Its going to get worse. Local CCGs and Health Boards will attempt to restructure and reconfigure to make savings. Doctors and Nurses will be re-applying for their jobs. Redundancies will be encouraged. No change will occur without the open debate that Mr Stevens called for. Exit interviews should be encouraged and gongs should be awarded to those who speak out, rather than those who keep quiet and wont “rock the boat”.
A toxic cocktail of under-pressure local authorities and low staffing has the NHS on the brink.
Among the grim litany of charges laid out in the Francis Report into the Mid Staffordshire scandal, time and again short staffing came up.
“It should have been clear,” the report said, “from the history and the nature of the deficiencies being reported, particularly in relation to staffing, that a dangerous situation had been allowed by the Trust leadership to develop and that urgent action and intervention were required”.
It went on: “The complaints heard at both the first inquiry and this one testified not only to inadequate staffing levels, but poor leadership, recruitment and training”.Two and a half years later, have the lessons of that dark episode been learned? Today’s Independent would suggest not. It reports that out of 89 acute hospitals inspected between 2014 and 2015, three quarters raised concerns over staffing levels.
Yesterday Addenbrooke’s Hospital in Cambridgeshire became the latest acute hospital to be branded “inadequate” by the Care Quality Commission (CQC) and the trust that runs it placed into special measures.
“Inspectors found a significant shortage of staff in a number of areas including critical care services,” the CQC said in a statement. “This often resulted in staff being moved across different services, with gaps back-filled by bank or agency staff.
After the long recess, it’s always a good time to reflect. Just as Parliament broke Jeremy Hunt was facing a backlash from, well, most of the medical profession, crystalised in the #iminworkjeremy and #weneedtotalkaboutjeremy social media campaigns; the King’s Fund’s Quarterly Monitoring Report in July revealed the highest A&E waiting times for a decade, 66 per cent of trusts forecasting a deficit by the end of the financial year and staff morale being the biggest concern for trust finance directors; the share of spending on GP services as a proportion of the overall NHS budget has fallen again; local authorities have been handed another £1.1bn of cuts; and a third of CCGs are now considering rationing – aka cutting back – services.
For a government which spins itself as the saviour of the NHS, it doesn’t look good. Especially when you look at the Addenbrooke’s case in more detail. Last year the hospital was awarded top marks by the CQC – I’ll just let that sink in. In May last year Addenbrooke’s passed with flying colours; yesterday it was ranked ‘inadequate’.
What could have possibly changed at one of the country’s top hospitals that it should decline so alarmingly in such a short space of time? Retired senior nurse and National Health Action Party member Hilary Price, who worked in the Cambridgeshire area for 40 years, tells me Addenbrooke’s has been the victim of a “pincer movement” of underfunding and regulation that has brought the trust to this point.
She says: “On the one hand, the CQC is criticising underfunded clinical care, whilst, on the other hand, Monitor is expecting the hospital to further constrain its expenditure, which will only exacerbate the problems identified by the CQC. The Government is withholding essential funds from Addenbrooke’s, instructing it to make untenable cuts, year on year, misnamed ‘efficiency savings’, whilst still expecting it to deliver safe, high quality services”.
It’s a familiar picture. With two-thirds of trusts forecasting a deficit, despite in all cases having already made significant ‘efficiency’ savings, the pressures on frontline services and frontline staff have gone beyond intense.
Unite national officer for health Barrie Brown says that the failings revealed by the CQC can’t be taken in isolation, nor should the trust take the rap.
He says: “The problems identified by the CQC reflect failures in workforce planning across the NHS; they’re not the direct responsibility of Addenbooke’s which is the victim of this failure. The overwhelming pressures on local authority care budgets cannot be dealt with by Addenbrooke’s, despite the implication of Professor Mike Richards who cites other hospital trusts doing that.
“What account has been taken of the CCG’s commissioning and payment for services against the backdrop of significant increases in healthcare demands, made more difficult due to the tremendous reputation of Addenbrooke’s for clinical excellence?”
The government isn’t flinching from its programme of enforcing £22bn of cuts on the NHS, nor from the planned evaporation of funding for local authorities, heaping even more pressure on hospitals – it was cited by the Commission on acute adult psychiatric care in England as the primary reason for delays to discharges from mental health wards. The UK has one of the lowest beds-per-capita ratios in the developed world – 2.95 per thousand people compared with 8.27 in Germany, and the ratio of spending on healthcare is set to fall from around 8 per cent of GDP –the second lowest in the G7 – to 6 per cent by 2020.
When the new general secretary and chief executive of the Royal College of Nursing (RCN) Janet Davies took up her post in August, she came out fighting for her profession in the starkest possible terms. Staff shortages and the pay restraint are threatening lives, she said, forcing nurses to resort to payday lenders and foodbanks, driving staff out of the profession and severely overstretching services. “This is not a great place to be”, she said at the time.
The truth of Davies’ words is all too stark when I speak to a local source in Cambridgeshire, who tells me that she sees “senior nurses at Addenbrooke’s taking sick leave with stress”. “There are people who are telling me they’re burnt out, and they’re only in their 30s”.
Stafford Hospital stands as dark monument to what can go wrong at a hospital. With 68 acute hospitals between 2014 and 2015 reporting serious concerns over staffing and the words of the Francis Report still echoing around the corridors and wards of hospitals throughout the country, the fear is now that we return to the dark days of the Stafford Hospital scandal, on a wholesale level. The warnings are there, for all to see.
Benedict Cooper is a freelance journalist who covers medical politics and the NHS. He tweets @Ben_JS_Cooper.