Category Archives: Nurses

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’

how long to numbers recovery? Much longer for morale recovery!

The health services are all broken. The exodus of staff when the opportunity arises and the cynical disillusion with system and management is evident. The doctors who “go over to the dark side” (management) are looked on with suspicion by colleagues. GP commissioners are derided, ad they have to ration health care without using the word. Taxpayers in poorer regions (such as Wales) get inferior care, lack of choice and poorer outcomes….. It is getting to the point where two tiers of health service are available: National or Private. A few more exit interviews would help…

Peter Russell for Medscape reports 12th Feb 2019: NHS Staffing Shortfalls ‘Threaten Long-Term Plan’

NHS staff numbers in England have failed to keep pace with demand, according to a report by an independent health charity.

In its third annual review of staffing levels, the Health Foundation highlighted specific problems in primary and community care, nursing, and mental health….

This is not the first time: Nicky Broyd on the 15th November 2018: Staff Shortages Threaten NHS Long-term Plan: Report – Medscape

According to the first of two reports by The King’s Fund, the Health Foundation and the Nuffield Trust, staff shortages in the NHS in England now present a greater threat to health services than funding.

The group of leading health thinktank experts predicts an increase in NHS staff shortages from over 100,000 at present to almost 250,000 by 2030 and warns the figure could be over 350,000 if the NHS continues to lose staff, fails to adequately fund training places and can’t attract workers from abroad.

and 4 days ago Peter Russell: NHS Staffing ‘a Make-or-Break’ Issue, Says Report – Medscape

Sign the Brexit petition – and have more wealth for better health

The Stop Brexit petition

The 4 UK health services need more staff: not less. The 4 UK health services need more money and new infrastructure, not less. Health is so closely related to wealth that in population terms they are virtually indistinguishable. There are only a few poor countries whose life expectancy has exceeded the richer countries, but this is mainly due to politics, warmongering, and subject populations in the richer ones. (Nepal has a better life expectancy than Russia, Venezuela and Zimbabwe, despite no natural resources, and with only tourism to bring in foreign currency). The threat from Brexit is closing fast, and the indicative voting from most recent polls is that there could well be a majority for remaining in the EU now. We will have fewer people, especially carers, less money, and poorer health after Brexit.

Informed consent is better than uninformed consent. The opinions of rich, self employed businessmen, and media owning magnates, are not important except that they have informed the first vote with false assertions. People are wiser now and more informed, which makes the peoples vote petition that much more important. This may be our last chance….

We all know that many elderly people are not “on line” and will not write. We all know the petition is self selecting for those with e ability. BUT this does not negate the need for another vote. Those of us who voted to remain will be much more accepting of another Brexit vote and the country will unite whatever the result. If Brexiteers ask for a third, fourth and fifth referendum, then this is the price we have to pay for Mr Cameron’s idiotic decision to replace representative democracy with a peoples democracy for a single issue. We can all make mistakes…

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The Stop Brexit petition is at

https://petition.parliament.uk/petitions/226509

27th November 2018: Seeking informed consent on Brexit

26 Jan 2019 On the Brexit slipway…. There is a problem: there may be too many to save, all at once.

23 December 2018: The Brexit deadline and the Health Services planning – standards and services are going to get worse..

8th December 2018: BREXIT will negatively impact the NHS and health services regardless of a deal, a new report has revealed, with devolved nations set to suffer the most.

August 2018: Patients should not be looking forward to a “hard” Brexit. Make sure you have a good stock of medications..

and Successive increases in the health budgets in Wales have not helped….. Brexit will make it worse… We all seem agreed, so why not change direction?

and Doctors warn “Brexit bad for health”, as calls grow for new EU vote.

Beware the tyranny of the mob. Brexit will harm those suffering from rare diseases.

The Commonwealth Fund compares health systems. Unreality of MPs. ..

Health is closely correlated to Wealth – If you are poor you get no choice (Wales), and live a shorter life, but if you are rich, or born abroad, you live longer and you do get choice! So much for equity…

Just for Health – “MPs must be brave and tell us we were wrong” December 29 2018

This made me laugh, but its sick.

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Can the NHS be saved? Only with different local and global thinking, and changing the “rules of the game”.

All of us in the caring professions know the answer to this question, and indeed that there is no “N”HS any longer. The Guardian knows the answer….. Iain Robertson Steel, a retired medical director acknowledges the problem (But suggests no answer/solutions), but on 26th April  in the Western Telegraph I suggested a “fourth option” for people in Pembrokeshire.  This last is only for local needs, and a letter suggesting a global rethinking was in the Western Mail 25th Jan 2018 is at the bottom of this post. What can save the 4 health services is not clever reorganisations, but an honest debate on overt rationing, and making it clear to everyone what is not available free, for them. ( Changing the rules of the game )

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Can the NHS be saved? The Guardian – Dennis Campbell – 

…the Guardian’s health policy editor Denis Campbell spent a day in King’s College hospital in London. He found staff and patients who are devoted to the NHS but who can also clearly see what is needed in order to sustain the service for future generations.

A long-term plan designed to secure the future of NHS England has been delayed once again by Brexit. But as Britain’s health service heads into its annual winter beds crisis, the Guardian’s Denis Campbell visits King’s College hospital in London to find out what staff and patients need for the future – and how much it will cost. 

“The Welsh NHS and social care is a shambles and no longer sustainable or fit for purpose.” Dr Iain Robertson Steel in the Western Telegraph 7th December.

Health service needs to be remodelled Western Mail 25th January 2018

From the perspective of west Wales there is no British health service.

I do not have access or choice to anywhere outside my own rural trust (Hywel Dda) unless the service needed is not available here. Even a second opinion has to be within the same trust.

There are four, and possibly five health services if Manchester is included. The WHO has said it will no longer report on an “NHS”.

The lack of choice, the covert rationing, and the unequal access to tertiary centres, primary care, and palliative care threaten to bring on civil unrest.

A Welsh mutual of three million people cannot offer the same quality of healthcare as one of 60 million. Even if the Welsh Government has tax-raising powers, there are not enough taxable earners to rise above the decline.

We seem to have forgotten the power and improved health outcomes in large mutuals. Since the UK’s health service has to be refashioned, now seems a good time to unify again, and re-establish the same rights across the country.

Increasing taxation to pour more into a holed bucket should not appeal to most taxpayers.

We need a new health insurance system (the original NHS was insurance based) and the caring professions will remain cynical until what replaces “in place of fear”, avoids bringing it back.

Dr Roger Burns

Haverfordwest

Pembrokeshire GP urges a “fourth option”. Western Telegraph 26th April 2018

The finances are in such a mess, that local post code and unexpected rationing is everywhere… The “Rules of the game” need to be changed…..

Changing the rules of the game

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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.”