Category Archives: Nurses

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….

 

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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

 

 

The Health Services in “Reality”: even the chief says it’s broken

How on earth did we get here, to this point in denial and lack of long term thinking. Now, if we employ GPs directly from overseas, we will be negating years of training and Improving standards. Teaching Hospitals and Deaneries will be irate. In the longer term the places filled from overseas will be blocked to UK trained doctors. History repeating itself from the pressure in the 1950s? The Health Services are in “Reality”: even the chief says it’s broken. More money will not make more qualified doctors and nurses. The options outlined do not include rationing health care overtly. A knee jerk response tells me it may happen suddenly and unfairly, and without a national debate on the best way to achieve fairness within rationing.

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Chaand Nagpaul, in the BMA Blog in the BMJ opines: A crisis acknowledged and a political choice

Last week, in a speech at the NHS Providers conference, Simon Stevens – chief executive of NHS England – broke ranks from his political masters and laid bare the full extent of the crisis in the health service.

Far from the ‘we’re spending more than ever in the NHS’ rhetoric, or the illusory mantra of politicians promising world-class convenience on second-class funding, Mr Stevens was unequivocal that the NHS was broken, declaring that the current budget ‘…is well short of what is currently needed to look after our patients and their families at their time of greatest need.’

He was openly critical of the impact of austerity on the NHS, describing it as ‘the exceptional choking back of funding growth of the past seven years.’

He mirrored the BMA’s own analysis of the NHS being woefully underfunded compared to European counterparts, arguing: ‘If instead you think modern Britain should look more like Germany, France or Sweden then we are underfunding our health services by £20bn to £30bn a year.’

Indeed I felt a sense of ‘at last’ in hearing language that could have been lifted from the BMA’s own NHS at breaking point campaign.

And as Mr Stevens made patently clear, we are not arguing simply about a number here but about the impact on the health of millions of lives, including explicit government priorities, saying that ’on the current funding outlook it is going to be increasingly hard to expand mental health services or improve cancer care’.

He went further to state it was a ‘duty of candour’ – relating to speaking up when patients were at risk – to ‘explain the consequences’ of this starvation of funds to the NHS.

He also spoke of the impact of inadequate resources on workforce: ‘On the current budget, far from growing the number of nurses and other frontline staff, in many parts of the country next year hospitals, community health services and GPs are more likely to be retrenching and retreating.’

And instead of the usual DH pronouncement of a wishful 5,000 more GPs he was candid: ‘GP numbers over the last seven years have actually fallen but their workload has risen’ – exactly what the BMA GPs committee have been warning of repeatedly.

Mr Stevens also argued for the ‘clinical and the financial logic for integrated care rather than fragmented competition’ – in doing so he reflected 25 years of BMA lobbying opposing the market-driven purchaser provider split.

I hope that he will now go one step further and unequivocally call for an end to competition law enshrined in the Health and Social Care Act – only that will put an end to fragmented care and the billions wasted in the transaction costs of competition.

It is these procurement rules that allow private companies to provide cherry-picked services in the NHS, and also mean that the future proposed accountable care organisations could be sold off to multinationals.

Mr Stevens speech crucially reinforced what the BMA has always argued – that with the UK being a leading health economy globally, the level of funding of the NHS is a political choice by Government. He said: ‘No-one disputes that these are choices that a chancellor could make.’

More specifically he claimed that next year’s funding gap is likely to be £4 billion, citing the analysis of three leading think tanks (the King’s Fund, NHS Providers and Health Foundation).

He asserted this should not be a challenge for the politicians, since it would only bring the NHS back to historic norms. ‘[The independent analysts] show there’s nothing out of the ordinary about needing such a sum. In their words, it would just be a return to the average increases of the first 63 years of the NHS’ history.’

Mr Stevens also rightly reminded government of the promise to the nation of an extra £350m per week paid into the NHS to leave the EU – at a time when indications show the antithesis that Brexit is likely to act as a further drain on NHS resources.

He called on the Government to meet this funding pledge on the fundamental matter of not undermining public trust: ‘You voted Brexit, partly for a better funded health service. But precisely because of Brexit, you now can’t have one.’

It is probably no accident that Mr Stevens’ comments came ahead of next week’s budget; so it’s over to the chancellor, health secretary Jeremy Hunt and the prime minister. The case for investment is overwhelming, as is the daily experience of an NHS that is failing patients, doctors and other NHS staff.

The Government has a choice, of whether to acknowledge the evidence it faces and whether to heed the clear message from the boss it appointed to run the NHS. And a choice between punishing patients or belatedly properly funding the health service this country needs, deserves and which the government itself has promised.

Chaand Nagpaul is BMA council chair

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