Category Archives: Nurses

Are there any administrators in the declining UK health services? We need more professionals, and we get managers.

The recent headlines on health service management numbers reveals the impotence of the politicians. The fact is that these are administrators who sore paid as managers. They need contraception and/or sterilization, rather than reproduction. Perhaps they are “cloning” in preparation for the thousands of new doctors they are recruiting from thin air…… are there any administrators? The emperors (politicians) have no clothes.

Chris Smyth reported in the Times 1st march 2018: NHS manager numbers up, but GP and nurses down. And he had warned us before, on 17th February with Hiring of NHS managers soars by over a quarter In  only 5 years.

NHS manager numbers have risen by a quarter in five years and are higher than before the implementation of reforms designed to cut bureaucracy.

The increase in administrative staff far outstrips that for doctors and nurses over the same period, provoking anger from health unions.

More than 6,000 managers have been hired since April 2013 when controversial reforms by Andrew Lansley, then health secretary, came into effect, abolishing more than 150 NHS organisations and making thousands redundant.

The Times has previously revealed that pay-offs for managers have cost £2 billion, with at least £92 million given to staff who were quickly rehired. They included a married pair of NHS managers who were given new jobs at the same hospital months after a redundancy settlement of £1 million between them.

Jeremy Hunt, the health secretary, has defended the reforms on the ground that they had saved money by cutting bureaucracy. Yet analysis of NHS Digital figures by the Health Service Journal finds that manager numbers have grown almost without interruption since the reforms took effect.

The 26,051 full-time equivalent managers and senior managers in April 2013 grew to 32,133 in October last year. This exceeds the 31,041 recorded on the eve of the reforms in March 2013.

The latest figures include a 26 per cent increase in senior managers, who earn £77,653 on average, to 10,279. Ordinary managers earn an average of £47,459.

Nursing numbers have increased by 4.6 per cent since April 2013, to 287,147, but there is concern about the rising numbers of nurses that left the NHS last year. Doctors are up 11 per cent to 109,679.

Janet Davies, chief executive of the Royal College of Nurses, said: “The public don’t want to see the NHS haemorrhaging nurses but hiring more managers. The health service must be well run but the majority of patient care is given by nursing staff. Standards are being hit as their number dwindles.”

Yesterday it emerged that managers in a hospital in Grimsby were drafted on to wards to help to deal with a shortage of clinical staff. They wore scrubs and gloves to help with making beds, collecting medicine and serving meals after nurses called in sick. The Diana, Princess of Wales Hospital insisted that they were not involved in direct patient care.

Nigel Edwards, chief executive of the Nuffield Trust think tank, said that the Lansley reforms, and subsequent attempts to unpick the least popular elements, had left the NHS with an “alphabet soup of new structures”.

“It’s not surprising manager numbers have gone back up again but the question we want to ask is not are there more or less managers, but is what they are doing adding more value?”, he added.

John O’Connell, chief executive of the Taxpayers’ Alliance, said: “Not only are the NHS recruiting more senior managers, but they’ve also increased salaries at a faster rate than that of nurses. Taxpayers expect their money to be spent fairly.”

A Department of Health and Social Care spokeswoman said: “We have record numbers of dedicated frontline staff working on our wards while there are actually 3,600 fewer managers compared to 2010. We will continue to work with NHS Trusts to cut bureaucracy and red tape even further.”

And the recent article:

The NHS is losing nurses and GPs while senior managers are the fastest-growing group of staff, official figures show.

Demoralised frontline workers are quitting and there are not enough trained doctors and nurses to replace them, unions have warned.

Data from NHS Digital shows the equivalent of 283,853 full-time nurses in hospitals at the end of September last year, down 435 from 12 months earlier. There is mounting concern about higher numbers of nurses quitting the NHS because of rising workloads and stagnant pay.

GP numbers were down 742 to 33,062 despite a government pledge of a 5,000 boost to the workforce by 2020. Figures showed that public satisfaction with GP services hit a record low last year.

Managers were up 3 per cent to 21,673 while senior managers, paid an average of £77,653, were up 7 per cent to 10,282.

Janet Davies, head of the Royal College of Nursing, said: “It feels to front-line nursing staff that, in a cash-strapped NHS, they have become an easy target for cuts. It will be galling when they see senior management burgeoning too — now officially the fastest growing part of the NHS.”

Candace Imison, of the Nuffield Trust think tank, said: “The NHS actually spends relatively little on management compared to other countries, so I’m not too worried by the relatively small increase in the number of managers. What does worry me is the GP and nursing numbers. This isn’t a question of the NHS intentionally reducing numbers. We haven’t trained enough in recent years and there is no strategy in place which will guarantee that changes.”

Many NHS bosses are more concerned about the difficulty of recruiting trained staff than about money. Official estimates say the NHS could need another 190,000 frontline staff over the next decade.

A Department of Health spokeswoman said: “NHS staff are our greatest asset and whilst there are now record numbers working in the NHS, investing in our workforce will continue to be a top priority. That’s why we recently announced the biggest ever increase in training places for both doctors and nurses, as well as helping existing staff to improve work/life balance and work more flexibly.”

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Who is going to be the last nurse standing?

The mental cost of health and social care, especially for the elderly, is getting so heavy that Nurses are leaving. The monetary cost is so great that we may have to find completely novel solutions. Meanwhile, who is going to be the “Last Nurse Standing”?  Don’t worry. patient and nurse will be smiling…

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Nick Triggle for BBC News reports an unfortunate truth 17th Jan 2018: NHS ‘haemorrhaging’ nurses as 33,000 leave each year

he NHS is “haemorrhaging” nurses with one in 10 now leaving the NHS in England each year, figures show.

More than 33,000 walked away last year, piling pressure on understaffed hospitals and community services.

The figures – provided to the BBC by NHS Digital – represent a rise of 20% since 2012-13, and mean there are now more leavers than joiners.

Nurse leaders said it was a “dangerous and downward spiral”, but NHS bosses said the problem was being tackled…..

The Nursing Times 8th March 2017: ‘Critical’ reasons behind nurses leaving profession laid bare | News …

2nd November 2017: Nurses and midwives leaving the NHS at an ‘alarming’ rate – The i …

The Guardian 2nd July 2017: More nurses and midwives leaving UK profession than joining, figures …

The cost of care is so great that we may end up exporting our elderly….

 

A dire shortage of specialist cancer nurses in Oxford reflects a staffing crisis across the NHS that can only be rectified with better long-term planning

NHSreality warned you it was going to get worse, and sure enough it is. It may be that the current crisis is forcing the oncologists to make decisions that they have ducked to now. Patients can often be led into making the right decision, and rarely is it to have toxic therapies that prolong their lives for only a few weeks. The letter from Dr Burt needs to be read and re-read. People are the most valuable resource in the UKs four health services, and we have just not trained enough.

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The Times leader 10th Jan 2018: Care Critical – A dire shortage of specialist cancer nurses in Oxford reflects a staffing crisis across the NHS that can only be rectified with better long-term planning

If anywhere in Britain can offer first-rate cancer treatment, Oxford should be on the list. It has some of the world’s best teaching hospitals, a good record of health service management overall, and every inducement for doctors and nurses considering where to live and work. Yet these inducements seem to be failing. Largely for want of specialist nurses, cancer care in Oxford faces severe rationing that could shorten the life expectancy of terminally ill patients and hurt the chances of recovery for the newly diagnosed.

Emails seen by The Times, written by a senior Oxford oncologist, describe a 40 per cent nursing shortfall that he considers “unsustainable in the short, medium and long term”. They set out a plan to delay the start of chemotherapy for new patients and stretch out fewer cycles over longer periods for those already undergoing treatment.

It is not the drugs that are in short supply, but the staff to administer them. If this were an isolated case the blame could be laid squarely at the door of local NHS managers. In reality the problem is more complex and widespread. Because of falling morale, falling real wages, the scrapping of nurse training bursaries and the impact of Brexit, a general nursing shortage is threatening the quality of care across the NHS. Andrew Weaver, the Oxford oncologist, has issued an appeal for constructive suggestions to fix his staffing crisis. On the national level similar appeals have produced a ten-year NHS “workforce strategy” and an undertaking to train 10,000 more nurses a year, starting in September. This is the right approach, with one glaring shortcoming. It should have been adopted a decade ago.

It takes three years to train a nurse and at least two more for him or her to specialise in cancer care. The work involves delivering lifesaving but also potentially lethal drugs and cannot safely be delegated to non-specialists. Faced with staff shortages, NHS trusts have historically muddled through or sought emergency funding to hire from agencies, overseas or both.

Muddling through is not an option for patients in urgent need of chemotherapy. Emergency funding is in short supply, and hiring from agencies is rightly frowned upon as an inefficient use of public money. Hiring from overseas has been complicated by Brexit.

In the year after the EU referendum the number of nurses from the European Economic Area (EEA) registering to work in Britain fell by 32 per cent. Some of the decrease was accounted for by nurses failing new and necessary language tests, but the fall was still significant. It has been compounded by a sharp increase in the number of EEA nurses opting to leave in the same period.

In absolute terms an exodus of British nurses from the profession is even more troubling. In 2015, for the first time, more left the national register of the Nursing and Midwifery Council than joined it. Last year the net loss was nearly 5,000. The Royal College of Nursing has spoken of a “perfect storm” of factors leading to a record 40,000 nursing vacancies nationwide. Prominent among these is a vicious circle of increasing workloads deterring new recruits.

Macmillan Cancer Support recently listed the consequences of a “historic lack of long-term planning”. One is that a majority of doctors and nurses are no longer confident that the NHS gives cancer patients even adequate care. Where this care is prompt, personalised and comprehensive it can still be second to none. Where it is not, outcomes and survival rates lag behind those of other advanced countries. Having fought to stay on at the Department of Health, Jeremy Hunt will want to do better. A good first step would be a more ambitious expansion of nurse training and a reinstatement of bursaries for specialist training where it is most needed. Starting with cancer.

Top hospital cuts cancer care due to lack of staff

Patients dying in corridors and on makeshift wards, A&E chiefs warn – Chris Smyth 12th Jan

A seminal letter on this subject 9th Jan 2018:

Sir, Oncologists need to take a long hard look at what they are trying to achieve. Response rates in second and third-line chemotherapy are very poor and inevitably interfere with quality of life. There is an obsession with including patients in clinical trials, which are costly and are often used for career progression rather than cancer progression. The hardest thing for an oncologist to learn is not how to treat patients but when to treat them. Many need to learn that no treatment is often the best treatment. It takes guts to tell a cancer patient that no further active anti-cancer treatment is now right for them. The best oncologists do that.

Oncology can surely not moan about staff shortages when literally dozens of consultants and senior nurses sit down for hours on end to discuss routine cancer cases, the management usually being obvious. Multidisciplinary team-working (or medicine by committee) is the biggest waste of NHS resources bar none.
Dr Paul Burt

Retired clinical oncologist, Stockport

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There are many more doctors in the rest of Europe, compared to Wales

NHSreality has long pointed out the deficit in provision of medical school places, the gender bias which means there is less continuity of care, and that graduate entry to medical school would help to correct this. There are still many applicants who are disappointed, mainly undergraduate men, and all should now be given the chance to qualify as a doctor. Doctors do prefer to live in areas with good schooling, and this also needs addressing…. especially in Wales.

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David Williamson in Walesonline December 11th reports: The shocking figures which show how many more doctors the rest of Europe has compared to Wales  There are almost twice as many doctors per person in Austria than Wales.

Shocking figures have revealed how poorly staffed the Welsh NHS has become compared to the rest of Europe.

Wales has fewer GPs than other European countries – including impoverished former Soviet states in Eastern Europe.

There are just 2.8 doctors per 1,000 people in the UK, compared with 3.9 in Spain, 4.3 in Norway and 5.1 in Austria, according to the OECD.

The OECD research shows that the former Communist states of Estonia and Latvia have better provision of doctors per 1,000 people, at 3.4 and 3.2, respectively.

Plaid Cymru says the figure in Wales is just 2.75 per 1,000 people.

Doctors per 1,000 people

OECD

Dr David Bailey, who chairs the BMA’s Welsh Council said more GPs were needed.

He said more training places for young doctors were vital.

He: “Those who train in Wales are more likely to stay here in the longer term.

“We have repeatedly called for an increase in the number of doctors trained in Wales as part of the solution to tackling recruitment challenges.

“The bottom line is that we need more doctors in order to offer patients a safe standard of care.”

In Wales they really can waste money: £68m unveiled for health and care hubs

BBC News reports 6th December: £68m unveiled for health and care hubs

The profession will not see this as positive. It marks the beginning of the end for self employed GPS. It is probably a waste of money, and it is part of the direction of travel, where fewer and fewer people have access to the expertise needed when they are ill. Differential diagnosis, risk analysis and safety netting are all part of a Drs training, and in the case of GPs, living with uncertainty so that good gatekeeping ensures minimal waste. These GP “Geese” who laid those golden eggs are not here now….

But it may be attractive to part time GPS with families often married to other doctors.

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ITV News 6th December covers the initial reaction of the profession: Plans for 19 new health and care centres…..

…Dr Charlotte Jones, chair of the BMA’s General Practitioners Committee says she’s concerned about the lack of involvement of local clinicians:

Whilst we welcome improving access to services closer to people’s homes, it’s difficult to assess the impact this will have without knowing the intricacies of how it will work. It’s concerning to us that the initial reaction from LMC members suggests that they haven’t been involved in the design of the scheme.

It’s vital that local clinicians, who understand the needs of the local community, are involved in service design to ensure that patients receive the services they deserve.

As part of the work to improve access to local services, investment is desperately needed to ensure the GP estate is fit for purpose. Robust premises strategies must be developed, with the full involvement of LMCs. – Dr Charlotte Jones, Chair GPC Wales

Dr Ian Lewis reports 26th November in Walesonline another money spend, mostly from charitable fund raising, which will cut out the GP. By deskilling the GP how does society gain? This is the opposite of utilitarianism. (Greatest good for the smallest number) and brings back the suggestion of the Court Report in the 1970s#; A child health centre in West Wales could be created 20 years after it was proposed – The venture has been in the pipeline for almost 20 years and is estimated to be worth £2.5million

Just as there wont be enough Doctors, there won’t be enough care homes. There are many opinions, but NHSreality fears that Wales is pouring money into a number of buckets which have holes in them. There are just not enough trained people: GPs, Nurses, Physiotherapists, Psychologists, OTs, Psychotherapists, Radiologists, Anaesthetists, you name them…

Mark Smith reports in Walesonline 4th December: The Welsh care homes under threat for not meeting standards – Care homes in Wales are under threat of being suspended or de-registered

BBC News 21st September: NHS reform can cut costs, says local council leader

BBC News 4th December: Cash ‘ploughed into NHS’ preventing change, AMs warn

BBC News 5th December: Welsh Government ‘sticking plaster’ on health services

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A budget should make us all think. We are all lost, and in denial with health care, which depends on jobs, productivity and the economy, all of which are threatened.

Going back to the original roots of the Health Service: NHS ‘birthplace’ Tredegar’s GP services ‘unsustainable’ – why? how?

As your local Health Service safety net corrodes, you might be interested to see the headlines and links in the medical and general media following the budget. Mr Hunt would never want the health service to fall apart…. wouldn’t he? Desperate measures such as “on line” consultations are of no practical use.                 Nick Triggle for the BBC reports: NHS Budget plan not enough, say bosses

Many employees “need to leave” to keep their sanity. Threats to disallow medics and nurses from travelling seem to have been withdrawn. Doctors demanding clarity….Nick Bostock for GPonline)  and then in August in the Mail the government backed down. The Mail also reports on “physician assistants” being poached from North America! Dennis Campbell in the Guardian “Junior doctor Nadia Masood: ‘Hunt’s driven a lot of us out of the NHS’ – Medics felt justified in opposing a new contract and their defeat has left many feeling demoralised, Masood says. Health service is ‘haemorrhaging highly trained, experienced GPs at an alarming rate,’ says top GP. BBC reports on “Thousands of out-of-hours doctor shifts unfilled”, and then on the locum situation Andy Philip in the daily record 13th November reports: GP crisis forces Health Board to pay a whacking £2000 for one (8 hr?) shift.

The Motherwell Times spares no one: GP recruitment has failed and since 1/5th or 20% are from overseas, and many are returning or retiring….. These tend to be working in the less popular areas, and some cities are now appreciating the crisis: David Ottwell for the Manchester Chronicle 18th November – NHS at ‘breaking point’ as GP numbers fall and patients soar in North East

The British Medical Association warns a chronic shortage of doctors is putting patient care at risk

The Belfast Telegraph tells us overseas doctors are crucial….

Whilst management attempt to apply artificial waiting times as “routine”. Henry Bodkin for The Telegraph 13th November offers : “Phantom waiting time branded unethical”. The Sun calls it “Op woe”.

In April atie Foster for the Independent warned us: Almost half of GPs plan to quit NHS due to ‘perilously’ low morale, survey suggests and then in November: Jeremy Hunt’s GP recruitment pledge in tatters as 1000 full-time …

If you cannot register or see a GP then you may not have a local A&E to go and see a medical student or a junior inexperienced Dr for your primary care needs either:  Dennis Campbell in the Guardian: A&E units, GP surgeries and walk-in centres to close as cash crisis bites

NHS bodies have decided in the last four months alone to shut or downgrade 70 services, says campaign group 38 Degrees

The Mirror: Budget pledges extra £1.6 billion for NHS next year but it’s less than half what health service chief asked for – The announcement also included a commitment to fund a pay rise for NHS nurses, midwives and paramedics – but only if negotiations on wider pay reform are successfully concluded.

Promises have been broken and the profession have no faith in discredited politicians. We always knew 5000 instant Drs and GPs was impossible. There are many doctors being trained, of whom 80% undergraduates are women, but the graduate courses are usually 50:50. men to women. Many will take career breaks, or work part time, or go abroad for relevant experience. They may decide to stay!  Chris Smyth in the Times 22nd November: Fewer GPs despite pledge to hire 5,000

GP numbers have fallen again, throwing a key NHS pledge of thousands more doctors into question.

The NHS has 541 fewer family doctors than a year ago. Doctors said they were “gravely concerned” by the figures at a time when patients were waiting ever longer to see a GP.

NHS Digital figures show that there were 41,324 GPs working for the health service in England at the end of September, 240 fewer than in June and 541 fewer than September 2016.

Full-time numbers are down even more as doctors cut back their hours, citing intolerable workloads. The NHS has the equivalent of 33,302 full-time GPs, 1,193 down on a year before.

Jeremy Hunt, the health secretary, has promised to recruit 5,000 more GPs by 2020. However, Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “We need to start seeing some progress, and fast. We understand that change takes time, but we desperately need more family doctors.”

A Department of Health spokeswoman said: “There are more than 3,000 GPs in training and 500 new medical school places will be available in 2018, with a further 1,000 in 2019. We’ve also outlined more flexible working options so we can retain the expertise of more experienced GPs.”

We have rationed medical school places for too long. The country does not deserve to be treated like this. We need honesty and admit that we cannot have “Everything for everyone for ever“.

Another call for a cross party fudge? We continue to break up the large mutual safety net which used to ensure choice, equity, and benefitted all.

BBC News reports on another slicing up of the English Health service. Already Manchester may be reported differently, and now London, when the WHO (World Health Organisation) compares different countries and systems and methods of delivery. The ultimate break up in health is to reduce it to each individuals own resources and their own budget. The absurdity of the current trend may be driven by politicians wishing to avoid blame for failure. So, lets break up the “mutual” a little more….. and lose the advantages of choice and size. Wales had shown what a disadvantage it is to be really small. Yet no lessons are being learnt. Even palliative care is private and charity funded, and in Wales this means “cut”. We used to have a National Health Service, but no longer. No party has shown the courage to rebuild and reinstate it, hence the call for a cross-party group? Small is not beautiful in high tech health care… In addition, no amount of money or manipulation can negate the need for rationing (cutting) overtly, as for vasectomy.

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BBC News 16th November 2017 reports: Sadiq Khan: ‘New deal will help London be world’s healthiest city’

Sadiq Khan says a new deal to improve healthcare in the capital will help London become “the world’s healthiest city”.

London’s health and care services will be devolved to the Mayor of London and London’s councils.

The NHS is being encouraged to sell buildings and surplus land in London which could be used to develop more housing.

Money would be reinvested to build new hospitals and GP surgeries.

The Mayor of London said it would encourage the healthcare organisations to work better together – around issues including payments and workforce.

Mr Khan said: “[The deal is] a really important step in the right direction in our journey to becoming the world’s healthiest city.

“It is vital London has the powers to plan and coordinate health services.”

‘Poor condition’

According to City Hall, the NHS is one of the largest owners of land in London – with an estimated value of more than £11bn……

Terrifyingly, according to the World Health Organisation definition the UK no longer has a NHS

Amazing how England has been able to kid themselves there is an NHS – until now. Manchester’s health devolution: taking the national out of the NHS?

Devolution of health to Wales was a mistake?

Dennis Campbell in the Guardian 16th November: A&E units, GP surgeries and walk-in centres to close as cash crisis bites NHS bodies have decided in the last four months alone to shut or downgrade 70 services, says campaign group 38 Degrees

BBC Bristol news reported 9th November: Nine NHS groups consider vasectomy funding cuts

BBC Wales reports 10th November: Jobs threat at Marie Curie cancer charity centre, Pontypool NHSreality believes that care in the community, hospice at home, etc is the only sensible way to proceed in poorer areas of the country whilst death and dying are not covered.

Cradle to grave? Why the cost of dying is rising.

Hugh Pym for BBC News 18th November 2018: Social care: MPs seek cross-party group to ‘sustain’ NHS