Category Archives: Nurses

Government plans to increase funding are missing the point.

The Huffington Post opines: Government plans to increase funding are missing the point. Philip Hunt reports: Austerity, workforce shortages, a social care crisis and a complete failure to factor in a growing older population – it’s little surprise the NHS is reeling, Lord Philip Hunt writes.

November 2019 saw the worst four-hour wait performance in A&E since figures were first collected, back in 2010. This has been matched by failures on key targets for cancer, GP appointments and hospital treatment waits. At the same time, rationing of medicines is on the increase – with failings being increasingly revealed in ambulance services, mental health support, and for people with learning disabilities.

Given all of this, it’s a huge tribute to NHS staff that so much care remains of a very high quality. But the calamitous drop in performance over the past decade is having an impact on patient safety as well as leading to longer waits.

Just before Christmas, the Norfolk and Norwich University Hospital advised staff to make the “least unsafe decision”, following a huge rise in admissions. It was

not an isolated incident. Indeed, 2020 has already seen the Royal Cornwall Hospital NHS Trust tell its staff to help reduce severe overcrowding by discharging patients – despite the obvious risks involved.

While many factors and pressures are at play, the alignment of austerity with workforce shortages, inadequacies of adult social care and a complete failure to factor in a growing older population, means it’s little surprise the NHS is reeling.

The lowest five-year period of funding growth occurred over the 2010/11 to 2014/15 period and the past five years have seen little improvement. Is it any wonder that the NHS is cash-strapped, in deficit and finding it very hard to invest the resources necessary to prevent hospital admissions? Latest estimates by the Health Foundation show a shortage of more than 100,000 staff, including 40,000 nurses.

All of this is happening when social care is in meltdown. By 2018, the House of Lords Economic Committee had reported that 1.4 million older people in England had an unmet care need. The number of older people and working-age adults requiring such care is increasing rapidly, yet public funding declined in real terms by 13% between 2009/10 and 2015/16.

If it applies in England that the “poorest get the worst health care”, it does in all 4 health services.

There are perverse outcomes of the austerity years, but more as a result of the rationing of places in medical school over decades. Add to this the removal of nursing grants and subsidies, and less than ideal recruitment for all the para-medical specialities. The short term horizon of politicians has led to a situation where the miners of Tredegar once again get a worse service than the bankers of London. I wonder if any of our politicians have read it? We have to reconfigure the 4 health services.

Spin doctors? Richard Smith isn’t buying it. “The NHS doesn’t need more money, it needs a radical rethink”. 2020

Aneurin Bevan: In Place of Fear A Free Health Service 1952 Chapter 5 In Place of Fear 1948

Dennis Campbell in the Guardian 23rd Jan 2020: England’s poorest ” get worse NHS care ” than wealthiest citizens

England’s poorest people get worse NHS care – Nuffield Trust
New QualityWatch analysis shows that people living in the most deprived areas of England experience worse NHS care. Read this scrolling story to find out how inequalities have changed over 10 years, and read this briefing for the low-down behind the numbers. The story was exclusively covered by the Guardian.

 

2016:What am I afraid of? More and more… Bringing back fear..

2017: Bringing back fear, and suffering. A return to 19th century inequalities.. How quickly politicians destroyed what was the best safety net in the world?

Cynical de-commissioning bringing back fear.. Dying patients waiting hours for pain relief in NHS funding shortfall.

2018: Bringing back fear – in the media led society. Lets charge for screening tests and spend the money elsewhere.

2016: What is the true story behind NICE stopping “A&E safe staffing guidance” levels? Money and fear of civil unrest…

The thin edge of the wedge. Is private A&E going to thrive and become the shape of the future? Aneurin Bevan, what would you do?

 

 

An unhappy new year looms for the 4 UK Health Dispensations. A worsening disaster…. Hold onto your life..

Nobody discusses reality in health any more. So just a few thoughts for an “unhappy” new year for the 4 UK Health Dispensations. A worsening disaster…. Hold onto your life..

Hugh Pym reports 20th December for BBC news: Political heat eases but NHS chill sets in

Nick Triggle reports for the BBC 29th December 2019: Why 2020 will be a crucial year for the NHS

So 2020 looks set to be a crucial year as ministers seek to meet the challenges facing the health service in England head-on.

But what are the most pressing issues for the Westminster Parliament to address in the year ahead?

Reducing waiting times

Health is devolved, meaning the Department of Health and Social Care does not control health policy in the rest of the UK, although Scotland, Wales and Northern Ireland will be watching closely to see what it does.

Undoubtedly the most high-profile problem – and the one used by critics to beat the Tories – has been the deterioration in waiting times.

It is now more than three years since any of the three key targets covering A&E, hospital operations and cancer have been met.

Both A&E and routine operations are at their worst levels since the respective targets have been introduced.

A&E figures

The first tranche of the extra funding the NHS is receiving – 3.4% above-inflation rises until 2023 – kicked in at the start of April 2019.

But that still has not been enough to reverse the deterioration. Many predict it will take years before the NHS gets back to where it was a decade ago, when it was regularly meeting waiting time targets….

…In fact, Boris Johnson promised to “fix the social care crisis once and for all” in his first speech on the steps of Downing Street when he took office in the summer.

The election manifesto provided no detail on how the Conservatives would do this, beyond promising that people would not have to sell their own homes to pay for care – only the poorest get help from the state.

 

Ministers want to set up a cross-party commission, but with both Labour and Liberal Democrats plunged into leadership races after the election, there will be huge pressure on the government to start coming up with plans.

After all, a working group of experts has already spent 18 months drawing up options for the government to consider.

It was set up after the 2017 election – exactly 20 years after Tony Blair came to power promising reform.

After more than two decades of talking, surely the time has come for action.

Filling the gaps

Another thorny issue is the workforce challenge. One in 12 posts in the NHS is unfilled.

The government is already increasing the number of doctors and nurses in training, but it will be many years before the full impact of that is felt.

NHS vacancies by staff group – see graphic on BBC link

Instead, immediate attention is turning to retaining more nurses – every year more than 30,000 leave the NHS – and international recruitment.

The number of staff coming from the EU has fallen since the referendum.

 

Rationing over Christmas. Just part of the routine now… in a toxic culture of denial.

Over Christmas we hate to hear about the hard truths of peoples lives. Dying alone is not something I look forward to, and I suspect I will not know the medical person who comes to see me in the last days. Continuity of care has disappeared, and in its place is part time working of both nurses and doctors. These professionals have not necessarily been trained to deal with the variety of conditions which the ageing community and General Practice demands of them, Many miss out on Paediatrics or Gynaecology or Dermatology as well. Most miss out on orthopaedics… The “hard truths” which Mr Stevens wishes to discuss (since 2014!), facing politicians and their electorate about health, are present all the year round. And its too toxic a subject for all politicians..

Image result for toxic culture health cartoon

So it is no surprise that diagnoses are late, especially for conditions with rather unspecific symptoms such as early leukaemia ( Susan Oneill in the Times 27th December: A quarter of cancer patients go to GP three times before a diagnosis ). Doctors are taught to use time as a diagnostic tool, and if all patients had all possible tests on presentation the service would surely implode. Sepsis on the other hand is severe and should be recognised by every doctor.. It is still “causing more deaths than expected” in Wigan.

Dennis Campbell reports 10th December in the Guardian: Thousands die waiting for Hospital Beds – study.

Shaun Lantern in the Independent 27th December reports that the nursing profession don’t think Boris Johnson’s NHS plan is deliverable.

Laura Donnelly in the Telegraph: Hip Rationing

The Daily Mail reports that the Scots are to get three rounds of IVF compared to the one offered by most English Trusts.

Andrew Proctor for the Dermatologists reports on the rationing of emollients (which are almost all very cheap)

It features National Eczema Society’s Chief Executive Andrew Proctor discussing the important issue of emollient rationing for people with eczema.

Denial for 5 years. On 4th June 2014 Mr Stevens asked for an honest debate…

The politics of health.. The Lemmings of the left leave a vacuum where Mr Stevens’ debate will not happen… Are we all lemmings as far as our health system is concerned?

The Election Horror Show, and denial… The political spin doctors are leading us into a health-less “black hole”. The Health services are too toxic for honesty…

NHS Rationing & Finances | A King’s Fund Report‎ March 2017. Understand the NHS financial pressures. How are they affecting patient care?

toxic work environment cartoon

 

Prudent healthcare reforms and a suggestion for GP recruitment

The numbers of GPs have increased, but the number of Full Time GPs, (Which means 9 sessions a week) has reduced because more and more are taking options to mix and match their portfolio careers.

The first letter below is correct: GPs need portfolio careers to survive themselves, and for the local service to survive. Changing the shape of the job…. In the festive season (see below ) doctors cannot be expected to behave like turkeys in their voting… Ask around and I expect you will find demoralised people who did not know who to vote for, but in a PR system would have voted Liberal.

The Times letters 18th December 2019:

Sir, Libby Purves makes some very good points about the crisis in A&E departments in many NHS hospitals (“Don’t just throw money at the NHS, be smart”, Dec 16). She suggests a return to convalescent homes or cottage hospitals, with both staffed by nursing auxiliaries and overseen by local GPs. Patients who did not require the “high tech” care provided by the acute hospital but required good nursing and general care before returning to their home or other long-term care could be transferred to one of these units. I was a GP and we had a 100-bed unit that did just this. The patients were well cared for and many were able to return home. Like many other units, however, it was closed; all we have now is a 600-bed acute hospital some miles away.

I met another retired GP this morning. He had been away: his wife, who is disabled, had suffered a serious injury to her face and he had taken her to the acute hospital A&E. They were there for about ten hours; the place was chaotic, being full of people suffering from minor ailments whom in the past we as GPs would have dealt with. When she was treated by the medical staff the care was first-class. We both agreed that it was time that the problem of GP out-of-hours care was sorted out; the pressure on A&E departments would then reduce.
GBR Fisher

Cononley, W Yorks

Sir, Libby Purves makes an important case for new convalescent homes but creating them will take time. A quick interim fix would be for the government to seek bids for building basic accommodation modelled on budget hotels over hospital car parks. Hotel operators and some house builders would respond quickly, a standard brief could be produced and a new permitted development right or development order could avoid planning delays.
Brian Waters

Chairman, London Planning & Development Forum

Sir, In her article Libby Purves makes many good points about the medium-term future of the NHS. A further core problem is unscheduled care. Until there is more integration between GPs and emergency departments problems are likely to continue. It is a pity that the so-called internal market of 1990 widened this chasm and that budgets within the system still drive change. The royal colleges of both the physicians and GPs advocate generalists, and some emergency departments have innovative ideas. There is, however, a need to devise a qualification for interested GPs to integrate seamlessly within emergency departments, thus allowing patients to see the most appropriate person on arrival.

Who knows, perhaps by offering a dual base this could help to solve the problem of GP recruitment.
Dr Michael Houghton, FRCGP, FRCP

Preston, Lancs

Sir, I went to my local surgery last week. The person before me was a “no show”; the nurse told me that there had been four “no shows” the day before. Last year I had knee replacement surgery. I was given an ice machine to take home after the operation. I didn’t want it and didn’t use it, preferring the flexibility of using frozen peas. I tried to return it but it was refused on the grounds of cross-contamination. I was also unable to return the crutches for the same reason. Throwing money at the NHS is not the answer to all its problems.
Ann Hadingham

Alton, Hants

Times letters: Prudent reform of the NHS and social care

Don’t throw money at the 4 health services. Put the plug in first, and then concentrate on recovery in 10-15 years time…

 

44,000 Nurse vacancies = 12% of the workforce. Cheaper staff and less spend means more deaths…

Shaun Lintern on 3rd December for The Independent reports: Leaked NHS document reveals government plans to use cheaper staff to fill nurse vacancies.

A leaked NHS document reveals that plans to grow the number of nurses rely on using 10,000 cheaper and less qualified staff.

Even then, the health service will still be more than 20,000 nurses short of what is needed in five years’ time, according to the file seen by the Health Service Journal and The Independent, for the as yet unpublished NHS People Plan.

The projections could be problematic for Boris Johnson, who has promised 50,000 more nurses by 2024 – although 18,500 of these are existing staff he hopes to retain….

Meanwhile the Times reported: nursing applicants fall by almost 20% in two years

Rebecca Taylor for Sky News reports: Leak of Jeremy Corbyn’s NHS papers raises ‘spectre of foreign influence’  – Researchers from a think tank say the papers emerged in a similar way to a former disinformation campaign from Russia.

The leak of documents which Labour claim show the NHS is on the table in trade talks with the US resembles a former Russian disinformation campaign, experts have said……

2019 – James Buchan’s report for “health.org.uk” Falling short: the NHS workforce challenge – …

2017 – The nursing workforce – Parliament (publications)

Richard Stephens in the Times 29th November 2019: NHS uses healthcare assistants and nursing associates to fill big staffing gaps

The Conservatives’ pledge to provide 50,000 more nurses was thrown into doubt as a report showed that the health service was relying on less qualified staff to plug huge gaps.

There are almost 44,000 nursing vacancies across the NHS, 12 per cent of the nursing workforce, but this could hit 100,000 vacancies in a decade, the Health Foundation charity said.

Support staff, such as healthcare assistants and nursing associates, have been used to shore up staffing numbers, according to the charity.

Its report also found that the number of full-time equivalent GPs fell by 1.6 per cent, from 27,834 in March last year to 27,381 in March this year. It showed that the biggest increase in NHS staff was among managers (6.2 per cent) and senior managers (5.7 per cent).

The report stated that a government target to recruit 5,000 more GPs by next year would be impossible to meet. Temporary staff and GPs in training were making up a greater proportion of the GP workforce than ever before, while non-GP clinical staff were playing an “increasing role in the delivery of care”.

The Tories say that the 50,000 nursing jobs will be achieved by training more staff, international recruitment and better retention.

Anita Charlesworth of the Health Foundation, said the shortages were “impacting on the front line”. “Services are being forced to make do with shortfalls of increasingly pressured nurses and rely on less-skilled support staff to pick up the slack,” she said.

A separate study suggested that the number of people searching for nursing jobs had slumped in the past two years. The online job site Indeed found that potential applicants fell by more than 17 per cent in the two years to October…..

Rhys Blakely reported 28th November in the Times: NHS spends least on patient health

The NHS is lagging behind the healthcare systems of other developed countries in spending, staff numbers and avoidable deaths, a study has found.

A comparison with the healthcare systems of nine other wealthy countries suggested that austerity policies and lower numbers of staff from the EU because of Brexit had taken a toll.

It showed, however, that patients were about as satisfied with their healthcare as citizens in other countries, with waiting times that compared favourably.

The study in the BMJ looked at healthcare in Britain, Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland and the US. It said: “The NHS showed pockets of good performance but spending, patient safety and population health were below average to average at best.”

Britain spent the least on health, £3,000 per person, compared with an average of £4,400, and had the highest number of deaths that might have been prevented with prompt treatment.

It had the lowest number of nurses per capita and was the only country where the figure fell between 2010 and 2017, the most recent year in the study.

“Relative to other countries, the NHS has lower amounts of labour, which have been decreasing at a faster rate, particularly after 2015, when large decreases in the annual inflow of EU-trained healthcare professionals have been seen,” the report said.

Survival rates for breast and colon cancer were the lowest and second lowest for rectal and cervical cancer. The chances of dying a month after having a stroke or heart attack in the UK were well above the average. Average life expectancy, however, was only just below the average of 81.7 years, at 81.3 years.

The UK had the lowest percentage of doctors dissatisfied with the time they could spend with patients and the lowest percentage of doctors along with Canada and Netherlands who were dissatisfied with their income.

In Britain, 65 per cent of patients reported seeing the doctor or nurse the next day when they last needed care, in line with the average of 67 per cent.

Forty-four per cent of UK adults thought the healthcare system worked well, compared with an average of 45 per cent. The UK figure had declined by 19 percentage points since 2010.

It said that the UK appeared to have higher rates of informal care “with high proportions of the workforce out of work or in part-time employment because they are providing care”.

A separate report from the Health Foundation charity said that the NHS was relying on less qualified staff to plug gaps because of a nursing shortage.

There are almost 44,000 nursing vacancies across the NHS, equivalent to about 12 per cent of the nursing workforce. This could more than double in a decade, the report warned.

update 4th December:

Chris Smyth in the Times 3rd December 2019: Immigration crackdown spells disaster for NHS, says report

Northern Ireland health collapses. It would be kinder to bring in co-payments than to let more suffer.

It looks as if the implosion of the different dispensations will begin in N Ireland where, without leadership and government for some years, the health budget and the recruitment are both broken. It would be kinder to bring in co-payments immediately… than to let more and more people suffer.

NHSreality appreciates that the 4 health services in the UK are all dependent on overseas staffing. We will need these people for a lot longer yet…

Claire McNeilly in the Belfast Telegraph 21st November 2019 reports: Nurses believe Northern Ireland health service is near to collapse, says frontline professional

Northern Ireland nurses are chronically stressed, suffering sleepless nights and pushed to the brink of exhaustion – with some even ending up crying in hospital sluice rooms.

The shocking revelation comes as the Royal College of Nursing (RCN) prepares for strike action, amid a dispute around staffing and pay, for the first time in its 103-year history.

Such an unprecedented move “goes against the grain of every single carer in the profession”, an experienced frontline nurse and RCN Northern Ireland board member told the Belfast Telegraph.

But Helen McNeilly said her colleagues – who number around 8,000 – have been pushed into making the difficult and highly contentious decision to down tools on December 18, after a two-week ‘work to rule’ period leading up to that date.

“Nurses are telling us there isn’t enough staff to deal with the ever-increasing number of patients that need to be treated… and they feel the whole system is close to collapse,” said Helen.

“Nurses are working 13-hour shifts without breaks, they’re stressed and they’re having sleepless nights worrying about work.

“Not only are they lucky if they get a 20-minute break during a shift that lasts from 7.30am until 8.30pm, many are then staying late to complete documentation and quite often that’s unclaimed overtime.