Professor Dame Carol Propper tells us about her research into the UK鈥檚 nursing problem and explores some of the issues plaguing the NHS
Universal, equitable, comprehensive, high quality, free at the point of delivery and centrally funded 鈥 these were the founding principles of the UK鈥檚 National Health Service (NHS) when it was created in 1948. But today the institution, besieged by financial woes, is facing yet another series of crises, as well as growing public outcry over the quality of its services.
Dame Carol Propper is Professor of Economics at Imperial Business School, a research associate at the Institute for Fiscal Studies and member of the Prime Minister鈥檚 Council for Science and Technology. Using the NHS as her 鈥渓aboratory鈥, former president of the Royal Economic Society Professor Propper has focused her research on the impact of competition in healthcare, the impact of incentives on the quality of healthcare delivery and health system productivity, and the interaction between the state and private markets. She was also a member of French President Emmanuel Macron鈥檚 expert commission to investigate three of the biggest long-term challenges facing the world鈥檚 economies: inequality, climate change and demography, including the problems associated with an ageing population.
Solving the nursing problem
After years of researching choice and competition in the healthcare sector, more recently Professor Propper has been focusing on the 鈥渘uts and bolts of the production of healthcare鈥. Using her access to NHS data, she is working with several experts, including colleagues at the Institute for Fiscal Studies, to research nursing teams.
鈥淭he NHS went into the pandemic already short of about 50,000 nurses and, with global competition, it鈥檚 important to solve this shortage and keep nurses in post,鈥 she says.
Her particular focus has been on which type of nurses within a nursing team really matter when it comes to patient outcomes.
鈥淲e鈥檙e looking at a very extreme situation 鈥 whether a patient has died 鈥 and we鈥檙e asking if it matters if you鈥檙e missing a nurse. And, if so, does it matter if you鈥檙e missing a senior nurse, a qualified nurse, an agency nurse or a healthcare assistant.鈥
The NHS has been through many crises since 1948 and each time we鈥檝e successfully managed them
Among their findings so far, they have discovered the most important nurses in the prevention of patient deaths are the senior ones.
鈥淭he policy implication of this is that you shouldn鈥檛 keep trying to fill vacant nursing posts by substituting them for less qualified people. Secondly, you should be trying to retain the nurses you already have because there鈥檚 a clear return to both seniority and familiarity with the hospital.鈥
Alongside this, she is working with academics Dr Andre Veiga and Dr Stephan Seiler in the Business School鈥檚 Marketing Department to find out what nurses value in their work other than pay. With a regulated pay scale in place, jobs don鈥檛 really differ according to salary, so the team are looking into how hospitals can boost staff retention without using higher pay as an incentive.
Rise in private healthcare
When it comes to the NHS in the post-COVID landscape, Professor Propper highlights the fact the institution is 鈥渇acing a lot of different pressures at the same time 鈥 all of which demand more money鈥.
鈥淲e鈥檝e seen senior staff choosing to take early retirement, the doctors' pension furore, which some have argued is causing people to leave the NHS prematurely, and the GP shortage, meaning lots of people are unable to get appointments. The huge rise in energy prices is also putting further pressures on NHS budgets.鈥
Additionally, the increase in waiting times has led to a huge shift in the number of people opting to use private healthcare. Earlier this year, The BMJ revealed due to the poor access to care exacerbated by the pandemic, warning this threatened to create 鈥渁 two-tier system鈥.
The NHS went into the pandemic already short of about 50,000 nurses
This is something Professor Propper had predicted: 鈥淲henever there鈥檚 a crisis in the NHS, waiting lists rise, and when that happens the demand for private healthcare rises.鈥
The current situation, she believes, is likely to lead to a review of how the NHS is financed, looking into European healthcare models based on social insurance.
鈥淪ocial insurance is not very different from tax financing because, where these systems exist in Europe, individuals with lower incomes tend not to have to pay anything while individuals who are higher income generally share the insurance costs with the state.鈥
With so many problems plaguing the NHS at once, some have dubbed this a 鈥渕ake or break鈥 moment for UK healthcare but Professor Propper isn鈥檛 convinced.
鈥淭he NHS has been through many crises since 1948 and each time we鈥檝e successfully managed them 鈥 and that鈥檚 with one of the lowest levels of funding of any wealthy European country.鈥
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