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

Friday 11 August 2017

Money For Nothing and Your Chips for Free

Jackie Smith, the chief executive of the Nursing and Midwifery Council (NMC), the nursing regulator, received a pay rise of nearly £20,000 last year on her basic pay. That is an 11% pay rise, but that was only on her basic pay. Her overall pay package rose to £256,027, a £35,743 rise, which includes a £11,921 “performance bonus” (1).

That £35,743 rise is equivalent to the yearly salary for a Band 6 Nurse (1), someone working as a Junior Ward Manager or Deputy Team Leader. In one year she has received a percentage increase in her salary greater than the combined pay rises NHS nurses have received since 2010. Since 2010 NHS nurses’ pay has risen by only 6% (2).

Is she worth this pay rise?

The NMC seems to think so. In their annual report they said, “Executive salaries in the NMC were generally out of alignment with median pay for comparable roles in the wider market, in some cases considerably so.” (1) It may sound familiar because it’s the same argument that was used in 2015 when MPs received an inflation busting 10% pay rise (3). That wasn’t a popular move.

Is she earning her £256,027 salary?

The NMC’s own Annual Report and Accounts 2015–2016 (4) details many of the NMC’s current failings. From it I learnt of the following failings:
  • They had a staff turnover of 23.5%, 24.5% the year before. Nearly a quarter of their staff left in a year, and just under a quarter of their staff left the year before. It must be a pretty toxic working environment.
  • It has taken until 2016 for nurses to be able to pay their registration fees in quarterly instalments, we still can’t pay in monthly instalments because that still seems beyond the NMC to organise.
  • As of March 2016, the NMC had £41million in reserves, yet their annual report makes no mention of using these reserves. In 2015 the NMC imposed a 20% increase in nurses’ fees because they said they needed that money to function, especially to pay for Fitness to Practice hearings (5). So if this was the case why do they have so much in reserves?
  • They had 120 data breeches, one more than the year before.
  • Their own Head of Internal Audit found that the NMC’s own internal control, governance and risk management were failing. “Significant improvements” are needed.
  • The Head of Internal Audit’s report found deterioration in services from having so many temporary senior managers, especially in Finance, Procurement, HR and Technology Business Services.
  • There were “specific weaknesses” in the NMC’s finance and procurement controls, there are serious problems in their financial department.
  • Their high staff turn has also resulted in “increased costs”, money wasted because the NMC has created such a poor working environment.
This are just the failings that the NMC themselves identified, even though their annual report tried to wrap them up in positive sounding management speak.

The Professional Standards Authority (PSA) is an independent body, accountable to Parliament, which has a duty to oversee the work of the nine statutory bodies that regulate health and care professionals in the UK, including the NMC (6). For the last two years they have produced an annual report comparing all the organisations they regulate and how well each organisation is operating. Their recent report did not paint the NMC in any type of glowing light (7). They found the NMC failing in the following ways:
  • The NMC took the longest time, out all nine regulators, from receipt of initial complaint (About a registrant) to their final decision. Their avenge time was 51 weeks, their longest time was 401 weeks (7). The NMC’s own Fitness to Practice report 2016-2017 (8) stated all that Fitness To Practices should be resolved in 15 months, not a fast resolution.
  • PSA requires regulators to deal with complaints as quickly as possible, but the NMC failed this standard and the PSA were not convinced that the NMC was improving.
  • They were also concerned about the lack of transparency when the NMC reached agreements were the nurse resigned from the register rather than face an investigation or a Fitness to Practice hearing.
  • The PSA has the power to refer complaints to the High Court when they feel a regulator has been too lenient in their Fitness to Practice decision, 62% of these actions were following NMC Fitness to Practice decisions. On “several occasions” PSA had to seek legal injunctions to stop the NMC allowing a registrant to resign from the register before the PSA had referred their Fitness to Practice decision to the High Court.
These are incredibly serious failing and all of them revolved around Fitness to Practice hearings, something that the NMC has repeatedly failed at. The previous year the NMC failed to meet five of the PSA’s standards (9). They have improved but it is disgusting that they first got into this position and that it took a PSA’s report to force them to improve. Would they have improved without this public naming and shaming by their own regulator?

What is most shocking, though, is that the NMC is being stripped of its supervision of midwives (10). They will continue to regulate midwives, but they will be stripped of their statutory responsibility to also supervise midwives. This is a huge change to the NMC, they are being stripped of one of their statutory responsibilities. The NMC are trying to spin this as a positive change (11), but this is a result of NMC failings. A damning Kings Fund report (12), commissioned by Parliamentary and Health Service Ombudsman following the failing in maternity care at Morecambe Bay NHS Foundation Trust, found that the NMC was not suitable to carry on supervising midwives. This is all in the light of this week’s news that maternity units in England were forced to close 382 times last year because of shortages of midwives (13).

These are not the only issues the NMC has in its role as regulator, it is failing nurses in so many different way.

It can take the NMC two to three months to be process a newly qualified nurse onto the nursing register and get them their PIN number (14), without which they cannot work as a registered nurse. This makes starting their first job challenging at best.

Disproportionate amounts of BME, male and older nurses are referred to Fitness to Practice hearings. 16% of new complaints to the NMC are about BME nurses, but only 7% of registered nurses are BME (15). 25% of new complaints were against male nurses and men make up only 11% of registered nurses (15). Nurses over 40 make up 76% of new complaints, and yet only 69% of registered nurses are over 40, and four out five nurses struck off by the NMC are over forty (16). The NMC has a legal responsibility to reduce discrimination, yet all they seem to have done is commission research that told them a disproportionately high number of BME nurses receive complaints against them (8), nothing more than that. So far they have announced no plans to tackle this obvious discrimination, nor do they seem very interest in it.

The NMC will regulate the new role of nursing associates (17), but soon as that was announced they showed that they actually understand very little about the role of the Registered Nurse. They released proposals to change Registered Nurse training (18), which was obviously designed to draw a distinctive line between Registered Nurses and Associate Nurses but all it showed was how little they actually know about the role of the Registered Nurses (19). They seemed to think it is solely made up of performing physical tasks.

Recent NMC Fitness to Practice Hearings have produced some very questionable findings. Jane Kendall, the nurse who was convicted of harming a patient because she didn’t perform CPR on that patient after they had died over an hour before. Donna Wood was convinced of falsely recording a temperature when there was no physical evidence that she did. They even tried to prosecute Pauline Cafferkey for contracting Ebola, they failed and were publicly roasted in the media for doing so. Their response to this was to no longer publish the names and allegations of nurses and midwives under investigation (20), removing another level of transparency.

The NMC proposes to split the role of mentor into practice supervisors and practice assessors (20a), were the supervisor would train the student and the assessor would only assess them. It is hard enough to find enough nurses to act as mentors, under this scheme we would have to double the numbers, even before we come to all the problems inherent with splitting the role. Again they showed they do not know what is involved in the role of a Registered Nurse, and they regulate the role.

Nursing is in crisis now and the NMC has provided no leadership on any of the problems facing us. They have been overly silent on the following issues:
  • The 40,000 nursing posts that are vacant in the NHS, leaving far too many wards, units and teams seriously under staffed (21).
  • In March this year, more nurses and midwives left the NMC register (affectively stopping working as nurses and midwives) than those who joined it (22). A reduction in the number of nurses and midwives.
  • There are still no safe staff levels for wards, departments and the community (23). This leaves units seriously understaffed and dramatically increases the workloads of nurses working there, the perfect storm for mistakes to happen.
  • Less people are applying to train as nurses. There was a 19% fall in people applying to train this year, and a 28% fall in mature students applying (24). This is when we need more nurses, not less.
  • There has been warning sign (25) after warning sign (26) that the NHS is heading towards a crisis. Sir Robert Francis QC said it was only the “superhuman” efforts of NHS staff that prevented the NHS breaking during the last winter (27). It is now the summer, traditionally a less stressful time for healthcare, and the NHS is so flooded with demand that the near-breaking strain has not eased up. The Point of Care Foundation said that NHS staff have become the “shock absorbers” for the overwork and demand heaped onto the NHS (28).
Yet the NMC has remained silent over all this, no advice, no guidance, no leadership. It is as if the NMC is not bothered by any of this. If nurses are under increasing stress and workloads, with falling numbers of actual nurses, this is the perfect situation for mistakes and errors to be made. Surely, as the nursing regulator the NMC would want to cut down on any mistakes? Or are they only interested in running Fitness to Practice hearings?

The NMC’s predecessor, the UKCC held regular elections to its governing council (29). All Registered Nurses were able to vote for who would be members of it. We cannot do this with the NMC because their governing council are appointed, after a selection process, by the Privy Council (4). As nurses, we have no say in the running of our regulator, the NMC, and no way to change their failings.

In 2015, Professor Ian Peate, professor of nursing at the school of health studies in Gibraltar and editor-in-chief of the British Journal of Nursing, wrote a scathing editorial criticising the NMC’s performance (30). He basically called them unfit for purpose, I cannot see how NMC has improved since then. His assessment of them still stands.

Is Jackie Smith worth £256,027 a year?

I cannot see how. Researching this blog left me feeling sick and demoralised reading all the failings of the NMC, and by how little the NMC seems to be doing to correct them. Jackie Smith is at the helm of this organisation and seems unable or unwilling to solve these failings. How can the NMC turn themselves around with Jackie Smith still in charge? The organisation needs a new chief executive, a new leader to solve their problems. But after bestowing an obscenely large pay increase on Jackie Smith, there seems no desire to do this by the NMC’s council.

As for me, there is nothing I can do about this, I have no voice in the NMC, but I still have to pay them my annual fee otherwise I cannot work as a nurse. I have no say in this at all.

Drew Payne