Category Archives: Nurses

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

The reality that Health and Social Care are not either of them free, has not sunk in to the politicians yet. We cannot have “Everything for everyone for ever” and for free, and in their denial, both houses thus conspire to avoid the important debate that Mr Stevens called for on 4th June 2014, almost exactly 5 years ago. If Social Care is means tested, why not Health Care? 

The unedifying spectacle of two potential leaders trying to bribe 160,000 older and richer people who happen to be their members, is the reality of todays politics. No wonder so many people dont vote. We need an honest party to speak “hard truths” to the nation. NHSreality believes the first party to do this, and be understood as honest and working for the overall good of us all, fairly, will eventually win a landslide. It will also win the hearts and minds of the medical professionals….. and they are trusted, and speak to many people daily.

Our political (moron) representatives need to permit commissioners and trust boards to ration overtly, so that their citizens know what is not available. Initially this will have to be by post code, but national guidelines from NICE would help. Eventually, for those services and treatments that none of us can afford, cancer and big operations for example, there can be a National Health Service again, and for cheap and cheerful, high volume low cost services, we can have local post code rationing if we still want it…

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BBC News reports 4th July: Social care: Hunt and Johnson urged to consider NHS-style free service

Public Service Executive reports: Peers call for NHS-style free social care system and an extra £8bn to tackle funding crisis

and the Guardian today also reports the Peers asking for an extra £80m for “vulnerable elderly people”. 

The reality is that for most of us the state safety net is absent. If social care is means tested, then why not health care?

New and higher taxes will never solve the problems of health and social care…

There is a toxic culture, and disengagement everywhere in Health and Social Care. Also in the CQC …

What principles should underpin the funding system for social care? Surely an ID card with tax status and means is now essential….

The reality of the post-code lottery and rationing of health and social care. It will just have to get worse before the “honest debate”…

A Happy Brexmas to everyone as our leaders duck health and social care funding crisis.. The media failure, and political denial can only get worse..

Nov 2016 NHSreality: NHS funding and rationing: The debate (and the denial) intensifies… It’s going to get worse..

Reality is a word rarely used in Health debate and discussion. The Economist comments on post election realities..

A dishonest and covert dialogue is all that is happening at present.. Simon Stevens says he would like to change this. (U tube 4th June 2014)

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Rethinking primary care user fees: is charging a fee for appointments a solution to underfunding? If we don’t keep the gatekeeper role for GPs the system will get constipated.

A recent report in the Times (Not on line) opines “Gatekeeping by GPs called into question. This is not new, as you can see from the debate following Matthew Paris’ article in 2015. The problem is not referrals, but the 90% who do not need a referral. Allowing others, less trained in dealing with uncertainty, will lead to more referrals, longer waits and a constipated system. The useless 111 service where there has seen no reduction in GP workload is another attempt to wriggle off the hook of under capacity and poor manpower planning. In his Imperial College funded report, Geva Greenfield and others report: “Rethinking primary care user fees: is charging a fee for appointments a solution to underfunding?”.

One solution is to make patients pay for their GPs and let them have appointments free with the nurses and paramedics. A two tier system by design. Lets see the comparisons in referral rates, expense and survival!! The result would be anarchy.. (sic) Geva Greenfield says “There is a trade-off that needs to be found between GPs serving as hgatekeepers to secondary care, and at the same time allowing patients to see a consultant when they wish”. We are trying to treat patients, and the governement are treating populations. Money matters, and the services are all rationed. (covertly)

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This is the sort of thinking “outside the box” of current opinion that we have to get to talking about openly.

On November 26th 2018 Chris Smyth reported in the Times: Bypassing GPs could help to diagnose cancer sooner

In Pulse 2015: GPs should give up their Gatekeeping Roles

Matthew Paris on June 16th 2012 reported in the Times: GPs – little more than glorified receptionists

In this age of medical specialisation, if family doctors didn’t exist we wouldn’t feel the need to invent them

Next Thursday, family doctors plan to strike. Striking doesn’t suit the profession’s humanitarian image. Interviewed, doctors’ leaders struggle to insist (on the one hand) that nobody needing medical attention will be denied it, without implying (on the other) that few will suffer if doctors aren’t there.

How much, though, would we suffer? If family doctors had not existed, would we today have found it necessary to invent them?

We pay general practitioners more than we pay airline pilots, but they are becoming glorified gatekeepers: a portal to the more specialist medical care that our health service offers in growing measure. As GPs have receptionists, so the NHS itself uses GPs as its receptionists. Are we investing too much in the citizen’s first port of call, to the detriment of investment in the specialist attention to which, to an increasing degree, surgeries are likely to end up referring the patient?……..

……..Nurse-led primary care, too, is plainly on its way and expanding fast, with (the research is clear) excellent results. Walk-in and appointment clinics are becoming more common, especially evening clinics. Sexually transmitted disease, family planning, coughs and colds, eye, ear nose and throat … in all these fields specialist practices staffed by nurses and pooled doctors, rather than personal GPs, are where we’re going.

The only question is how fast. Let’s hope next Thursday’s strike prompts us to speed this thinking up. Decades ago, at the bookshop Foyles, you had to get a little chitty from a person in a booth before you could get your purchase. One day we’ll remember the GP surgery in the same way, with the same amusement that the archaic practice lingered so long.

The response June 18th 2012:

Sir, Matthew Parris (Opinion, June 16) is not quite correct in describing GPs as “becoming glorified gatekeepers”. We have already had that role (among others) for decades.

It is true that part of this role is to refer to secondary care, but he seems to miss the corollary of this; that we also judge when not to refer, thus saving patients, and the country, the burden of over-investigation and over-treating. The internet has expanded everyone’s access to specialist knowledge, but has not, perhaps, increased our ability to apply that knowledge appropriately. We know more, but understand less.

Mr Parris also fails to acknowledge that GPs have a vital role in the other direction of travel; from specialist care to the community. In this past week I have picked up the care of patients after their discharge from heart by-pass surgery, psychiatric in-patient treatment, dermatology, gynaecology, child autism and palliative care clinics.

In addition, we need to manage patients whose symptoms and conditions cover several specialties, as well as those who have exhausted all secondary care investigation without any diagnosis being reached.

“A decent grasp of the whole thing” is exactly what GPs need.

Dr Jonathan Knight
GP, Ipswich

Sir, Matthew Parris assumes that his interaction with his GP is typical of the work that GPs do. I have been working in general practice since 1987 and my experience is very different. We spend most of our time managing long-term illness such as high blood pressure, diabetes, kidney disease and asthma. When I was in training in the 1980s these conditions were managed in hospital but are now managed mainly in primary care. Of course I do not profess to be an expert in everything so I may refer to colleagues for opinions about aspects of a patient’s care, but they are then usually discharged to my care.

Allowing less-qualified health professionals to manage patients has never been shown to be more cost effective than using GPs.

It is this system of every patient having a GP, enshrined in Bevan’s original vision for the NHS, that other health systems around the world have strived to emulate. We should not discard it lightly.

Steve Charkin
London NW3

Sir, Matthew Parris says that he believes he could refer himself appropriately to a specialist, but he is not our typical patient. GPs’ time is predominantly taken up with the very young and the elderly, particularly those with chronic, complex and multifaceted medical conditions. For these folk, it is their GP who sees the “big picture”, the context and impact on the individual and their family, while each specialist focuses in on his own area of expertise. Approximately 90 per cent of healthcare needs are met in the community, by GPs and their practice nurses, with only 10 per cent of care being hospital-based, at far greater expense. It is true that a GP’s role includes “gate keeping” access to expensive specialist opinion, but I would suggest this is essential.

As Mr Parris concedes, most GP consultations do not lead to a referral to a specialist. His vision of a future without GPs to manage the majority of our health concerns would be financially unsustainable and bewildering to many. Would a woman with lower abdominal pain and back ache refer herself to a gynaecologist, urologist, gastroenterologist, oncologist or orthopaedic surgeon? Does she need a specialist at all if it is just a urine infection? How does she know?

While a single day of industrial action will cause no more inconvenience than the extra bank holiday for the Diamond Jubilee, Mr Parris belittles our role at his peril.

Dr Isabel Cook
Reading

Sir, Before getting rid of GPs Matthew Parris might be wise to wait until he is a bit older when he may have to see more than one specialist at the same time. He will find that the treatment for one condition often aggravates another and he will then be grateful for a generalist’s opinion. He will also find it more efficient to keep seeing the same GP so that he does not have to keep repeating his past history.

Dr Richard Stott
Epsom, Surrey

Sir, As a GP I know Matthew Parris is right. A lot of what GPs do is pointless or could be done by others. So there is a simple solution: stop giving us work.

John Booth
Middlesbrough

Sir, There is overwhelming evidence that GPs deliver highly effective, cost-effective care to our patients. Moreover, we do so with the trust of our patients, and with care and kindness.

I invite Mr Parris to sit through a surgery with me at any time, where he will see first hand how GPs care for the elderly, the frail, the disadvantaged and the ill. I’m sure that afterwards his perceptions of general practice will be different.

Professor Clare Gerada
Chair of Council, Royal College of General Practitio

 

An administration with no direction, no virtue, and no future.

The ministry of health has reversed it’s intention on nurses, and selling it’s outsourcing. Both recruitment and procurement are long term problems that are impossible to solve in a shirt time horizon. However, procurement could be so much more quickly solved. Its just that its politically impossible to outsource… Part of the reason for this is the thoughtless devolution 20 or so years ago. A health mutual is stronger when it is larger, and 4 dispensations rather than one makes for inefficiencies, particularly in procurement.

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The Observer reports Sunday 2nd June: on Plan to hire thousands of foreign nurses for NHS is axed

Target was politically difficult for a government committed to reducing net migration

The Guardian initially reported 2nd June: US wants access to NHS in post-Brexit deal, says Trump ally

Before president’s visit, Woody Johnson says every area of UK economy up for discussion

and then Francis Elliott the Times the following day (June 3rd) reports Jeremy Hunt apparently reversing his successor’s intention : NHS will never be part of US trade deal, says Jeremy Hunt

Jeremy Hunt has warned Donald Trump that the NHS will remain off-limits to American companies, whoever wins the Tory leadership race to become Britain’s next prime minister.

The foreign secretary became the second candidate to rule out allowing US firms access to NHS contracts in a post-Brexit trade deal after Woody Johnson, the US ambassador to the UK, said on Sunday that the “entire economy” would have to be “on the table” in any deal.

Pressed whether that included the NHS he said: “I would think so.” Access to NHS contracts and farming standards are the two most controversial elements of any future deal. Speaking before he left Washington Mr Trump said: “[We’re] going to the UK. I think it’ll be very important. It certainly will be very interesting. There’s a lot going on in the UK. And I’m sure it’s going to work out very well for them.

“As you know, they want to do trade with the United States, and I think there’s an opportunity for a very big trade deal at some point in the near future. And we’ll see how that works out.”

Matt Hancock, the health secretary, became the first of the Tory leadership candidates to insist that the NHS was off-limits yesterday…..

Drug Procurement scandalously profligate and inadequate…

The Health Services Procurement – inefficient and risky… Centralisation and management control is needed

Procurement in the NHS – next stop the courts.

Kimberly Hackett in the Nursing Times 8th May 2019: NHS to step up nurse recruitment overseas, says leaked report

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To paraphrase Spike Milligan: “I told you the Health Services were all ill”.

NHSreality as well as Spike told you it was going to get worse. Is it not ironic that in a country where we have depended on nurses, carers and doctors from overseas (usually less developed countries than ourselves) that we are now threatening not to allow them in, and especially not from Europe and the EEC, which means we may well get staff from less culturally affiliated countries, OR we have to export our elderly, OR we have to look after them with robotics! Personal continuity of care has died in the 4 health services, but many of us, if we can afford it, will pay for it.

In the last few weeks the shortage of GPs and poor access to the health care system applicable in your Post Code has become more evident. Rich areas like Horsham cannot attract GPs, partly because the price of property is so high, and poorer areas of the country cannot attract GPs because of the poor housing and schooling problems. Gainsborough surgery closed suddenly… (Connor Creaghan 29th May 2019 in the Lincolnshire Post)

Don’t believe it when the government says they are learning from their mistakes. They still have no “honest language” and they have no exit interviews. These are their main mistakes….

The whole idea of a mutualised health service is to care for those with the bad luck to have a serious illness or a physical / mental handicap. The latter do not often vote, and numbers don’t influence an election so they have been left behind, to the benefit of voters. Our Minister of health seems more concerned with innovation and Big Pharma than she is in boosting numbers of staff!

In a world market (English speaking) Nurses and Doctors have skills and are people who can move. The best way to keep them is to look after them, and to train a surplus.

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Meanwhile clinical acumen and skills, and organisational issues are in decline. Public health has been underinvested and now people are starting to suffer.

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

Nursing crisis extends all the time… Surgery, ICU, intensive care and now oncology and cancer care…

29th May 2019 BBC News: ‘Lessons learned’ over £24m Altrincham health hub failings

Sarah Page in the West Sussex county times 22nd Jan 2019: Shortage of GPs in Mid Sussex

and Martin Bagot on the Mirror 31st May reports that there are over half a million people who have had to change their GP.and Desperation recruitment from abroad (Philippines, India, Ireland and Australia are targets, but Bangladesh and Pakistan may be the reality)

BBC News 21st May: ‘Broken’ care system for most vulnerable

on 21st May ITV reported that there were not enough nurses and doctors to meet demand  and the implication of their report is that there won’t be in the foreseeable future.

The Government is in denial and Nicola Blackwood in a speech to the ABPI opined: “We are going to have one of the most exciting health innovation systems in the world.” It certainly will be different for those who fall foul of it…

Thank Goodness one health Trust has agreed to actually pay nursing trainees! Cornwall’s Megan Ford on 14th May in The Nursing Times.

The Yorkshire Post: Scandal of the growing wait for a GP appointment. (YP 11th May 2019)

Meka Beresford and Ollie Cole in Human Rights News report 21st March 2019: NHS staff shortages could double without radical action.

Nick Triggle admits through the BBC news 21st March that there is “No chance of training enough staff”.

BBC News 29th May: Glan Clwyd Hospital told to improve orthopaedic care by coroner

BBC News 31st May 2019: Llwynhendy TB outbreak: Family ‘disgusted’ after death

And Matthew Parris in 2018 asked “How does anyone know how to navigate the maze of our second-rate NHS: ( You can download the whole article below)

The Maze of the NHS – Matthew Parris

Just cry at the bribery, and the Death of the Goose that used to lay the golden eggs that used to make the Health Service(s) so efficient, and the envy of the world.

Say goodbye to continuity of care.

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Nursing crisis extends all the time… Surgery, ICU, intensive care and now oncology and cancer care…

We have as a nation, rationed the training numbers of nurses for decades. Now that Brexit means more are leaving than joining the profession, and we are obviously reluctant to accept more overseas staff, the crisis is on us, and the dissonances of the politicians, who want both Brexit and more Health Service staff are apparent. Export our elderly for their cancer and other care?

Dennis Campbell in The Guardian 19th February 2019 reports: Record numbers of NHS staff quitting due to long hours  – Number of nurses leaving the service almost triples – at a time of more than 40,000 nursing vacancies

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Today 19th May 2019 Andrew Gregory in the Sunday Times reports: SOS call for 1,500 cancer nurses – A shortage of specialist hospital staff is having a ‘devastating’ effect, including cancellation of life-saving chemotherapy

Cancer patients face “life-threatening” delays to treatment because of a shortage of specialist nurses.

Some are told on the morning of hospital appointments not to attend because there are not enough staff. Others have chemotherapy cancelled repeatedly.

The NHS has begun a global recruitment drive for tens of thousands of nurses, but the shortages are having a devastating impact, Britain’s most senior nurse and cancer charities say.

NHS providers needed 1,411 specialist cancer nurses in the six months to September 2018, an analysis by the Royal College of Nursing shows. That figure was up 16% on the 1,213 vacancies for the same six-month period the year before.

The statistics, from NHS Digital, count advertised posts. NHS Digital says they are likely to understate the shortage because one advert can be used to fill many vacancies and not all hospitals advertise on the NHS Jobs website.

Nurses breaking – NHS spends millions on agency staff because nursing is an increasingly unrewarding job

The richer areas of the country, with good schools, are the areas most doctors want to work in. Now the bill for locums will be much higher in the unpopular areas than the popular (wealthy) ones. So a perverse outcome of the mismanagement of manpower, people, and politics, is that those areas which need the most have to spend more of their emergency budgets on locums. Jenni Russell needs to be reminded that there is no NHS, and that devolution has failed.

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Jenni Russell opines in the Times 9th May 2019: We’ve pushed our nurses to breaking point. NHS spends millions on agency staff because nursing is an increasingly unrewarding job

ike many others, I’ve had a recent and alarming encounter with the NHS’s critical shortage of nurses. A relation came out of hospital with a serious condition which required constant monitoring by the hospital team.

Inside, their care had been exemplary. Once outside, and with worrying symptoms, it was as if a steel door had been slammed. No amount of hammering on it made any difference. Every number given for nursing or follow-up advice rang out. Nobody responded to the voice messages we were told to leave. The switchboard said it wasn’t their responsibility to find an actual human being, and put us through to more machines.

It took 11 days of calling, and the intervention of the chief executive’s office, before anyone rang back to advise. In between, quite apart from the absence of a nurse to offer guidance, everything had indeed fallen into a hole, with none of the critical tests or appointments listed on the discharge letter scheduled. “We don’t have time to listen to the messages. Phones ring out on the wards all over this hospital,” one staff member told me, apologetically. Efficiency can’t be assumed in an overloaded system. England’s nursing crisis, with 42,000 unfilled posts, hospitals desperate for staff, and hundreds of millions being spent on expensive agency nurses instead, is neither unpredictable nor an accident. It is entirely the government’s fault.

Beyond Brexit, three key decisions over the past nine years have worsened the current and future shortfalls. The most recent, misguided and blithely foolish of these was the decision by Jeremy Hunt and George Osborne in 2015 to remove bursaries and free tuition for nursing students and replace them with loans from 2017.

They were widely warned not to do anything so stupid. The NHS pay review board, the Royal College of Nursing, and the Labour Party were all aghast, pointing out that forcing low-paid nurses into about £50,000 of student debt would be a huge disincentive. Far from it, the government insisted. The £1 billion saved by the Treasury would fund more training, and produce more nurses.

Two years in and the proof is there: the critics were right and the government wrong. Applications for nursing have fallen off a cliff, down a third since 2016. The fall is steepest among mature students, traditionally the majority of new nurses; women with families or life experience who want a new career. Those are down 40 per cent.

The numbers accepted on nursing courses have also gone into reverse, spinning down from a peak of 22,000 to just over 20,000 in 2018. It means the shortage will only worsen in the future. The government’s strategy has been a disaster.

Whatever the arguments for fees and loans in principle, it makes no sense to apply these to nurses. University students have short terms and predictable schedules, allowing them part-time jobs. Nursing students work for 45 weeks, and spend half their course contributing to the NHS by working in hospitals or the community, often in long, unsocial shifts. They can’t cut their debt by working on the side. Nor do they have the earning potential of other graduates. For the vast majority, nursing will be a steady job but not a lucrative one.

This makes the debt both a real burden to nurses and an illusory saving to the Treasury. Official figures show that eventually 45 per cent of nurses’ loans will be written off. Almost half the claimed savings from the change are in fact a pretence.

Bursary abolition compounded two other major errors. In 2010 one of the first coalition decisions was to cut university nurse training places by 12 per cent within two years. Had they retained Labour’s quota, thousands more nurses would be available now. In 2013 they cut the potential supply further by deciding nursing should be graduate-only. That has eliminated swathes of caring people who are less academic. The belated attempts to make up for that by creating nursing apprenticeships and associates have been pitiful and little-noticed; last year, fewer than a thousand were taken on.

This is a crisis that will hit every one of us when we or our families need care. The sticking-plaster solution, increasing our raids on other nations’ nurses by another 5,000 a year, will only meet part of the shortage, and raises the question of how we can defend making other countries pay for the training we refuse to fund ourselves.

The government has to change tack. Its new NHS long-term plan relies on nurses it doesn’t have. A third are due to retire within five years. Meanwhile, staff gaps are creating a vicious circle where exhausted nurses quit the NHS, forcing hospitals to fill rotas with agency staff. These are inevitably less efficient, and less committed, as they aren’t familiar with the computers, systems or patients. The cost is another ludicrous burden. Last year the Open University reported that replacing agency nurses with full-time ones would save £560 million a year.

The Royal College of Nursing has a practical solution to increase numbers sharply, with the government either paying nurses’ fees and giving means-tested grants, or writing off loans in return for ten years’ work in the NHS. Either gives a net saving of almost £1 billion per year group once the cost of agency nursing and existing loan write-offs are added in. Without action, the staffing gap will be 48,000 by 2023. The government must listen, learn and reverse its policy, now.

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Wales is bust, and cannot pay for its citizens care. Devolution has failed. This is the thin end of a very large wedge..

The service quality is falling, and staff are leaving

Across the four health services staff are demoralised and leaving. Bullying is endemic, and Scotland and its midwives are at least is trying to address this more actively.  Staff numbers are at their lowest, and Brexit will only make this worse. Most pregnancies are now to women over 30, and such a large proportion are “high risk” that midwifery led units are probably destined for extinction…. The NHS England site mouths platitudes like “participation is important”… for NHS staff, but those employed no longer believe it.

Bullying and Maternity Care Plans in Scotland (Nursing Times 15th April)

Laura Donnelly in in the Telegraph 27th March 2019: The number of NHS staff quitting over long hours trebles in the last 6 years.

Jane Dalton reports for the Independent today : One in four wards has dangerously low numbers of nurses..

Meka Beresford and Oli Cole report in RightsInfo: NHS Staff Shortages Could Double Without ‘Radical Action’

The NHS in England could be short of 70,000 nurses and 7,000 GPs within five years unless urgent action is taken to address a growing staffing crisis, according to analysis by three leading health think tanks.

A report by The Nuffield Trust, Health Foundation and King’s Fund warns that existing nursing shortages could double and the shortfall of family doctors treble, without radical action.

The analysis says that urgent measures must be adopted in a new NHS workforce strategy to prevent the shortages from worsening, with a combination of international recruitment, student grants and innovation needed…..

The NHSExecutive website reports 8th April: Widening pay gap between private and NHS staff ‘risks damaging the health service beyond repair’