And The Truth About Stress

This winter has been very hard on the NHS; nearly a quarter of patients in A&E waited over four hours (1), far less than the 95% target of patients being seen within that time; there were more than 18,000 "trolley waits" (1), patients kept in corridors and on trolleys as they wait for a bed to become available; over 190,000 patients a month waited more than 18 weeks for their surgery (2); at one point 40% of hospitals issued alerts over bed capacity, which happened during the first week in January (3); it has all added £900m to the NHS deficit (4), and this all lead to the British Red Cross calling NHS a “humanitarian crisis” (5).

There has been a lot in the press and on our media about the effects all this has had on patients, there have been many stories of people’s grandparents lying on trolleys for hours on end, but there have been no stories about the stress this crisis has put NHS staff under. Working at this level is physically and emotionally draining, it well certainly take its toll from people. This is busy and stressful work day in and day out, no one day when the pressure eases up (No “slow Tuesdays”), no chance for staff to have an easier day. I have worked in situations like this and I know the physical and mental pressure this puts you under.

Sir Robert Francis QC, who chaired the infamous inquiry into Mid Staffordshire NHS Trust, said that the NHS was only being held together by the “superhuman efforts” of its staff (6). He is right, the extra effort staff have made at work, working above and beyond their required duties is what is holding the NHS together, which has preventing another Mid Staffordshire type scandal hitting the NHS. The RCN (Royal College of Nursing) has found evidence of nurses repeatedly working 12 hour shifts without a break or even without drinking enough water during their shifts (7).  But this situation cannot continue, staff cannot survive under this level of stress. As Sir Francis said: “It can’t carry on like that indefinitely without something going badly, or risking going badly wrong” (6).

How have staff been rewarded for this “superhuman effort”? With nothing!

NHS staff have faced a 1% pay freeze since 2010, as we are repeatedly told that it is patient care or our pay rise (Making it seem we are “selfish” for wanting a pay rise), and in reality our pay has been cut as inflation hits day-to-day prices. In this week’s budget there has been no extra funding for the NHS (8), so no pay rise for NHS staff. MPs received a 1.4 % pay rise last year (9), after they’d received an inflation busting rise of 10% in 2015 (10). This week’s budget did find an extra £2 billion for Social Care funding, but to be phased in over three years (8). This £2 billion has to be shared amongst 152 councils (11) and phased in over three years, this will not relieve the chronic under funding of social care by next winter.  This shortage of social care has caused 10% of NHS hospital beds to be filled by people medically fit to be discharge but who cannot be discharged because there isn’t the social care to support them at home, costing the NHS £900 million a year (12). Yet, at the announcement of this extra Social Care funding, Jeremy Hunt has demanded that all NHS A&E Departments MUST met the four hour target now (13). The Minister of Health, in the face of the “superhuman efforts” by NHS staff, has announced that we HAVE to work harder. Can anyone respect such an arrogant man?

This increased pressure has already had a severe impact on NHS nurses. Janet Davies, chief executive at the RCN, has said that conditions are worse than they have ever been in the NHS (14). Record numbers of nurses have applied for hardship grants just to make ends meet, the RCN also reported (15). The pay freeze forced on nurses is biting hard into nurses’ welfare. But many nurses are already voting with their feet and leaving the NHS. Last year 4,663 nurses requested verification certificates from the NMC (Nursing and Midwifery Council), the documents needed to work overseas as a nurse (16). Since 2011 26,028 nurses have request verification certificates (16). This is just nurses wanting to work overseas. The NHS has a record number of empty nursing posts. As of December 2016, there are 21,205 empty nursing posts in the NHS, 10% of the nursing workforce (17). Between 2013 and 2015, there has been a 50% increase in nursing vacancies (18). There seems no end to this shortage of staff, and all the stress it creates for NHS nurses. Universities have seen a 23% fall in the number of people applying to do nurse training since the Government removed bursaries for student nurses (19). Leading nursing academics have warmed that Brexit could also severely affect nursing numbers (20). There are 33,000 EU nurses working in the NHS (20), if they leave after Brexit (Whether voluntarily due to fears of job security or forced to leave due to post Brexit immigration legalisation) then the NHS will be in a severe crisis.

Whenever Jeremy Hunt has been challenged over the shortage of NHS nurses he has replied with the claim that he has “put” an extra 3,000 nurses on hospital wards (21). Yet 93% of NHS Trusts reported shortages of registered nurses and 78 per cent reported hard-to-fill nursing

vacancies (jobs vacant for three months and longer) (17). How does this equate with Hunt’s claim? Is this just another example of how little he understands about the real situation in the NHS?

I work as a Community Nurse, in a District Nurse team, and our team is made up of approximately 50% agency nurses. This week I have regularly one of only two regular staff on duty (The rest being agency nurses). Since 2012 our workload has over doubled but the number of regular nurses in our team has reduced. These stresses and staff shortages are right across the NHS. I have been a nurse for over 25 years and I cannot remember a time when stress levels were so high and moral was so low in the NHS.

The NHS’s staff are its biggest and most valuable resource, a resource that it should be valuing and caring for. Yet, the Government’s actions this week (The Budget [8] and Jeremy Hunt’s post Budget statement [13]) show how little they are concerned about the crisis affecting the NHS and over stressed NHS staff. On Sunday (5/3/17) 250,000 thousand people marched through London in support of the NHS and against the proposed £20 billion in cuts by 2020 (22). Why didn’t Theresa May, Philip Hammond and Jeremy Hunt listen to them? Is it that they just don’t care about the NHS?

Drew Payne