When the arm’s length body that now runs day-to-day healthcare in the island was established in April 2021, Noble’s Hospital was down a total of 92 nurses.
This comes after it was revealed that only one ward had a safe average level of nursing staff in December 2022, with most wards having unsafe levels throughout the entire year.
Paul Moore, director of nursing and governance in Manx Care, has spoken to the Examiner about the issues raised.
He says that when the organisation was established it commissioned a full establishment review.
This is used to assess how many nurses are needed at the hospital and therefore concludes how many staff it is short of.
‘As far as I could establish, it had been at least five years since a review had been done when Manx Care took over,’ said Mr Moore.
‘To put that into perspective, in the organisation I came from we were doing security and dependency analysis four times a day. To go five years is an awful long time.
‘When we do the establishment review we check every single patient, every single day for a whole month. We’re measuring how poorly they are to determine what level of care they require.’
Mr Moore added: ‘We check every patient for a whole month and then we put these figures into a tool, which is based on the safer nursing care tool, which is a UK national standard.
‘It’s endorsed by the National Institute for Clinical Excellence.
‘It will tell us what the staffing levels need to be on average for people in that location with that level of need.
‘When we did that first time round, it showed us we were minus 92, so we need 92 more registered nurses to match the care needs of the people.
‘I have an approach where you don’t make any changes after the first time you do that, instead you do it again a few months apart to see if the previous was just a blip or if there is a consistent issue.
‘We did two reviews six months apart and they said the same thing, which gave us confidence we were short of around 92 nurses if we had every single bed open.
‘That’s been the origin of the gap.’
To manage this problem, Manx Care is working on international recruitment, increasing trainees, and getting associate nursing programmes up and running.
However, recruitment is ‘very competitive’ as the ‘whole world is short of nurses’, says the nursing director.
He said: ‘The Isle of Man is competing with everybody else for a diminishing number of people, so it’s actually quite hard to get them.
‘To make it safe, we scale back our capacity, so we reduce the number of beds open, so the staff we do have is a better ratio and then manage our patients through that smaller bed base.
‘Every day, several times a day, we’re making adjustments to that.
‘We then redeploy staff and use temporary workforce to get us through. Those are reactive countermeasures.
‘The vacancy doesn’t go away. The scaling back just means we have a smaller number of beds to match the available staff that we have got to make that work.
‘But we always need those beds over winter so you’re constantly trying to open them all the time because of the demand on the service.’
In terms of on-island training, the head of the ambulance service recently told the Isle of Man Examiner his worries about training people here and losing them to the UK.
Asked if he has similar concerns, Mr Moore said: ‘There is definitely a risk of that.
‘It’s very important that the island is competitive and through being competitive it will be attractive to the people who want to come here and work and take on the Isle of Man lifestyle.
‘Staying competitive for me is quite an important, strategic ambition.’
Mr Moore explained that decisions made today on training more nurses won’t have a benefit until at least 2026 or 2027.
‘If it was a decision about doctors that we were making, those decisions are 15 years in the making before you see a benefit,’ he said.
‘That’s the kind of horizon we’re working with and we know that’s far too far in the future, so to fill the gap in between we use international recruitment to help us get stable.’
Manx Care is currently sourcing international recruits to the island and has around 66 in the pipeline to join the organisation in the first half of this year.
Mr Moore continued: ‘When they get here that will make a massive difference.
‘It will allow us to open up the additional beds that we need to get through the backlogs and give people care faster, so there’s definitely some hope on the horizon in the short term.’
In addition to the solutions already being carried out, Manx Care is planning on doubling the number of training places available for registered nurses in the adult branch and the mental health branch. It will also double the bursary for students this year, which is going to increase from £5,000 to £10,000.
‘I’m hoping that will be a real boost, especially to some people on the island who need a bit of extra help,’ Mr Moore said.
‘Once they’re in that career they’re going to have a great path because there’s plenty of work, it’s good wages, you’ll do very well in your career, and there’s lots of opportunity.
‘This year I’m going to introduce a nurse associate programme, which is an advanced level of healthcare support worker who are very skilled, very capable people and they can help fill some of the gaps that we’ve got from registered nurses.
‘They can work under supervision and in some cases work autonomously.’
While these solutions are taking place, Mr Moore admitted some would take longer to achieve than others.
On a career in nursing, he said: ‘This is a great time for the island.
‘We’ve made some very important decisions and we are increasing the focus given to nurse staffing, which hasn’t happened before.
‘If you’re interested in a career in nursing, now’s your time, now is your chance.
‘There’s never been a better time to get on board and be involved and learn to be a nurse and help people in their hour of need.
‘There’s nothing more rewarding and now’s a good time to do it.’