showed how fast the NHS crisis is accelerating: the number of people waiting more than 12 hours in A&E rose by 40% just between September and October this year. Overcrowding and long waiting times cause serious harm; the report counted 4,519 excess deaths in England due to these waits in the last year. The Association of Ambulance Chief Executives recently published its own harrowing analysis of the actual harm done by delays. District nurses (whose number was cut by half in eight years), would not be surprised by a 30% rise in those dying at home, with nearly 6 million people waiting for hospital treatment.

The overwhelming reason for this crisis is a lack of staff. Doctor and nurse training places were the first casualty of George Osborne’s 2010 budget. A workforce plan has been promised, but this week Jeremy Hunt’s amendment, which would require an independent assessment of future workforce needs, failed in the Commons. Yes, he was health secretary for six years of NHS austerity, but these days he packs a punch on staff shortages with his weekly blog on patient safety. He says a fraction of the £6bn a year squandered on locums would pay for enough training places to meet the shortfall. While ministers fire-fight today’s crises, planning for the future “is never top of the list”, he says. He should know.

Take nurses, the deepest black hole in NHS staffing. (Yes, it was Hunt who scrapped nursing bursaries.) The government boasts that recent nursing figures show that “more than ever” have joined the register: another 24,000 in the past six months. Unfortunately, more nurses than ever have left the profession, too: at 14,000, the highest ever attrition rate. Almost all the new nurses are not trained in the UK; some 7,500 were hired after a huge campaign in India and the Philippines. Many may only be stopping off in the UK to qualify for higher pay in the US. Naturally, none chose to come here from post-Brexit Europe.

The pandemic encouraged more UK student applications to become nurses, but the drop-out rate is at its highest, too, with 30%-50% leaving when they discover the working conditions, says Prof Alison Leary from South Bank University in London. “Too many students are being treated as just another pair of hands.” She says experienced nurses are leaving, replaced with “rookies” daunted by finding themselves alone with overwhelming responsibilities in understaffed wards. Everyone is forced to act up beyond their training, with cheaper health care assistants and nursing associates doing registered nurses’ work. An amendment to protect the word “nurse” to mean trained nurses was also voted down this week.

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The register is deceptive: half of registered nurses don’t work in the NHS, says Leary, but take easier jobs with agencies, charities, in the medical industry or teaching, leaving almost 40,000 NHS vacancies. But that “vacancy” number is a deception, too. “It represents posts that trusts can afford, not the number they actually need,” says Prof Anne Marie Rafferty, former president of the Royal College of Nursing. What’s needed to retain nurses, she says, is a strong professional career path upwards, recognising “both intellectual and emotional intelligence”. Health Education England, protesting at underfunded training, has just been swallowed into NHS England.

The Royal College of Nursing – which has never gone on strike in England – sent out an indicative ballot on action in support of a 12.5% pay claim. Nurses have had a real-terms cut since 2011. With inflation currently heading for 5%, their 12.5% claim is modest. The real test is whether it will be enough to hire and retain future nurses.

A strike is highly unlikely, but even a vote against working extra shifts would be crippling. So the health secretary, Sajid Javid, needs to pay up. Here’s the Treasury wickedness: any pay for NHS staff, as for all the public sector, causes more cuts – as it’s taken from existing budgets. On target for a promised 50,000 more nurses by the next election? Unlikely. Two things should alarm Tory MPs: the billowing cost of living and an NHS collapse caused by their decade of underfunding.

• Polly Toynbee is a Guardian columnist