Monday, 12 February 2018

Boris Johnson and the Art of the Headline Grab

Boris Johnson has never been shy of grabbing the headlines, he has certainly never knowingly turned away from a photo opportunity. When he was Mayor of London, it sometimes felt like all he did was try and grab the headlines, with one stunt after another.

At the end of January the press revealed that Boris would be demanding an extra £100 million a week funding for the NHS, at a Cabinet Meeting (1). That would have resulted in an extra £5.2 billion a year. Now he was quickly slapped down by both Theresa May and Philip Hammond, the Chancellor (2). Since then Boris does been very quiet on the subject, it obviously didn’t get him the good headlines he was after, but it did highlight this government’s failure to fund the NHS or even look realistically at future NHS funding.

This Government has under funded the NHS since 2010. Since 2010, when the Conservatives came back into Government (In coalition then), they have cut the increase in NHS funding to 1.1% (3), after last year’s autumn budget the NHS yearly increase in funding was increased to 1.2% (4). Previous to 2010 NHS funding was increased by, on average, 4% a year since the NHS was founded. NHS funding increases have been cut by nearly 75% and yet demand has not decreased. A&E attendance in December 2017 was up 3.7% on December 2016 (5), and that was just A&E attendance. All areas of the NHS have seen increases in demand, year on year.

This all has had a knock-on effect on the service the NHS can deliver, it’s now failing at all its mayor targets. The four hour A&E treatment target hadn’t been met since July 2015, the 62 day target from urgent cancer referral to treatment hasn’t been met since 2014 and the 18 week target for referral-to-treatment for elective care hasn’t been met since February 2016 (6). Good quality healthcare is not cheap, and repeatedly providing the NHS with below inflation funding increases has a direct affect on patient care. There are no more “efficiency savings” to be made, the fall in funding cannot be absorbed in any other but by cuts to patient care.

The Government had a chance to at least begin turning around this chronic under funding with November’s Autumn Budget. In the run up to the budget there was active campaigning for more NHS funding, at least £4.6 billion to stop the shortfall in NHS funding (6). Simon Stevens, head of NHS England, called for extra funding too, warning that NHS waiting lists will soar to five million by 2021 if its funding isn’t increased (7). Yet when Philip Hammond announced his budget, in November, the NHS only received an extra £1.6 for the next year (8). Officials at the Treasury have leaked to the press that Philip Hammond was angry at all the campaigning for extra funding, especially that of Simon Stevens, and this is why he didn’t provide all the funding the NHS needs (9). I am left speechless with disgust and anger at his petty and vindictive actions. Instead of listening to the reasoned arguments, he followed his ego. What kind of politician is he? Unfortunately he’s typical for this government.

Boris Johnson’s attempt to grab the headlines pushed a much more important NHS policy story out of the back pages. A cross-party group of ninety MPs wrote a letter to Theresa May calling for a cross-party convention on the future of the NHS and care social and the funding they will need (10). The letter was organised by Sarah Wollaston, Conservative MP and chair of the Commons health committee, Norman Lamb, Libdem MP, and Liz Kendall, Labour MP (11). It was signed by 90 MPs from all parties, a third of them were Conservative MPs (11). This was a golden opportunity for Theresa May to tackle the problems dogging the NHS and to do it with the full support of Parliament. This would have provided cross-party support for raising taxes to fund the NHS. So far the Conservative party has shied away from raising taxes, seeming to fear losing political face doing so, but with cross-party support all parties would have taken the “hit”. This was a political initiative that has been long overdue. But Theresa May, in her usual limp-handshake-way, dismissed this call for cross-party action, saying the government were managing the NHS themselves (12). Another typical failure and missed opportunity by Theresa May, and I’ve lost count of how many there have already been.

70% of Conservative voters, in a recent pole, said that the NHS was their main concern (13), and yet this government constantly ignores the problems of the NHS staring them in the face. Even when their own supporters are worried about it, it still doesn’t appear as a high priority for this government. Theresa May does not seem very bothered about it and rarely comments on the NHS. What have we done to deserve politicians so apathetic and uncaring about the NHS? For so many voters, the NHS still remains such a major concern, but to listen to our politicians you would think that there were no great problems with the NHS, beyond a few people moaning about it.

What can we do to finally make this government take the NHS’s problems seriously? Yet another winter crisis in the NHS certainly hasn’t done that (14).

As for Boris Johnson. During the 2016 EU referendum the Leave campaign, which he was the leading light of, claimed that £350 million a week extra funding would go to the NHS (15). Last month Boris only called for an extra £100 million a week for the NHS. So it seems his concern for the NHS has fallen by over 70%. As I said, what can we do to make these politicians take the NHS seriously?

Drew Payne

Monday, 22 January 2018

When You Just Don’t Understand the Situation

If you can keep your head, while all around you others are losing theirs, believe you me you don’t understand the situation.”

I don’t know who said it but I do like this quote, except when it comes true. Jane Cummings, NHS England’s chief nurse, has recently shown that she is a living example of this.

The crisis in nursing has further deepened, last week figures from NHS Digital were released that showed last year (2016 to 2017) more nurses left the NHS than joined it (1). Last year 33,500 nurses left the NHS (about 10% of the nursing workforce), 3,000 more than joined, and 20% higher than left in 2012-2013 (1). Some of these nurses have moved into the private sector, to work for nursing agencies and private companies and private hospitals, but an alarming number of nurses have left the profession altogether. Last year saw 1,678 more nurses leave the NMC register than joined it, 35,363 nurses left the register, 27% less nurses joined the register than left it (You have to be registered with the NMC to practice as a Registered Nurse, therefore if you leave it you cannot work as a Registered Nurse) (2).

A closer look at these statistics makes an even more uncomfortable read.

3,000 more nurses left the NHS than joined it (3). This is the biggest gap but not the first, for the last three years more nurses have left than joined the NHS, but last year saw the biggest gap. There’s no evidence that this trend isn’t going to carry on.

The largest percentage of those nurses leaving, 51%, were nurses under 40 (3). These are nurses at the beginning of their career. Traditionally, the largest percentage of nurses leaving had been over 55, nurses retiring. This has been a concern because of the drain of skills and experience from losing these nurses. Last year we saw the largest percentage of nurses leaving were ones at the beginning of their careers. Nursing is now so stressful and undervalued that it is driving away nurses at the beginning of their careers.

"We are haemorrhaging nurses at precisely the time when demand has never been higher,” Royal College of Nursing head Janet Davies said: "The government must lift the NHS out of this dangerous and downward spiral.” (3) She added that the government needs to address nurses’ poor pay and lack of support to start filling the huge number of empty nursing posts (3). She hit the nail on the head, unlike our Chief Nurse.

Jane Cummings told the BBC: "We do lose people that need to be encouraged. We're in the process of bringing in lots of nurse ambassadors that are going to be able to talk about what a great role it is, to be able to tell their story, so we can really encourage people to enter the profession and for those in the profession, to stay in it," (3).

She is the professional lead for nursing and midwifery in England (4) and yet she makes a comment as crass and patronising as this one. Nurses are the backbone of healthcare, we are the ones who actually carry out the vast majority of patient care, and the NHS is haemorrhaging nurses. Yet all Jane Cummings can say, in the face of this of all, is that she’s introducing “nurse ambassadors” who will tell everyone what a “great role” nursing is. She plainly ignores all the factors that are stripping the NHS of nurses, and instead she announces a pie-in-the-sky project. As if all we need are people to go around saying how great nursing is and nurses will stop leaving the NHS. What planet is this woman on?

If a “nurse ambassador” turned up at my workplace and told me it was great to be a nurse, I’d reply asking them what they were going to do about our ever increasing workload, all the empty posts in our team (let alone we need more nurses to manage our increasing workload) and what where they going to about the fact that my pay has decreased, in real terms, by 14% since 2010 (5)? If they answer nothing then I’ll demand to know what good are they? But let’s cut out the middle people, if this is all Jane Cummings can offer then I want to know what good is she?

According to NHS England, Jane Cummings was appointed National Lead for emergency care in 2004 and she had been working in management for many years before then (4). It is safe to say that it is many, many years since she worked on the clinical coalface of nursing, and it shows how her patronising response to this latest crisis is. Why is she in such an important role when she cannot offer the leadership needed?

In 2012, Jane Cummings’ salary was £165,000pa (6), and I am sure she has not seen her salary fall the way the clinical nurses have seen our salaries fall, in real terms.

How has Jeremy Hunt reacted to this latest nursing crisis? He is the Minister for Health and Social Care, he is the politician responsible for the NHS.

He has shown his typical complete lack of knowledge about the situation. In reply to the fall in the number of NHS nurses, Hunt said that he will increase student nurses places by 25%, training 5,000 Associate Nurses this year and 7,250 next year, make it easier for Associate Nurses to re-train as Registered Nurses and give nurses first refusal on any “affordable” housing built on former NHS land (7).

At first this may sound great but a quick glance at the figures shows how hollow they are. It takes three years to train a Registered Nurse and two years to train an Associate Nurse, so any extra training places will not give us more nurses now. In three years times how many more nurses will be leaving the NHS than joining it? There seems no evidence that the NHS will stop losing nurses. This Government has abolished bursaries for Student Nurse training, since then there has been a 23% fall in the number of people applying for nurse training (8). Will they be able to find enough appropriate people to fill these extra training posts? Associate Nurses are not a replacement for Registered Nurses, as yet there are no plans for Associate Nurses to be able to give IV drugs.

As for first “dibs” on “affordable” housing, well only on the ones built on former NHS land. You still need a mortgage for an “affordable” home, it’s not social housing, and with nurses’ pay falling in real terms who can we get a mortgage from? And how many “affordable” homes will be built this way? Certainly not enough to house all the nurses, and their families, who need them. This is another patronising and meaningless “bone” thrown at us by Hunt, which does nothing to ease all the problems faced by nurses.

Nursing is in crisis, we are haemorrhaging nurses from the NHS, yet this has been a problem for years and no one in leadership is doing anything meaningful about it. I want to scream “You’ll miss us when you’re gone, when there’s no nurses left you’ll be in trouble!” But with the leadership styles of Jane Cummings and Jeremy Hunt, I don’t think anyone will notice or will they even care, and that makes me so sad.

Drew Payne

Tuesday, 19 December 2017

Today Would Have Been His Birthday

Today, the 19th December, would have been my father’s birthday but he died in 2003. He died before Facebook, Twitter, Instagram, Smartphones and Tablets. He only started to use a computer after he retired, discovering the internet after that. His use of emails could be erratic and interesting, to say the least.

He came of age during the Second World War, which left a very formative impression on him. For him it brought great freedoms, as a teenager he was given so many adult responsibilities, many of the adults were away at war so he was needed to fill their shoes, going from boy to man almost overnight, and he loved it. His stories about that time were always filled the pride that that was the best time of his life.

He lived his life in a world that was so different from ours now, not just new technology but a whole different world of attitudes. When my parents married, in 1952, the only divorce you could get was for adultery, being gay could land you in prison, terminating a pregnancy was illegal, if your parents weren’t married you wouldn’t be automatically recognised as your father’s child, attitudes to any sex outside of marriage were almost medieval; and racism, sexism, homophobia and prejudice toward the disabled were just perfectly acceptable “values”.

The world I live in is a world away from the one my father grow up in, yet it is also within living memory. The world has changed so much since I was born, but it is unrecognisable from the world that my father grew up in, and I am so grateful for that.

My father lived through so much change in his life but I still wonder what he’d make of our social media. Part of me feels a sinking feeling of how he’d have over shared on it, tagging me into all his posts, did I really need to know what he had for breakfast and that he discussed his constipation with his GP, again, and I can hear him complaining, “How can I say anything in only 140 characters, what fool thought that was a good idea?”

Tom Payne, my father, a man who lived through the world that changed.

Drew Payne

Monday, 27 November 2017

Just More Number Crunching

We’ve had the Equality Act since 2010 (1) and for many LGBT people it has been a game changer. It requires that anyone providing a service for the general public, including healthcare providers, does not discriminate who they provide that service to, no more “We don’t serve your sort in here, this is a family establishment.” In October 2017, NHS England has only just waken up to the fact the Equality Act also applies to the NHS, and in response they have released their latest initiative.

They announced that they want all patients’ sexuality recorded, with their other demographic details (2). So at every face to face encounter with a patient with doctors and nurses and all healthcare professionals have to ask patients what their sexuality is, if it does not already state so on their demographies. Patients do have the opinion to decline to answer.

But this is NHS England’s only response to the Equality Act, to gather data on patients’ sexuality, nothing more. We’ve had several studies, in recent years, about the poor treatment LGBT patients have received from the NHS, there have also been studies into what an unfriendly working environment for LGBT staff the NHS is.

Back in 2007, Stonewall published their study Being the Gay One (3), on the homophobia faced by staff working in health and social care, it was more than an uncomfortable read. Since then they have published four different studies on the experience of LGBT patients in the NHS (4, 5, 6, 7) and all of them have highlighted the negative and homophobic experiences they have received, with many LGBT patients unwilling to be open about their sexuality for fear of homophobic treatment from healthcare professionals.

In 2015 Stonewall published Unhealthy Attitudes (8), their report into a survey of LGBT healthcare staff. The findings of this report showed so little had changed since 2007, and Stonewall’s first report (3). Unhealthy Attitudes found that 25% people surveyed had been the victims of homophobic abuse at work. Last year a BMA study found that 70% of LGBT doctors had experienced homophobia at work, and three quarters of them had never reported it out of fear of reprisals (9). Last year we had the unpleasant sight of NHS England itself going to the High Court to win the right not to fund the HIV preventative drug PrEP (10).

Yet we also have areas of good practice and there are resources out there for NHS Trusts that want to turn around this situation. In 2012 Stonewall published Sexual Orientation, A guide for the NHS (11), which is full of practical advice for combatting homophobia in healthcare. Back in 2009, the Department of Health produced Sexual Orientation: A practical guide for the NHS (12), which was designed to help reduce the healthcare inequalities faced by LGBT people.

We already have a lot of evidence about the homophobic treatment many LBGT people have received at the hands of the NHS, NHS Choices acknowledged the problem back in 2012 (13), there is also guidance on how to reverse this, and yet all NHS England can think to do to combat healthcare homophobia is to ask patients what their sexuality is. A third of gay and bisexual men are not open about their sexuality to their GPs (7) and half of Lesbians and bisexual women (5). Why isn’t NHS England launching a high profile initiative to tackle homophobia in the NHS and to make it a welcoming place to LGBT people? Why isn’t NHS England ensuring that the NHS complies with the Equality Act? Instead all they can do is collect data on LGBT people. So typical of NHS England, too little and much so late.

But why should nurses, be concerned about this? How can we say we are providing open and non-judgemental nursing care when so many LGBT people are afraid of being open about themselves in front of us?

(This was originally written for the Nursing Standard)

Drew Payne

Friday, 3 November 2017

The 1% Problem

In one speech in Parliament, Jeremy Hunt scrapped the hated 1% cap on NHS staff’s pay rises (1), the cap that saw staff’s pay cut in reality. With one speech the seven year old pay cap was gone.

As nurses, this is what we wanted to happen, this is what we have campaigned for (2), we have even threaten industrial action for it (3), but this really a victory?

When Hunt was questioned by MPs, he wouldn’t say what pay rise NHS staff could expect, he wouldn’t say if he’d got the Treasury to fund a pay rise, but he did say that any pay rise would be linked to “productivity” (4).

Only a few months ago, Chancellor Philip Hammond was reported as saying, at a cabinet meeting, that public sector staff are overpaid, being paid 10% above their private sector equivalents (5). Now this is not true and is a distortion of the facts (6), which is unsettling enough for our Chancellor of the Exchequer to do, but it does show Philip Hammond’s attitude towards NHS staff’s pay. In his last budget he provided no increase to NHS funding (7).

A decent pay rise for nurses is urgently needed, and not just as a selfish pat on the back. The NHS is haemorrhaging nurses. There are 40,000 full-time equivalent empty nursing posts in the NHS, 1 in 9 of all nursing posts (8), Janet Davies (General Secretary of the Royal College of Nursing) directly linked these empty posts to low pay and high workloads forcing nurses to leave the NHS (9). Since the pay cap was started in 2010, nurses’ pay has fallen in real times by 14% (10), which equates to nurses being at least £3,000 worse off each year (11). Fourteen unions, including the RCN and Union, have called for NHS staff to receive a 3.9% pay rise (12), which only seems fair to me.

In his announcement, Hunt did talk about any pay rise being linked to “productivity”(4), which is unbelievably arrogant. The NHS would be in a far worse state if it wasn’t for the dedication for its staff. This year we’ve seen NHS staff, and especially nurses, going above and beyond their roles when faced with the aftermath of terrorist attacks and disasters; the Finsbury Park mosque attack (13), the Grenfell Tower fire (14), the Manchester Arena bombing (15), Royal Stoke University Hospital fire (16), and the Westminster Bridge and London Bridge attacks (17). But it isn’t just the nurses responding to national disasters, like so many other NHS staff, its the extra work that nurses provide on a day-to-day basis that is holding the NHS together. This isn’t just my opinion, Sir Robert Francis QC, the chair of the investigation into the Mid Staffordshire NHS Trust scandal, earlier this year said the NHS was only being held together by the “superhuman effects” of its staff (18).

But I think Hunt’s reference to “productivity” is something different. During his speech to the Conservative Party Conference, Hunt announced that he wants to pilot an app whereby staff can be called in to fill shifts at a short notice (19). Sound familiar? He wants to introduce an Uber like app were staff will only work when they are needed or staff will be called in to work on their days off. Is this how we want to work and is this safe for patients? I wouldn’t want to be looked after by a nurse dragged into work on their day off. But I fear accepting this app maybe a condition of receiving a pay rise next year.

There is also the question, who will fund any pay rise we’re offered next year. Neither Hunt or Philip Hammond have announced any extra funding for the NHS, and Hammond’s attitude shows he’s unlikely to do so (5). NHS Trusts cannot afford to fund any pay rise. Simon Stevens, the chief executive of NHS England, told the Commons cross-party health select committee, after Hunt announced he’d scrapped the cap, that the Government will need to increase the NHS’s funding to met any pay rise because Trusts’ funding is far too stressed to do so (20). I suspect that we will get a pay rise and then Hunt will announce that we will only receive it if there are substantial cuts to fund it. This is an approach he’s used before.

At the beginning of the year, during a speech, Hunt said he wanted to increase staff’s pay but he “couldn’t” because that would take money away from recruiting more doctors and nurses (21). In 2014 Hunt vetoed a 1% pay rise for nurses, saying that to fund it would mean losing 15,000 nurses from the NHS (22). This was an out-and-out lie. After industrial attack, Hunt backed down and we were awarded a mere 1% rise (23), and strangely enough no nurses were sacked to fund it.

(The Government found £1.5 billion to fund their deal with the DUP, to secure the DUP’s support in parliament (24). A 1% pay rise for all NHS staff would cost £500 million (25). Therefore the £1.5 billion found very quickly to fund the DUP would fund a 3% pay rise for all NHS staff. Says a lot about this Government’s priorities)

I fear that Jeremy Hunt’s announcement that the cap has been scrapped is nothing more than spin. The Government needed some good news and so Hunt’s announcement, without any funding or guarantees behind it. I fear that the wage cap has only been replaced by spin, emotional blackmail and demands for us to work even more unrealistically harder. With Hunt still in charge, I’d be very surprised to get a pay rise next year above 1%, and certainly not one without a lot of strings attached.

Drew Payne

Friday, 18 August 2017

Smile, You’re on Camera

The Met Police have rolled out the use of Body Worn Cameras (1) across 30 of the 32 London boroughs, and they have had a great deal of success with them. They have said that the cameras have helped with the Met Police’s transparency (2). There are now plans for armed police officers to use them (2).

On the back of this success Guy’s and Thomas’ NHS Trust has started to use them with their security guards (3). This is in response to a 27% increase in reported “incidents” (3).

Body Worn Cameras have showed that they are useful with the police and proving useful for security staff but Northamptonshire Healthcare NHS Foundation Trust has rolled them out for nurses to use in Berrywood Hospital, a psychiatric unit (4). This is certainly going one step further.

The report of the pilot study, of the cameras usage, makes interesting reading, but has to be carefully read (5). The report is written in very positive terms, a casual read would easily give the impression that these cameras were perfect and solved all the unit’s “incidents”. But a closer read showed that these cameras are not the “perfect solution”, there were many problems with them, such as:

  • ·         The cameras were not recording all the time, they had to be turned on to record an incident and then turned off (5). It relies on staff stopping and remembering to turn the camera on.
  • ·         The cameras had to be worn, over clothing, on a special harness, (5) they don’t just clip onto clothing. They cannot be discreetly worn.
  • ·         Staff had to be trained to use the cameras (5), a 90 minute training session. It seems they are not as easy as taking a selfie, and many staff found the training was not comprehensive enough.
  • ·         The video has to be uploaded to a cloud server at the end of each shift (5).
  • ·         These cameras are expensive. For just 12 cameras, the cost of equipment alone was £7,649 and the cost storage of the video for three months only was £569 (5). This doesn’t include the cost of staff time using them.
  • ·         The cameras do not upload their film automatically, it has to be connected to a computer to do so. Also, the video is stored on a cloud server (5), how safe is that? How easily can it be hacked? In May this year, many, many NHS computers were the victim of a mess cyber attack (6).
  • ·         The cameras seemed to have little impact on patient behaviour. During the pilot of them incidents of verbal abuse increased, actual violence increase, while the use of restraints decreased and complaints about the use of restraints also decreased (5).

They don’t seem the perfect solution to violence against staff that they are being painted as.

I work as a Community Nurse (Delivering nursing care in people’s own homes) and if my Trust introduced body worn cameras I would refuse to wear them, and my reasons why are very plain.

  • ·         I would be very concerned that about them affecting my relationships with patients, patients feeling the camera was spying on them and it was breaching their confidentiality.
  • ·         I also disclose personal details to patients from time to time, if I feel can help a situation, such as telling relatives of palliative patients that my parents have died from cancer. I don’t want this recorded with the potential for senior management to view it.
  • ·         What would happen to the recordings? This year’s cyber attack isn’t the only time the NHS has had data breaches.
  • ·         I don’t wear uniform, for safety reasons, and when I walking between patients’ homes, I don’t wear my work ID badge, because I don’t feel comfortable being identified as a nurse while out on the streets. These cameras cannot be worn discreetly.
  • ·         The majority of our complaints are about visiting times or patients complaining nurses said or did something they did not. These types of incidents don’t usually have obvious “trippers” so when would I start to film?
  • ·         These cameras are expensive, and I will argue the money would be fare better spent elsewhere providing patient care.
  • ·         The Berrywood Hospital pilot hasn’t shown any reduction in verbal or physical violence so why should we be using them?

I am not na├»ve, I know violence against NHS staff is a raising, there are almost 200 assaults on NHS staff a day (7), and that I am particularly venerable working as a Community Nurse, half of Community Nurses (who took part in an RCN survey) said they’d been assaulted at work (8), but I don’t see body worn cameras as the solution. I can see why they are appearing popular to senior management, they are a quick and easy fix, a “simple” IT answer. But a closer examination shows that they do not provide that solution.

Whatever happened to the zero tolerance to assaults on NHS staff? In 2015/2016 there were 70,555 recorded assaults on NHS staff, these assaults resulted in 1,740 criminal prosecutions and 1,588 civil sanctions (9). 2.25% of all assaults on NHS staff resulted in a criminal prosecution. Punch a doctor or a nurse and you have a very good chance of simply walking away. That doesn’t happen if you punch a police officer. So “zero tolerance” has just become another NHS catch-phrase.

Where is the political will, in the NHS or parliament, to tackle violence against NHS staff? Is it too busy looking at shiny, new body worn cameras?

Drew Payne