Friday, 11 January 2013

NHS 'sleepwalking to a disaster'

In a previous article this week I argued why it is disingenuous for the government to claim that £20bn cut in the NHS budget could be made without affecting front line staff, doctors, nurses and vital technical support.  The claim  that 'streamlining' efficiency savings could be made without cuts in front line staff is wrong. The government knows this of course. But it doesn't stop them repeating the falsehood.

The Royal College of Nursing  has identified 61,276 NHS posts which have either disappeared or are set to go as a result of cuts in spending and warn that the NHS is "sleep walking into a crisis." Nurses say that they "do not have enough staff to deliver good quality care. Demand for services is continuing to rise, however staffing levels are being slashed."  

Looking around the country and the reality is revealed. At the Royal Bolton Hospital 500 jobs are to be cut with further savings being considered by changing the contracts of 1685 nursing, midwifery and support staff.  In April last year the University of Leicester Hospital announced cuts equivalent to the loss of 271 full time posts.  Up and down the breadth of the country hospitals are announcing savings leading to staff redundancies.  Cuts are being made to clerical workers and other support staff as well as front line staff. But this is not without its impact on patients and patient services. In one case in North London elderly patients are being asked to check themselves in for appointments.  

The NHS is a huge organisation that employs around 1,180,000 staff. During the previous Labour government NHS funding increased in real terms by around 7% each year, particularly since the prime minister Tony Blair had set the target of reaching the European average as a percentage of GDP. By 2010 many of the targets set by the Labour government had been met and significant progress was being made in others. Health inequality stubbornly refused to budge.

The numbers of doctors increased from 88,693 in 1999 to 132,683 by 2009 (an increase of 49.6%). The number of fully qualified nurses increased from 261,340 to 336,007  (+28.6%) over the same period; scientific, therapeutic and technical staff increased from 86,837 to 128,331 (47.8%). Clinical support staff increased by 32.9%. But managers and senior managers increased from 23,378 to 42,509 (82%).

This percentage increase in managerial staff  is large. Nonetheless the percentage of staff who are categorized as managerial  (3-4%) may not be inappropriate. Indeed even TheTaxpayers Alliance accept that this is lower than some private companies.  The requirement for management and support staff is not proportional if new services are being developed in new buildings. What you cannot do is streamline management by simply cutting the budget. Whilst efficiency savings might be made over time, the immediate impact of savage cuts is on the ability to deliver front-line services, and sometimes with the absurdity of elderly patients having to check themselves in for care. It is just as likely that units would have to close down for lack of resources.

It isn't easy to compare the structure of the NHS with any other type of corporation. The scale and diversity of services is a problem; the collection of information, its storage and accessibility about patients made daily creates a burden few companies would manage. The term manager covers a variety of grades including 'team leader'. A team leader may also be a member of front line staff in say portering. There is not always a clear distinction between front and back line staff. We could say that front line is doctors and nurses but this would ignore the support the front line requires. When a doctor takes a sample it is sent to a laboratory for analysis; when a doctor or nurse processes a patient's notes these then get processed, stored and retrieved.

Developments in modern medicine are founded on laboratories and advanced technical services.  Preimplantation genetic diagnosis and IVF, for example,  require scientific and technical staff in the running and the development of the services provided. The laboratories are housed in buildings that have to be managed, they require supplies of reagents and laboratory equipment that has to be ordered and processed. They have administrative work that needs support. All this requires some kind of management. It isn't easy to pick a figure of management that is appropriate. But services such as PGD were in their infancy just a decade ago. Now they form a key part of diagnostics and reproductive choices for patients.

Demographic change means that the NHS has to be continually changing to meet shifting needs. But the NHS had been doing well. Yes it has had its share of scandals and poor service. But on the whole it has been a remarkable success story. Now it is under threat as never before faced with fragmentation, creeping privatisation of services, and cuts. The Royal College of Nursing are right. We are sleep walking to a disaster.

Postscript

According to rulings by the official safety watchdog, The Quality Care Commission, 17 hospital trusts have dangerously low numbers of nurses.

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