Friday, 21 April 2017

Jeremy Hunt: The Man Who Doesn’t Understand Nursing?

“If I put money into pay, it would be hard to increase doctor and nursing numbers.” Jeremy Hunt (1).

At a conference for senior nurses, last month, Jeremy Hunt made the above statement. He said he “dearly” wants to increase nurses’ pay but he just can’t, resources are too tight. He was basically saying that we, nurses, have a choice, a decent pay rise or more nurses working on the wards, he can’t do both. This is emotional blackmail at its worst. He should be ashamed of himself for trying to guilt people into accepting his own harmful policy, and for lying.

He is lying because it is his decision what pay rise nurses receive, he is the Sectary of State for Health. I, as a Community Nurse, have NO SAY over my pay rise. Nobody came to me and said, “You can have a pay rise equal to inflation but the five empty poles in your team will go unfilled.” I was never given that chose, even when Hunt is trying to use emotional blackmail to imply it is the only choice. Even for him it is not the only choice.

NHS resources have been cut to the quick. Since 2010 NHS funding has only increased by 0.9% a year (2), well below inflation and obscenely below the increased demand on the NHS. But Hunt is the Sectary of State for Health and could be making special petitions to the Treasury for more funding, he could be lobbying the Chancellor for a realist increase in the NHS budget, Hunt is a member of the Cabinet (3). But instead he does nothing, and when faced with angry nurses looking at another real term cut in pay, says his hands are “tied”.

Hunt says he “dearly” wants to give nurses a decent pay rise, but his previous actions show the opposite. In 2014 he vetoed a 1% pay raise for nurses (4). At the time he claimed that the NHS couldn’t afford this measly pay rise, and that it would lead to the loss of 15,000 nursing posts to pay for it (5). Hunt’s argument sounds all too familiar. Yet after industrial action, Hunt did a climb down and we got that 1% rise (6). Strangely enough, the NHS didn’t sack 15,000 nurses to be able to afford it.

But why does nurses’ pay matter? Because of the high number of nurses leaving the NHS. Last year there were 23,443 empty nursing posts in the NHS, 9% of the nursing workforce (7). Last year 5% of nurses did not renew their Nursing and Midwifery Council (NMC) membership (8). All Registered Nurses have to be registered with the NMC to work as a Registered Nurse, if you do not renew your membership you no longer can work as a nurse, or you no longer want to work as a nurse. There also has been a 92% fall in EU nurses coming to work here since the Brexit Referendum (9).

With such large numbers of empty nursing posts Hunt should be doing everything he can to fill them, nurses are the glue of healthcare because without us the vast majority of patients would not receive the treatment they need. Yet Hunt seems to be doing everything to increase those empty nursing posts. Nurses’ pay has fallen in real terms by 14% since 2010 (10), while MPs’ pay has increased by 14% since 2010 (11).  This has seen a 50% increase in nurses applying for hardship grants since 2010 (12), grants to help nurses pay household bills and mortgages and for travel to work, the essential things of life. Last year alone £250,000 was paid out in hardship grants (13).

The NHS is haemorrhaging experienced and well trained nurses. At the same senior nurse conference Hunt spoke about this, but his answer left me dismayed. “We need to think about new ways into nursing,” Hunt said (1). Instead of looking at keeping nurses in nursing, his attitude seems to be “Just find me some new ones to replace them.” Why isn’t he valuing the experienced nurses he has? A newly qualified nurse couldn’t simply replace me, with the best will in the world they would not be able to do all the clinical work I can. They would need the years of training and experience that I have been fortunate to accrue. The NHS needs nurses like me, especially as we face increasing demand from increasing unwell patients. Hunt needs to ensure the NHS keeps its experienced and well trained nurses, so why isn’t he doing this?

Retention of staff is about pay and conditions, is about keeping staff working for your organisation. How does cutting staff’s pay in real terms by 14% (10) while their workload increases year on year encourage people to stay in their jobs? How can Hunt think this is a rational way to run an organisation like the NHS? He cannot reply on the false idea that nurses are “dedicated” and therefore will work for low pay. Nurses need to pay the bills as well, and are leaving the NHS in droves to find better paid work. What will Jeremy Hunt do when there aren’t enough experienced nurses left to safely deliver patient care? How is this man still Sectary of State for Health?

Someone has published on Amazon the book Everything I Know About Nursing by Jeremy Hunt (14). It consists of 100 blank pages and nothing else, and it sums up so much of what I feel about Hunt. At the coming election I can but hope that Hunt will lose his seat and the NHS will be finally free from him. Unfortunately Theresa May would probably appoint someone just as awful and arrogant as Hunt to replace him, the NHS is such a low priority to her.

Drew Payne

Thursday, 13 April 2017

A Spoonful of Sugar

In my Trust’s staff canteen you get a subsidy off hot food (Including deep fried chicken and chips) but no subsidy for cold food (Including all salads and sandwiches). Which foods do they encouraging me to eat more of?

NHS England has announced that it wants to cut NHS staff obesity, and to do that they want to cut the consumption of sugary drinks in hospital, even banning the sales of them (1). It is recommended that we get only 10% of our daily energy intake from sugar, which equals 70g of sugar for men and 50g for women (2). A can of Old Jamaica ginger beer contains 52g of sugar, Coca Cola and Pepsi contain 36g (3). It is easy to see how these “full fat” drinks can surpass our daily sugar intake in only two different drinks, and that’s not counting the sugar found in our food.

NHS England claims that 700,000 NHS staff who are overweight (1). They say that because this affects people’s personal health it also increases rates of sickness (1). The NHS does have a problem with sickness. The NHS sickness rate, for last year, was 3.93% (4), which does not compare well to the national rate, for the same time, of 1.9% (5). Now all this sickness cannot be blamed on staff’s waistlines, even though it is always a good escape-goat. The high workload levels in the NHS and the ensuing stress levels surely have an effect on sickness rates.

The NHS has become an increasingly more stressful place to work. Cuts to resources and funding (in real terms), staff shortages (there are now 21,205 empty nursing posts in the NHS, 10% of the nursing workforce (6)), and increasing demand on NHS services (patients attending A&E Departments has increased by 6% in the last year (7)). It has all had a detrimental effect on staff. An RCN survey found that many nurses were too busy to take their breaks during a shift, or were even drinking enough water to keep hydrated (8), and this was happening right across the NHS, not just in emergency care. Yet it is a legal requirement that workers have three breaks during a shift, at least one being a twenty minute uninterrupted one, if we work for six hours or more, as part of working time regulations (9).

As a Community Nurse, I have forgotten the last time I took my lunch break, I am just too busy to do so. I come back to our office, after a full morning visiting patients, and immediately start my patient follow-up at my desk (Ordering medications and dressings for patients, referring patients to other services, catching up on my paperwork). Because I have afternoon patient visits this is the only chance I have for patient follow-up, my lunch break. Therefore my lunch is snatched at my desk, because of this I need food that is easily eaten, sandwiches and bottled drinks. I am not the only nurse who does this. When lunch has to be snatched then it has to be something quick and easy to eat, processed and fast food provides this, even though they are not the healthiest of options.

Banning or surcharging sugary drinks might be a step in the right direction but it is only a small step and not the complete solution for improving staff’s health. Management could take much more sweeping measures to help make staff’s working environments make them more healthy, such as: reducing workplace stress, being realistic with workloads and ensuring staff are not regularly over-stretched; make breaks compulsory and ensure staff take them, and provide staff rooms away from the clinical area for staff to take their breaks; encourage training away from the clinical area were staff can keep themselves up to date; and provide staff with decent on site gyms. There is a lot to be done to promote staff health. And this shouldn’t be done because staff are “role models” or just to reduce sickness, it should be done to benefit staff.

Of course even if they do ban the sale of sugary drinks in hospitals this will have no effect on many NHS staff’s lives, those who work in the community.

What leaves a cynical taste in the mouth is that this is the cheapest and least option they could do, banning the sale of sugary drinks. It costs nothing, would be easy to implicate and could actually generate positive publicity. Aren’t we, NHS staff, worth more than a cheap stunt? The NHS’s staff are its biggest resource and yet our well-being seems to be of a lower priority then painting hospital buildings. Who cares about NHS staff, not the NHS?

Drew Payne

Friday, 7 April 2017

Where Have All The EU Nurses Gone?

I work as a nurse in London and I’ve always worked in very ethnically mixed staff teams, it’s one of the joys of working here. I currently work with a Portuguese nurse who is extremely good, when she was promoted to a Band 6 role I was very happy.

I have worked with many, many EU nurses. They have been some of the best nurses I've worked with. The NHS in London would not be able to function without all the EU nurses who work here. But London isn’t the only place in this country were the NHS is reliant on EU nurses. The NHS employs 33,000 EU nurses (1), a little over 10% of all the nurses it employs (2), and these nurses have enabled many NHS services to keep going.

But it now looks as if we are to lose those EU nurses we so desperately need.

A Freedom of Information request has shown that there has been a 92% fall in EU nurses coming to work here since the Brexit referendum in July (3). Only 96 nurses applied to work in Britain in December 2016 (3), compared to 1,304 in July 2016. 2016 also saw 2,700 EU nurses leave the NHS, when only 1,600 left in 2014 (3). That is a 68% increase.

This only adds to the shortage of nurses plaguing the NHS, and leaves it facing a problem that will only impact on patient care.

Since 2010, there has been a 15% fall in the number of student nurse places being funded (4). Add to this that there is a dropout rate of 26% on nurse training courses (5) and we are not training enough nurses. We are also facing an ageing nursing population, 45% of registered nurses are now over 45 (4).

Since 2003 there has been a 50% increase in empty NHS nursing posts (6), EU nurses have been very important in filling many of the gaps in the NHS nursing workforce. Without them we would be a far worse place than we are now, but soon we may be finding out what that place will be like. We are losing our EU nurses and we should be very worried.

There is only one reason for this sudden and huge lose of EU nurses and that is Brexit. No matter how you voted in the referendum, Brexit has made Britain a very unattractive place for EU workers. This could have been eased by Theresa May offering a guarantee to all EU workers in Britain that they are safe to continue working here as long as they want to, but she has refused to do this (7). Therefore Britain is no longer seen as a safe place to work for EU nationals, and the NHS is suffering already.

What is Jeremy Hunt, Minister of Health, doing in the face of this sudden and dramatic loss of EU nurses? Is he lobbying Theresa May for special protections for EU nurses? Is he working hard to portray the NHS as still a safe and welcoming place for EU nurses to come and work in? No. He is denying that there is even a problem. He has said, in answer to MPs questions about this 92% fall, that it was not caused by Brexit but, “the reasons why there has been a drop in the number of nurses coming from the EU is because, prior to the Brexit vote, we introduced much stricter language tests.” (8) The level of his denial is breath-taking and this is the man in charge of the NHS, but he has previously bluntly ignored problems facing the NHS, why should we expect different now?

The NHS needs its EU nurses, there is no debate about that because the figures back this up, but Brexit has cast a shadow over them. If we lose them the NHS will hit a crisis that could easily eclipse the Mid Staffordshire scandal (9). But our leaders are openly ignoring this. Theresa May’s and Jeremy Hunt’s words and actions show that they are not concerned about this and are not going to take any actions to stop this.

What do we do when our political leaders ignore another crisis facing the NHS?… Pray for a revolution?

Drew Payne

Thursday, 30 March 2017

The NHS: A Happy and Safe Place to Work?

For most of my working life I’ve worked for the NHS, for different organisations and different Trusts, in a lot of different jobs. My very first job, even I trained as a nurse, was working for the NHS, it was back in 1984 and it was entering data into a computer, in an old prefab building in the grounds of a Liverpool suburban hospital.

I have seen many changes in the NHS over the years, many Governments have “reformed” it, and there have been many changes to its structure, and many of these changes have not been for the best. The one thing that has always been a constant is the staff. The NHS is the biggest employer in the country, and is the fifth biggest employer in the world (1), its staff are its biggest resource. An empty hospital never made anyone well, it’s the staff that work there that do.

So what is it like to work for this huge institution?

Since 2003 the NHS has run its Staff Survey (2). This yearly survey asks NHS staff about their experiences
of working for the organisation. Since 2010 the NHS and its staff has been under enormous stress and pressure, budgets have been cut, there are staff shortages, pay has been frozen and yet demand on the NHS keeps increasing. Last winter, a mild winter, saw the NHS plunged into another “winter crisis”, now almost a yearly event. Therefore we would expect the NHS Staff Survey would be full of negativity and staff stress being vented, but it’s the opposite.

The latest Staff Survey (3) paints a picture of staff who enjoy their work and value working for the NHS. 75% see the NHS’s priority as patient care and 75% are enthusiastic about their jobs (4); 59% of staff said they always look forward to going to work and 60% would recommend the organisation they work for as a good place to work (4). Staff still value the NHS and enjoy their work. Sir Robert Frances (the QC who chaired the enquiry into the Mid Staffordshire scandal) said that the NHS was only being held together by the “superhuman efforts” of its staff (5).

So the NHS is a great place to work in for everyone. Well yes and no. Unfortunately, it is not the same for everyone.

Black and ethnic minority staff (BME) are much more likely to be bullied and harassed by white colleagues and managers, the first national review by NHS England (6) found. It found one trust were BME staff experienced twice as much harassment from colleagues than white staff, and in over 80% for Trusts BME staff faced far higher levels of discrimination from managers than their white colleagues.  Yet levels of harassment from relatives and the public were the same for BME staff and non-BME staff (6).

In 2014 a damning report was published into the state of BME staff in the NHS, called The Snowy White Peaks of the NHS (7), a title that is more than ironic. Its findings are very uncomfortable. In all the NHS Trusts serving London, the most racially mixed city in the country, the vast majority of leaders were white. This was repeated at national level, with key NHS organisations and healthcare regulators having very few BME staff in top leadership roles. Only 3% of Directors of Nursing being BME nurses, a figure that had not changed in ten years. The number of BME nurse managers fell from 8.7% in 2007 down to 7.8% in 2012, with few BME nurses at Band 7 and 8 (7); 14% of the population of England and Wales is non-white (8).

This report maybe three years old but we just have to think about our own Trusts, how many of the senior managers are non-white. In the Trust I work the senior management is very white experience.

But it isn’t just racism that NHS staff face, the organisation is not free from homophobia either.

In 2015 Stonewall (the LGBT campaigning organisation) published Unhealthy Attitudes (9), their report
into the treatment of LGBT health and social care staff; and it was shocking reading. It found that one in four people (25%) had heard a colleague make negative or homophobic statements about LGBT people, and one in five (20%) had hear negative statements about trans people. A quarter (25%) of them had been the victims of homophobic bullying from patients and service users, and 10% had heard colleagues make claims that LGBT people can be “cured”.

These statists may sound cold but the report also carried the realities behind them, it was full of personal quotes. The nurse who was told he should be hung for being gay, by another nurse. A nurse's manager told her that homophobic comments were “only banter”. A nurse who was ostracised by his whole staff team, at work and socially, when it came out he's gay. And many comments were trans people are called “it” or “she-male”.   Then there were the NHS staff who almost wore their homophobia as a badge of pride. A Healthcare Assistant who said people are not born LGBT but “choose” this “lifestyle”. A doctor referring to anyone he doesn't consider “normal” as “deviants” whose needs shouldn't be “forced” on the majority.

This year’s Stonewall Top 100 Employers list (The top 100 employers who have worked to be inclusive and to be a safe place for LGBT people to work) is out (10), and only seven of them were Health and Social Care organisations. None of the top ten organisations were an NHS ones, and only one of the top fifty was an NHS organisation, St Andrews Healthcare at number 43. None of the big NHS Trusts or any of the famous ones even made it onto the list. This speaks volumes about how seriously NHS organisations take LGBT inclusivity.

How has the NHS got into this situation? Unfortunately, it reflects the wider society we live in, with all its prejudices and discriminations. We still do not value difference in people. NHS senior management is still dominated by white heterosexual people, and too often they promote people like themselves. We still often only pay lip-service to diversity, seeing as a tick box on the mandatory training list. My own diversity training this year was an online presentation, that took 15 minutes and it covered all “minorities”.

We need a culture that values all NHS staff, and values the differences people can bring to their roles. LGBT and BME people are part of our society that the NHS serves. If the NHS does not value and encourage its own LGBT and BME staff then how can we say we can offer non-discriminatory care to LGBT and BME patients?

The NHS is a far more positive place to work then it was in 1984 (When I first worked for it) but it still has far to go, though on the other hand there are worse employers to work for.

Drew Payne