Category Archives: Nurses

Nurses vote overwhelmingly to strike for first time ever over 1% pay rises More than 50,000 of the Royal College of Nursing’s 270,000 members took part in the poll

Don’t say that NHSreality has not warned you. It’s going to get worse, civil unrest is a real possibility as the safety net becomes obviously holed to all. The profession has seen this coming, but not the one eyed successive ministers of health. NHSreality says pay up or the last chance saloon will close..

Alan Jones in the sunday Independent 14th September 2017 reports: Nurses vote overwhelmingly to strike for first time ever over 1% pay rises

More than 50,000 of the Royal College of Nursing’s 270,000 members took part in the poll

….More than 50,000 of the RCN’s 270,000 members took part in the poll. Another ballot would have to be held before any action takes place.

Opinion by Ally Jamah : Nursesstrike a stinging indictment on politicians The Evening Standard today 15th September

That the health crisis resulting from a national strike by nurses has dragged on for several months is yet another clear and depressing indication of indifference among the country’s political and bureaucratic class to the welfare of ordinary Kenyans.

Since June 5, millions of Kenyans have been unable to access basic and crucial health services in public facilities across the country due to a dispute between nurses and various government agencies over the signing of a collective bargaining agreement.

Critical health services including antenatal, postnatal, outpatient care and vaccination are no longer available to Kenyans in public hospitals, but politicians and bureaucrats in the national and county governments are still strutting around as if nothing is amiss.

In other countries, this lack of access to healthcare by the majority of the population would have been treated as an emergency or a crisis, but in Kenya it is business as usual.

Despite the rhetoric, the political class, which enjoys public-funded generous health insurance covers allowing them access to high-end private facilities both locally and abroad, does not appreciate the suffering that many Kenyans are going through.

The Council of Governors has even advertised some of the nurses’ positions, seeking to replace them through one-year contract terms.

The claim that the money demanded by nurses as salaries and allowances (estimated to be Sh10 billion per year) is too much may not be convincing if one considers the intolerable amounts of money lost in Government through waste and outright graft.

The Salaries and Remuneration Commission has also reportedly vetoed some agreements between nurses and county governments, worsening the crisis.

The media on the other hand continues to highlight the healthcare crisis but not adequately enough to push the political class to action to resolve the matter. One of the main TV stations, KTN News, aptly dubbed the strike ‘The Forgotten Strike’ in a recent report.

ELECTION SEASON

In this election season, the media has understandably focused on politics but the healthcare crisis deserves a big spot in the headlines because of the suffering many are facing.

Similarly, Kenyans who should be united and at the forefront of demanding from politicians a quick resolution of the strike to ease their suffering have unfortunately been distracted by the electioneering fervour.

The strike comes barely months after another one last December that was called off after nurses were lured back to work with promises of the signing of a CBA. And instead of putting heads together to resolve the strike, everyone is busy shifting the blame. This demonstrates the nonchalant attitude in managing the country’s health sector.
Reports indicate that many Kenyans who cannot afford private healthcare are resorting to self-medication at home, while others, especially in border counties, are crossing the Kenyan border for healthcare.
The number of Kenyans who may have died as a result of the unresolved strike has not been documented.
It is well known that nurses are the backbone of the healthcare sector in Kenya and without them, services are effectively paralysed even when the other cadres of health workers are available.
That’s why the resolution of the strike needs more urgent attention and political will. Kenyans are tired of the excuses and buck-passing by politicians and bureaucrats.

On the contrary, the majority of the population relies heavily on public health facilities because they cannot afford healthcare in private facilities.

LARGELY IGNORED

President Uhuru Kenyatta and his deputy William Ruto as well as Opposition leaders have largely ignored the issue and instead focused on political campaigns with their eyes on top public offices. The same attitude is displayed by county leaders.

It is amazing that the absence of healthcare in public hospitals has not featured in the campaigns of the main political blocs as one would ordinarily expect; the matter is being ignored as if it doesn’t exist.

The few public statements by politicians and Government bureaucrats have so far been limited to issuing threats to sack the nurses or urging them to return to work without offering solutions to the sticking points that precipitated the strike in the first place.

 

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Rationed to dangerously low levels – “..Nine in 10 of the biggest NHS trusts are below safe staffing levels”.

The collusion of denial of rationing by politicians and administrators continues. Caroline Wheeler reports in The Sunday Times 13th August 2017: Nurse numbers dangerously low – Nine in 10 of the biggest NHS trusts are below safe staffing levels

This is the result of rationing places in nursing to save costs over a short time horizon (4 years or one term of office). The longer term loss of money due to inefficiencies and diminishing standards does not concern today’s politicians. In my own constituency the MP won by a few hundred votes, and is likely to lose the seat next time. An “honest debate” is what the public wants, but all parties are denying them… It does not help that Nurses are “graduates” as the caring side of personal care is excluded from their jobs as they get more senior. And now we are threatened with fewer immigrant nurses…So, it’s going to get worse.

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Nearly all England’s 50 biggest hospital trusts are failing to hire enough nurses to ensure patients are safe.
Nine in 10 of the trusts, which oversee 150 hospital sites, are not meeting their own safe staffing targets, according to analysis by the Royal College of Nursing (RCN).
The data also suggest nurses are being increasingly replaced by cheaper, unqualified healthcare assistants.
To cope with the shortage of nurses, more than half the largest hospitals (55%) brought more unregistered support staff onto shifts, the figures show. The situation is worse at night, with two thirds (67%) of hospitals using unregistered support staff — which critics claim will lead to higher patient mortality rates.
Janet Davies, chief executive and general secretary of the RCN, said patients can pay the “very highest price when the government encourages nursing on the cheap”.

She added: “Nurses have degrees and expert training and, to be blunt, the evidence shows patients stand a better chance of survival and recovery when there are more of them on the ward.”
A separate study of staffing in NHS hospitals, published in the online journal BMJ Open, found that in trusts where registered nurses had six or fewer patients to care for, the death rate was 20% lower than where they had more than 10.
Hospitals have had to publish staffing levels since April 2014 in response to the scandal at Stafford Hospital, where hundreds died from neglect.
The RCN analysis, which calculates the average fill-rate across the month, reveals the worst affected site was the Royal Blackburn Hospital, which had on duty only three quarters of the nurses needed.
According to the RCN there are 40,000 nurse vacancies. Brexit, low morale, the end of bursaries for tuition fees, and the public sector pay freeze have all been blamed.

The Department of Health said: “Just this month we announced an extra 10,000 places for nurses, midwives and allied health professionals by 2020, and there are over 12,500 more nurses on our wards since 2010.”

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Comments are legion at the Sunday Times. Here is one..

Stephen G Spencer letter by e-mail

With the culture of bullying so prevalent, pay held so that salaries today are worth less but nurses expenses like others have gone up, and a plainly mad Secretary of State and Department of Health that thought doing away with nurses training bursaries was a good idea, together with all those nurses from EU countries worried about the implications of Brexit for them and their families. No surprise at all. But quite worrying if you do have to go into hospital.

The Reality on recruitment: we need more of whoever, whenever, wherever …..

The “reality” in the current position for staff shortages in health is summarised by “we need more of whoever, whenever, wherever …..” It is interesting that the BBC reports questions its feasibility.. Language issues in Wales do not help, especially related to schooling. We are reaping the harvest of long term covert rationing of medical school places. All students with the required grades and abilities should be allowed to do Medicine..

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Kat Lay in the Times reports 31st July 2017: NHS drive to recruit 21,000 mental health staff ‘not realistic’

The NHS will create 21,000 mental-health posts by 2021 in an effort to ensure that psychological conditions are treated as seriously as physical health problems.
The drive will tackle a “historic imbalance” in workforce capacity, the government said. The new staff will include nurses, therapists, psychiatrists and support workers.
Medical schools will be asked to treat psychology A levels as of equal merit to “pure” science subjects, in an attempt to boost recruitment of young people with an interest in mental health.
Ministers have promised £1 billion of investment to provide round-the-clock care every day of the week, treating an extra million patients by 2020-21.
Doctors’ and nurses’ representatives questioned whether 21,000 extra staff was a realistic target, with NHS vacancies growing…..

…Analysis
Promising an extra 21,000 staff in any area is a big ask for the NHS (Kat Lay writes). Last week figures revealed at least 86,000 vacancies had been advertised across the NHS in the first three months of the year, up 10 per cent from the year before.

Jeremy Hunt admits the figure is “ambitious”. However, a deadline of four years’ time is difficult. As Janet Davies, of the RCN, points out: “If these nurses were going to be ready in time, they’d start training next month.”

A lot of the factors that have driven staff away have not changed. There is the 1 per cent pay cap, but also an increasing workload. Brexit is making Britain less attractive for EU doctors and nurses and visa restrictions are hampering efforts to recruit from elsewhere. Parts of government beyond the Department of Health will need to co-operate.

The BBC reports: Reality Check: More mental health staff for the NHS? and the following day

From Tuesday 1 August, most new students of areas such as nursing, midwifery and physiotherapy will no longer be able to apply for grants, and will have access instead to the student loans system

Families asked to feed dementia patients…. How do we design a system that is fair to both the well spread, and the very locally based families?

The quality of care that demented and dementing patients are receiving is inadequate. There is not enough funding, in any system, and especially one without rationing, to provide the quality of care needed. ( National Dementia Audit: Important improvements in dementia care, but more support needed report finds) If you have a stroke, or have cancer, the treatment deficit is similar. These people won’t have votes for much longer, but they have paid into the safety net. So what is to be done: an open and frank discussion about the need to ration, and then an informed discussion of the options and the implications of those options…. It may be reasonable that, where possible, families should feed their relatives in todays financially constrained world. But this is rarely possible in our mobile society. Many UK children think internationally rather than nationally ( hence the Brexit differences between generations), and are working intensive days. Should the next generation be contributing financially if they cannot contribute with care/feeding? How do we design a system that is fair to both the well spread, and the very locally based families? And do this before we are completely swamped?

An educational imperative on Advanced directives might help reduce the numbers….

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Image result for dementia care cartoon

Chris Smyth reports 22nd July in the Times: Families asked to feed dementia patients

Families must be drafted on to wards to feed relatives with dementia who are routinely going hungry in hospital, a comprehensive audit of NHS care concludes. One in four staff caring for dementia patients says they cannot feed them properly, with some resorting to sharing their own food, the study by leading doctors found.
Overstretched hospitals can struggle to provide meals when people need them and do not have the staff to ensure vulnerable patients actually eat what is put in front them, the figures suggest.
Oliver Corrado, consultant geriatrician and author of the report, argued that if families helped out more, it would also be good for those without relatives…….

….“we can’t subcontract out feeding people”, saying it would be “awful” if families felt they had no choice but to come in at mealtimes.
Ms Carter said the system worked well in hospitals where staff discussed with relatives what role they wanted to play and both showed flexibility.
Eileen Burns, of the British Geriatrics Society, said: “On the surface it might be perceived as simply a cost-saving exercise but in reality it is often highly beneficial for older patients with dementia. Relatives and carers can help create a supportive, familiar environment.”

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Understanding NHS financial pressures and how they are affecting patient care (The Kings Fund report) by Ruth Robertson, Lillie Wenzel, James Thompson, Anna Charles 14th March 2017

Harvard Medical School and Medical Publications: Practical advice for helping people with dementia with their daily routines – 7 ways to make life easier and more rewarding for demented people

( National Dementia Audit: Important improvements in dementia care, but more support needed

report finds) Simple Measures: National Dementia Audit: Important improvements in dementia

care, but more support needed report finds 

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Advanced directives needed. Choice in death and dying. Lord Darzi warns of “draconian rationing”. GPs need to be involved at the interface of oncology and palliative care.

An advanced directive or living will – It’s important to specify, especially lying flat. Good news if you take action.

 

When will public anger over the NHS reach a political tipping point? More NHS mental health patients treated privately…

It seems we are a long way from the tipping point whilst “most” services are up and running for the articulate and coherent. NHSreality has opined that “civil unrest” is not far below the surface, but whilst the Regional Health services can hoodwink their populations, and whilst citizens (mainly healthy) can remain in denial as their elderly and mentally infirm get a “rough deal”, and whilst the media and press, including Toynbee, fail to grasp that “overt rationing” is a pragmatic necessity, post coded and covert rationing will drive more and more into private care, and result in a two tier service. Harry may have had “counselling” but I expect it was private, unlimited, and done by a fully trained psychology counsellor. In the Health service it would be limited to six sessions, provided by a Nurse Counsellor who has done an extra short course, and terminated when the allowed sessions expired.

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Polly Toynbee in the Guardian 13th April asks: When will public anger over the NHS reach a political tipping point?

here is an ebb and flow in reporting on the NHS as Trump, Syria and Brexit dominate front pages. But the pressure-cooker state of the entire service still worsens. This morning’s latest figures are just a snapshot of deterioration – but every target is missed: for A&E, ambulance response times, for treating psychosis within a week, for cancer waiting times, blocked beds and diagnostic tests.

“Demand” is rising, the government says, as if serious illness were a choice, though the pressure comes from well-predicted, rapidly increasing numbers of old, sick people: this February’s A&E figures are, as ever, better than deepest winter January, but worse than February last year, as this crisis ratchets up.

Major A&E centres are treating 81.2% of patients within four hours, against a target of 95%, which used to be hit before 2010. The government likes to blame frivolous users of A&E, but those are easily triaged to on-site GPs. Serious delays are because of very ill people needing to be admitted with no empty beds: bed occupancy is at dangerous levels, as Chris Hopson of NHS providers warns, where doctors often have to decide “one in, one out”, discharging those who still need more care too early.

Take the temperature in virtually every part of the NHS and the wonder is how the heroically overstretched staff keep the wheels on the trolley. Take this week alone: the Royal College of Physicians says 84% of doctors have to cope with staff shortages and gaps in rotas.

GPs? Two years after a government promise of 5,000 more GPs, numbers are still falling. They dropped by 400 just in the last three months of last year: as doctors find the workload unmanageable some escape abroad, take earlier retirement or become locums. Too few new doctors want the burden of running a GP partnership, so 92 practices closed last year, tipping hundreds of thousands more patients on to already overloaded neighbouring GP lists.

Today the Royal College of Nursing, traditionally most reluctant of unions to take action, starts consulting its members on whether to hold a strike ballot. But with public sector pay frozen yet again at 1%, when inflation will shortly hit 3%, nurses are departing – as are doctors – for less stressful, better-paid work. Recruitment from the EU is plummeting, as predicted…..

…This is the dismal background to the reorganisation that the head of NHS England, Simon Stevens, is attempting, almost undercover. His state-of-play review of his five-year forward plan passed hardly noticed, announcing a first tranche of England’s 44 STPs, (sustainability and transformation plans) to reconnect local services fragmented by the Lansley 2012 act.

Most observers think it the right way to go, putting the NHS and social care under a united structure with one finance hub, ending destructive and expensive competition and tendering of services. But hardly anyone thinks this can be done with no new money: every STP calls for capital for new beds and units. Virtually all involve closures and mergers stirring a local political outcry.

Jeremy Hunt, who always presented himself as the patient’s ally, rooting out poor quality, wallowing in the Labour disaster at Mid-Staffs, has fallen uncharacteristically quiet. He has nothing much to say about patient safety in A&Es or elderly patients turned out of beds too soon. Not even deaths on trolleys in A&E corridors in Worcester roused his usual righteous ire.

Concern about the NHS has risen high in recent polling: what no one knows is when public anger will reach a political tipping point. Theresa May and Philip Hammond stay iron-clad adamant: all this is NHS shroud-waving and there will be no more money. Lack of any opposition helps, but can they really tough it out where Margaret Thatcher, John Major and Tony Blair all bent in the face of NHS crises?

Chris Smyth in the Times 18th April reports: Sick children ‘denied drugs to save money’ and Spendthrift NHS regions face big cuts. This is the reality of todays health services, and which/what quality of service depends on which. post-code you live in. You cannot plan for the deficit, because the “priorities” change from year to year.

George Greenwood for BBC 18th April: More NHS mental health patients treated privately

 

Nurses consider whether to strike over low pay – if all nurses joined an agency on striking what could happen?

It takes a lot to make the nurses even think of striking. However there is a solution: they ALL join the agencies!  NHSreality believes that if this happened reality would come home to the politicians and the UK citizens. Nurses are underpaid…

James Gallagher for BBC news reports 14th April 2017: Nurses consider whether to strike over low pay

Image result for nurses strike cartoon

Image result for nurses strike cartoon

Nurses and pharmacists to replace GPs for 1 in 4 visits

The highest risk situations in General Practice are when seeing patients without records, when complex elderly people who may have communication difficulties are seen alone, and when there is no chaperone and /or a language/communication problem. Telephone triage may weed out the most risky cases, and reserve these for the GP, notes may be available on a portable computer, but there will be a temptation for “drift” and for those untrained in diagnosis to be over extended. The risk may be more than the insurers will accept. Expect mistakes, and premiums to rise, or for even more pressure on A&E as more patients are referred …. (defensive medicine).

Chris Smyth reports 16ht Feb 2017: Nurses and pharmacists to replace GPs for 1 in 4 visits

One in four GP appointments will be conducted by pharmacists or nurses under plans to relieve pressure on family doctors.

Health chiefs in the South West have said that by 2020 they want doctors to cut their appointments by 27 per cent by drafting in other health professionals and by getting patients to manage their own conditions.

Simon Stevens, head of NHS England, has said that he wants patients across the country to be treated by pharmacists, counsellors and physiotherapist to ease the pressure on GPs. For the first time, health chiefs have now estimated how many doctors’ appointments this could avoid.

The sustainability and transformation plan for Bristol, North Somerset and South Gloucestershire has set a goal to “reduce the number of consultations conducted by GPs by up to 27 per cent through diversion of work to more appropriate multidisciplinary team members and non-clinical services”.

Health chiefs in the area said that the figure was a rough estimate that aimed to show how big a change was needed to keep pace with an older, sicker population when cash and doctors were both in short supply.

They also want to use online consultation and monitoring services to reduce surgery visits by 15 per cent by helping people to look after themselves at home.

Medical leaders have backed the plan as a way to deal with routine problems when waits for appointments are lengthening, but warned that it must not become a way to stop patients seeing a GP.

Richard Vautrey, of the British Medical Association’s GP committee, said: “Nurses, pharmacists and other healthcare professionals could play a vital role in supporting GPs to deliver care in the community.

“This is needed particularly at present as the government has so far failed completely to deliver the much-needed 5,000 new GPs they promised.”

However, he added: “While expanded teams can be beneficial, they should not be seen as a replacement for GPs, as it remains essential that patients can access a GP when they need to.”

Mr Stevens announced plans last year to hire 1,500 in-surgery pharmacists to carry out blood pressure checks, to treat for minor ailments, and conduct routine follow-ups and medicine reviews for older people.

Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “These highly trained healthcare professionals can provide much-needed support to GPs and our existing teams at a time when the profession is under intense resource and workforce pressures, and they will be instrumental in freeing up GPs’ time to deal with complex patients who really need the expert skills of a family doctor who considers the physical, psychological and social context during the consultation.”

A spokesman for the plan said that the figures “reflect a blended assessment of the scale of the challenge we are trying to address with changes to the way we plan, organise and deliver services both in community and in hospital. What we do want to do is to reduce demand for GP appointments.”

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