The NHS has “taken its eye off the ball” when it comes to safe staffing, Unison’s outgoing national officer for nursing has warned in an interview with Nursing Times marking his departure.
Stuart Tuckwood, who last week stepped down from the union to join NHS Education for Scotland, spoke about the major issues facing the profession today – from the ongoing fight for fair pay and recognition, to the challenges facing international nurses.
“When it comes to nursing particularly, there should be alarm bells ringing everywhere”
Stuart Tuckwood
A registered nurse himself, Mr Tuckwood previously worked as a senior charge nurse in a critical care rapid response team at Addenbrooke’s Hospital in Cambridge.
He also volunteered for six months at Yangon University Hospital Intensive Care Unit in Myanmar and returned to clinical practice during the peak of the Covid-19 pandemic to support the workforce.
When Mr Tuckwood first joined Unison, the NHS was grappling with chronic workforce shortages and trusts were increasingly turning to overseas recruitment to fill the gaps.
Countries such as India and the Philippines were targeted and, by 2023-24, nearly half of all new joiners to the Nursing and Midwifery Council (NMC) register were internationally educated.
Together with other unions, Unison sought to “make a real big difference” to all those arriving in the UK to work, including helping establish a code of practice on international recruitment, Mr Tuckwood explained.
He said: “A lot of the overseas nurses worked very closely with us on that, and fed back their experiences and helped us strengthen that guidance.
“I think that’s sent a message to the system about how we need to treat overseas nurses,” he said.
The past year has seen recruitment slow down, with latest data showing a 30% drop in international joiners in the last 12 months.
Yet a significant portion (24%) of the current NMC register remains internationally educated.
“Just because we’ve stopped recruiting overseas, it doesn’t mean their issues have gone away,” argued Mr Tuckwood.
Most concerningly, he said the current political environment was becoming increasingly hostile for these nurses, who were facing rising levels of racism and discrimination by colleagues and the public.
Mr Tuckwood pointed to the growth of Reform UK as a likely factor. It comes as a recent YouGov poll found that the right-wing populist party could secure the most seats if an election were held now.
“A lot of migrant nurses are now living in areas where Reform councillors have got elected, and they feel very vulnerable,” Mr Tuckwood said.
“The rhetoric and everything going around at the moment is making them feel very scared, and that just makes them more prone to being exploited by bad employers and being victims of racism in their workplaces.”
Mr Tuckwood expressed particular concern over a recent government decision to reject funding for international nurse support groups, describing the move as a blow to vital pastoral support.
“I’m really disappointed that the government decided not to support the nursing diaspora associations,” he said.
Another defining moment during Mr Tuckwood’s tenure was the historic wave of strike action by nurses in the 2022-23 winter, when they walked out over pay.
Unison members on strike in Liverpool on 21 December 2022
“I count that as a real highlight, that our members went to the picket lines [and] took action to force government to listen,” he said.
“The pay dispute then was obviously successful for us, in that we got more money for our members at a really difficult time that they were happy with, and we made a big difference.
This year, the government has proposed a 3.6% pay rise for all NHS staff on Agenda for Change contracts.
Unison is currently consulting its members to gauge appetite for industrial action.
Asked whether nurses were prepared to strike, Mr Tuckwood said “we’ll see”. “In this kind of environment, some people are very angry about it all, and they want to fight, and they want to go out and strike, and other people are worried about their jobs, and they just want to keep their heads down,” he said.
What is clear, however, is that the government has failed by not holding direct pay talks with unions, according to Mr Tuckwood.
At present, nurse pay in England is still decided via a process involving unions and the government giving evidence to the NHS Pay Review Body, which then gives advice that ministers can choose to accept or not.
The process was originally designed to take some of the politics out of deciding NHS pay rises, but unions have increasingly called for direct talks with ministers; something that now happens in Scotland.
“We’re very disappointed that they’ve not engaged in that,” Mr Tuckwood, referring to the Westminster government’s reluctance so far to change the annual process.
He noted that the current deal falls short of what nurses had received in Scotland and was lower than the 4% awarded to doctors. “There’s a lot of frustration, a lot of disappointment amongst our membership.”
However, he highlighted that one of the most pressing issues facing the workforce was dangerous nurse-to-patient ratios.
Unison’s latest report from its Only Enough is Enough campaign revealed that on nearly seven in 10 shifts (69%), staff reported unsafe staffing levels.
Mr Tuckwood said: “Despite the development of policy in England, and the [safe staffing] legislation in Scotland, Wales and Northern Ireland, still most nurses don’t think the shifts they work on are safe, and when they ask for help, they don’t get help.
“In all honesty, I think the NHS is taking its eye off the ball on safe staffing,” he said. “I think all the other issues have just overtaken it, and we’re not paying enough attention to it.”
More on the Only Enough is Enough campaign
To address the issue, Mr Tuckwood called on health leaders to “stabilise the nursing workforce”. But with overseas recruitment in decline and a slump in new joiners to university courses, this could be a challenge.
He added: “When it comes to nursing particularly, there should be alarm bells ringing everywhere.
“The numbers going on to courses are going down. Retention has improved somewhat, but it’s still a big concern. And so I think that massive work to be done to turn that around.”
One longstanding solution championed by Unison is to ensure nurses are valued fairly.
During Unison’s health conference earlier this year, nurses described not being valued fairly for their work and their expertise, despite their pivotal and safety-critical role.
Members voted unanimously for early career nurses to automatically progress from band 5 to 6, upon gaining the necessary experience and competencies.
Over the last year, the Royal College of Nursing has also been lobbying for this type of progression, following a period of preceptorship.
Mr Tuckwood said: “There’s a lot of band 5 nurses who are not being paid as much as they should be – they should be band 6s.
“I think it’s a real success that we’ve got the system to pay attention to this as much as it should be.
“But unless we, over the next few years, support those nurses to get rebanded, and we have more progression from a band 5 to 6… then we’re not going to retain people and we’re not going to turn the workforce situation around.”
“Whatever union you’re in, get involved and support them and work with them”
Stuart Tuckwood
The past year has also ushered in a new era for the NHS, with the Labour government coming to power on a platform of promises to rebuild the health service.
Unison strongly backed Labour during the 2024 general election, believing it was the only party capable of reversing years of underfunding and mismanagement.
As the first year of the new government draws to a close, there are mixed feelings.
Mr Tuckwood said: “The [previous] government was absolutely shocking and irresponsible when it came to the health service, constantly delaying everything, not giving the NHS what it needed, not talking to trade unions, actually attacking trade unions and our ability to organise and represent our members.
“So, the fact that Labour have come in [and] they’ll speak to us [means] we’ve got a closer relationship. They will work with the [NHS] Staff Council.
“It’s still early days, and there’s so many huge problems that they need to deal with, but we think they could certainly do a lot better just by sitting down and working with us more closely and talking to us more regularly. We can help them to fix a lot of the big problems there are.”
Over the years, Unison has worked alongside Nursing Times on campaigns around preceptorship, workplace violence and the long-term impact of the Covid-19 pandemic on the workforce.
“It’s great to have the partnership with the Nursing Times to give the space to these nursing issues to be debated and explored properly,” Mr Tuckwood said.
“A lot of these things are really complex and we need a space to have debate and discussion,” he said.
Mr Tuckwood urged all nurses to get involved in their unions to make changes that will benefit the profession.
He said: “All nurses need to be active. The unions can’t do that stuff for people, they need to do it with people.
“Whatever union you’re in, get involved and support them and work with them to try and achieve these things.”
Looking ahead, Mr Tuckwood will be joining the workforce education team at NHS Education for Scotland, which he described as a natural continuation of much of the work he led at Unison.
The union is now recruiting for his successor, with applications for the national officer for nursing post open until 10 July.
Mr Tuckwood said: “It’s a really interesting, exciting role. It can be done a lot of different ways.
“I’m sure there’s a lot of people out there who are looking for good nursing jobs, and jobs where they can make a difference in nursing, and this is definitely one of them.
“So I’d encourage anyone who finds this kind of work interesting to apply,” he added.
Read more Nursing Times campaigns
