Tag Archives: NHS

Staffing the NHS

Nurse Jessica
Latest solution to nurse staffing crisis

The NHS isn’t really the subject of this blog, but once again I find myself compelled to comment. Mainly about the total failure of joined up thinking coming from the Government…

I used to work as a speech and language therapist. I stopped finding it remarkable when I used to go onto wards in the afternoon to find only one trained nurse in charge of 3 bays of 5 beds and 3 siderooms. But with no official guidelines as to what constituted a safe level of care, it was hard to make a case for more staff. The Mid Staffs scandal changed all that. The problems at the Mid Staffordshire NHS Trust shocked us all. Poor patient care, lack of dignity for vulnerable people, deaths which should have been avoided. There have been extensive inquiries, which found, among other things, that inadequate staffing levels played a significant part in the problem. Recommendations were made as to what safe staffing levels might be, and the Government told hospitals to increase the number of nurses on the wards accordingly.

Fast forward three years. The Government is now telling hospitals they need to cut back staffing levels, including nurses on the wards, in order to deal with huge financial deficits in most trusts. Patient safety and high standards of patient care can once again be sacrificed on the altar of balanced books.

Let’s look a little closer at these deficits. Far and away the biggest expenditure in the NHS is on staff salaries. And a significant proportion of the money spent on staffing is spent on agency staff; agency staff who are needed because there are not enough qualified nurses (or doctors) directly employed by the NHS to fill all the shifts required. I think it would be very revealing to ask why people choose to work as a locum or via an agency, rather than taking a regular job. But for whatever reason, there is a shortage of trained nursing staff available to fill posts.

Finally, let us consider one more piece of recent Government policy regarding the NHS. It concerns nurse training. Aha! No doubt this is a policy designed to encourage more people to train to be nurses and so eventually overcome staff shortages! Well, not exactly. It is the decision to scrap bursaries for student nurses and midwives, and instead replace them with loans, making it much more expensive for anyone wanting to train and therefore creating an additional barrier for anyone considering the profession.

Maybe this isn’t a failure of joined up thinking. Maybe it all joins up very nicely, forming a perfect pathway to privatisation, with a few lucrative deals for some along the way.

24/7 Smokescreen

doctorstrikeI’m backing the Junior Doctors’ strike all the way. Not least because being able to withdraw one’s labour is a vital part of our democracy and protection for workers against exploitation.

Yes, even doctors should have the right to withdraw their labour. They continued to cover emergency care. Senior doctors (consultants) stepped in to fill in the gaps and make sure patient care wasn’t compromised. Patient safety was never at risk. Yes, there was some disruption as clinics and operations were put off for another day. But quite frankly, that’s the point. Strikes are meant to be disruptive, otherwise there is no point in having them.

But mostly I’m supporting the strike because the government is deliberately and systematically undermining the NHS for its own ends. Its rhetoric about improving care and developing the 24/7 NHS is a complete red herring. Or total bollocks if you don’t mind me being less polite.

The government isn’t interested in improving patient care, only in saving money. We already have a 24/7 NHS. Nurses are on the wards all day every day. Perhaps there aren’t enough nurses. The scandal at the Mid Staffs hospitals led to an independent review to establish how many nurses is enough, but now this programme has been stopped.

Doctors are also on the wards all day every day. Shift patterns, rotas and on call may vary at night and at weekends, but doctors are there. Is the new contract accompanied by a plan to employ more junior doctors, so that more doctors are available? No, don’t be silly! The same number of doctors will be spread more thinly across the week because mostly they sit and twiddle their thumbs Monday to Friday.

But apparently it is possible to run a truly 24/7 NHS only with doctors and nurses. Because as yet I have heard no discussion at all about increasing the numbers or working patterns of anyone else who makes the NHS work. Despite suggesting he wants the NHS to offer the same services on Saturdays and Sundays as well as during the week, it seems that this will happen without any extra services being supplied by speech therapists, physiotherapist, occupational therapists, dietitians, clinical psychologists, pharmacists, radiographers, theatre staff, porters, phlebotomists etc etc etc. The list goes on and I’m sure I’ve left people out – please add your own profession in the comments if it’s you, sorry!

The media is fond of scare stories about our hospitals, and the Tories seem determined to blame the doctors. Targets for waits in A&E to be less than four hours are now way off being met. But this fuss over the junior doctors’ new contract is a smoke screen, and doctors are the scapegoat. The government isn’t really interested in making it better, because that will cost money. Jeremy Hunt might like to tell you that the Tories are investing more money in the NHS, but apart from being a trick with the figures, it is putting small amounts of money in at one end and taking vast amounts out at the other.

Why do patients have to wait for more than four hours in A&E? Why do people have to wait for operations or have them cancelled at short notice? Mostly, this is because there are not enough beds. Why are there not enough beds? Because they are already occupied, often by well people. People who are no longer sick enough to need to be in hospital, but are not well enough to go back to the circumstances they were living in before. People who need extra support at home, or a place in a residential home, or other form of social care. But they can’t go home because this care isn’t available or isn’t ready or takes too long to organise. Who supplies and pays for this kind of care? Mostly, local councils. And which area of government spending has seen the most dramatic and devastating cuts since the Conservatives came to power? Yes, local councils!

So I don’t believe for one minute that this dispute is between two groups of people who both genuinely believe they want the best for patient care and the future of the NHS. One side talks about a 24/7 NHS but has no intention of doing what it takes to look after the NHS. The other side is already delivering it.

Psst! Do you want to know a secret?

It’s been quiet on these pages over the summer holidays. Not that stuff doesn’t happen, but getting up late and being out of the country means I’ve missed most of it. The terrible distressing stories from Iraq, Syria and Gaza haven’t gone unnoticed, but I haven’t felt able to make an informed, helpful comment on these issues.

Something else has been slipping by unnoticed, though. I expect it has slipped by most people, without them ever realising it was happening. I’m talking about TTIP. See – you’ve still no idea what that is! And if I tell you it stands for Transatlantic Trade and Investment Partnership, are you any the wiser?

It is a deal being negotiated between the US and the EU to removed barriers to trade between the two regions. So you’d expect this blog to have something to say in criticism of an unfettered free market. And I do have a problem with the elevation of “the market” as the solution to all our problems, economic at any rate. But my problem with TTIP runs deeper than this.

For a start, there’s the fact that most people have never heard of it. Negotiations are being carried out in secret, and most of our MPs don’t have any idea about the details of the deal. Its remit is wide ranging, and it needs to be subject to scrutiny. In the interests of democracy, the general public should know what is being discussed, understand its likely impact on our society, and have a say in whether they agree with this or not.

I have more concerns because most of the “barriers” to trade between the EU and the US are in the form of the higher levels of safety standards, environmental protection and workers rights which we have in the EU. Clearly it is better for business if standards are regularised, so that products are compliant across both regions. But lets guess which way standards are likely to change in areas where they differ.

Another aspect of the deal would be to force public services to open themselves up to private companies bidding for contracts, removing any option for governments to choose to keep them in public ownership. Maybe you think private ownership is a good thing, maybe you don’t. Right now, that’s a debate that is raging in the UK with regard to the NHS. If this deal is agreed, there will be no debate, and the NHS could soon be in the hands of American private healthcare companies.

TTIP could prevent better laws to protect our environment and combat climate change
TTIP could prevent better laws to protect our environment and combat climate change

But most insidious of all is the erosion of government power to introduce legislation to protect workers, consumers and the environment. If governments want to implement a living wage, or raise standards for air and water pollution, for example, and a business feels this will impact on their profits, they will be able to sue that government. Not through the usual channels of the national court, but by taking them to an ad hoc secretive arbitration panel, overseen by corporate lawyers. Businesses already hold way to much sway over government policy. This further diminishes government’s ability to make policies for the public good, where people’s taxes will end up paying for corporations to keep the law.

I don’t think you need to be against free trade to recognise that this deal, as it stands, is bad news. Large multinational corporations don’t need more power. It is difficult enough to make sure they pay proper taxes, don’t exploit their workers and take responsibility for tackling climate change and taking care of the environment. And we certainly don’t want to be handing over power to big business in secret without knowing what is being negotiated and given up on our behalf. The secrecy and the strait-jacketing of our elected governments make this deal an attack on democracy.

If you’d like to raise your voice in opposition, you can join the campaign on the 38 degrees website. If you’d like to read more, try George Monbiot or this blog.