Mind the Rota Gaps
The NHS is facing a £30 billion black hole in its finances by 2020, caused by 10 years if flat-line funding and a 4% year on year increase in demand for its services as people persist in living longer that they used to. Prior to the last election, NHS England chief Simons Stevens said – in the best case scenario – the NHS could recoup £22 billion in efficiency savings without damaging patient care, something MD (amongst many others) said was highly unlikely. This would leave the government with just £8 billion extra to provide over £5 years, enough to just about keep the lights on. Lib Dem expenses expert David Laws is now alleging Stevens asked for £16 billion from the government and was sent packing. True or false, the NHS is now being sucked into a huge black hole of debt and services and waiting times are suffering.
The demand on the NHS is made worse by 20% cuts in social care as patients can’t be discharged from hospital or stay well outside it. Poverty causes ill health too, and cuts in welfare payments add to the burden on the NHS. A sure sign the NHS isn’t coping is the chaos at its front door. General practice has faced huge funding cuts and is short of at least 5,000 GPs in England. But there aren’t enough doctors wanting to be GPs even if there was the money to pay them. Cameron made an inane manifesto pledge that ‘everyone over 75 will see a GP on the same day if they need to’, when in fact anyone should be able to see a GP when they need to. But with a dire shortage of GPs, many can’t.
The knock on effect on emergency departments is equally alarming. The emergency medicine workload is so unremitting that it has the greatest attrition rate of any medical specialty in the NHS, with almost 50% of year three and four registrars resigning. Dr Clifford Mann, president of the Royal College of Emergency Medicine, has warned of ‘unprecedented levels of pressure, overcrowding and a desperate shortage of medics’, with 20% of posts unfilled. He has asked for doctors from other specialties to be diverted to A&E to keep the public safe. ‘There have been some reports to harm to patients, and a collapse in the morale and resilience of the medical and nursing staff.’
The lack of safe staffing levels for nurses was a key finding of the Mid Staffs review, and NICE were given the task of gathering the best evidence for the safest ratios of patients to nurses in different healthcare settings, with the intention of moving onto other staff groups. Alarmingly, this work was pulled by the government and NHS England, who then tried to bury NICE’s finding before being forced to publish them under FOI. It seems the government wasn’t prepared to commit the funding to safe staffing, making a mockery of its manifesto promise to make the NHS the safest health system in the world. So many nurses are left caring for more than eight very sick patients at once.
Unsafe staffing levels are clearly bad for patients, but so stressful for staff having to cover rota and shift gaps that they either give up themselves after a few years, or decide that part time working is all they can cope with. In the annual census for the Royal College of Physicians, 21% of respondents said that gaps in the trainee rotas were so frequent ‘such that they cause significant problems for patient safety’. This problem is greatest for specialties that provide emergency cover for the NHS. Further up the ladder, the picture is equally bleak. Across the UK 40% of advertised consultant appointments could not be filled. Almost all were due to there being a lack of trained applicants, and many jobs attracted no applicants at all. Vacancies are most acute in the North West and West Midlands.
Ever determined to balance the books in the impossible hope of making £22 billion efficiency savings, the government has capped the rates of NHS locum pay, and locums are simply refusing to do the most stressful jobs for less money. Hospitals have now been forced to reduce medical cover on wards at night and reduce training for junior doctors. Out of hours care is flying by the seat of its pants and the government knows it simply doesn’t have the staff for its fantasy pledge of an extended ‘truly 7 day NHS’ even if it was able to bully the junior doctors into submission. Which it can’t.
As with every other policy in the NHS, workforce planning is driven by the need to save money, not what patients need. Despite the challenges of an ageing population, the NHS is training 19 per cent fewer nurses in 2014-15 than it was in 2004-05. Unsurprisingly, there was a 25% growth above inflation in temporary and agency costs between 2013-14 and 2014-2015. The solution is to train and retain more staff, not spread the existing staff thinner until they break. The National Audit Office found that in 2014, the NHS in England was short of 50,000 clinical staff. The latest estimate is a shortfall of 70,000 clinical staff. The twin obsessions of austerity and profitability will only make this worse. Far from being the safest health service in the world by 2020, the NHS is fast becoming the least safely staffed.
MD is performing at the Edinburgh Fringe and is supporting an independent legal review of the imposed contract. We all need to know if Jeremy Hunt’s actions are safe and legal.