In the room…


There’s a Russian fable, by Ivan Krylov, in 1814… the tale of The Inquisitive Man, who…

‘… describes, to his friend, the detail of a visit to a natural history museum. He speaks of birds and tiny insects… some no bigger than the head of a pin.

‘Did you see the elephant…’ the friend asks?


The man confesses… he didn’t notice the elephant!’

… and that is where we get the phrase, ‘The Elephant in the Room.’ Something so big, no one sees it.

The NHS has an elephant in the wards, operating theatres, outpatients, the community, GP practices, in every nook and cranny.

The elephant? The workforce. We don’t have enough people and no in-reach-prospect of getting them.

NHSI are the Mahouts, it’s their job to tame the elephant. The Pahans.

What are they doing? This is an emergency but I get no sense of urgency, alarm or immediacy… they have committees!

Do their committees know;

Around 40,000 applications to train as a nurse are turned down very year.

Question; is there no part that some of these disappointed candidates can play in healthcare?

Answer; of course, we have apprentice schemes, alternative entry into nursing, other vital jobs. Follow up the disappointed and offer opportunities.

Applications from 19-34year-old, mostly women with family commitments, fell 22%.

Question; what can we do to make the NHS family friendly?

Answer; ask them. Probably; self managed teams, workplace crèche, flexible rota, part-time, job-share. Ask Amex, Deloitte, Buurtzorg. They’re good at it….

Applications from +35 yrs fell 23%.

Question; is that because of the change in the bursary arrangements and the increased interest on student debt?

Answer; if it is, change it.

In London, nearly 20% of newly qualified nurses leave within the first year.

Question; is this uniquely London and can we support new nurses better?

Answer; no and ask them.

Applications from EU nationals… slumped to 850 last year. The year before it was 6,382.

Question; is there a post-Brexit-fix-it?

Answer; yes, an ethical, national-recruitment programme from outside the EU. Remember there is a global shortage of care staff, our offer has to be stunning.

Accept some places have the geography and local economy running against them.

Question; how to ameliorate it?

Answer; social media, networks, employee referrals, revised job descriptions, visit schools and colleges. Turn HR apartments into job shops.

Between 2014-18, under 2 nurses a day returned-to-practice in the NHS.

Question; is the difficulty pension-tax issue, rota problems and clunky refresh-training schemes?

Answer; change the rules and let the Trusts run the return-to-practice schemes, locally.

The Uni’s can create more student training places than Trusts can provide supervised-placements.

Question; how to bridge the gap between university capacity and what providers can cope with, with a safe level of oversight.

Answer; encourage more Trusts to do what some are already doing, train their own.

Last year 33,000 nurses walked away. That’s 90, every day. All the time NHSI, is dithering debating, consulting and palavering… another 90 are gone.

More than 10% of the nursing workforce have left the NHS in each of the past three years. The number of leavers would be enough to staff more than 20 average-sized Trusts.

The spotlight is on the Trusts. What kind of employers are they? We need data.

Question; which Trusts have the lowest number of early leavers, which the highest?

Answer; oblige every Trust to do independent, detailed exit interviews, collate and report the outcomes every week. Hold the nurse-director’s feet to the fire. Find out what works. Copy the best.

More than that?

A national recruit campaign, with a fast track enrolment scheme. Don’t wait for the university calendars. Have weekly enrolment… we are in a hurry.

Guess what; no one wants to work where they are hassled, exhausted, oppressively regulated, have no opportunity to train and advance, and their good-will exploited.

It’s not just nurses. No health professional wants to work at the cost of their own well-being and unsustainable work-life balance.

Remember, the more nurses leave, the more nurses will leave and the more others will follow.

This is the most important issue facing the NHS.

Question; is NHSI in the room?

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Reproduced at by kind permission of Roy Lilley.