Making My Vote Count

No one could not have notice that there is a general election on the 8^th June. Not many of us saw this election coming, and it can be argued that many of us don’t even want this election, but it is happening. 23.59, on 22 May is the last day we can register to vote (1), but we can register on line here. 

Already Brexit is already dominating the media coverage of this election but an election should never be about one subject. An election should be about the whole of a Government’s policies and how they have behaved in government. This government’s record on the NHS has been anything but high quality.

We have just come out of another winter crisis, the third winter crisis the NHS has suffered in a row (2), even though the past three winters have all been mild, without any long cold spells (3, 4. 5). And this is only one of the many problems facing the NHS.

As nurses we have a voice and we need to make our voices heard in this election. We must stop the agenda just being about Brexit and what the politicians want us to hear. Health unions have already called for this election to be about the state of the NHS (6), unions including the RCN, BMA, Unite, UNISON and the Royal College of Midwives. The Royal College of Nursing (RCN) has already launched its “Nursing Counts” campaign (7), to ensure healthcare priorities are at the heart of all the political parties’ manifestos. 

But what can we do as individuals? In reality we don’t elect a Prime Minister at an election, we don’t vote for a specific political leader, what we do is elect our local MP, who then has the responsibility of representing us in parliament. Therefore shouldn’t we ensure that the candidate we vote for has our best interest at heart?

At the last election I emailed all my local candidates asking them how they would support the NHS, their responses were certainly a mixed bag and often not what I wanted to hear (You can read my blogs about it all here, here, here and here). But this hasn’t deterred me. At this election I am going to do exactly the same. This time I will also blog about it and the experience, we need to engage with candidates or how else will they know our concerns. At the end of this blog I’ve pasted the email I’ve sent to my local candidates, complete with reference links. Feel free to use any or all of it if you want to email your local candidates too (Details of your local candidates can be found here).

Wouldn’t it be wonderful if every nurse in the country emailed their local candidates and quizzed them on how they were going to support the NHS? Those candidates wouldn’t be able to ignore the problems facing us and the NHS. Wouldn’t it be wonderful if everyone who reads this blog emails their local candidates? We need to make our voices heard, we need the candidates to listen to our concerns, otherwise the media will make all the running and all we will hear about is Brexit. Nursing and the NHS deserves better.

Drew Payne

Why Should I Vote For You? email

Dear ______,

I live in the ______ constituency and I intend voting at this coming election, but my vote is very precious to me, I only get one vote, and I want to make my vote count. As a candidate, you want to represent me in parliament, I want to know that you will support my concerns and worries if you were elected.

I am a nurse, working in the NHS, and I am very worried about the state of nursing today. Nursing is under threat from the following factors:

•         Last year there were 23,443 empty nursing posts in the NHS, 9% of the nursing workforce (a1).
•      93% of NHS Trusts reported shortages of registered nurses and 78 per cent reported difficulty in finding nurses for hard-to-fill nursing vacancies (jobs vacant for three months and longer) (a2).
•         Last year 5% of nurses did not renew their Nursing and Midwifery Council (NMC) membership (a3), they effectively left nursing because you cannot practice as a Registered Nurse unless you are registered with the NMC.
•         There also has been a 92% fall in EU nurses coming to work here since the Brexit Referendum (a4).
• ·       Since 2009 there has been a 28% fall in District Nurses numbers and the Community Nurse workforce has shrunk by 8%, putting a huge strain on this important service (a5).
• ·         Since 2010, there has been a 15% fall in the number of student nurse training places (a6).
•         This year saw a 23% fall in people applying to train as a Register Nurse, after the scrapping of student nurse bursaries (a7, a8, a9, a10).
•          Nurses’ pay has fallen in real terms by 14% since 2010 (a11).
•          There has been a 50% increase in nurses applying for hardship grants since 2010 (a12), last year alone £250,000 was paid out in hardship grants (a13).
•          Last year there was a 3% increase in emergency admissions to hospital via A&E (a14), yet last year NHS funding only increased by 0.9%, as it has done year on year since 2010 (a15).

Nurses are the glue of healthcare, without us so much patient care just would not happen, yet our profession is being eroded. What would you do, if you were elected my MP, to reverse this erosion and to protect and value nursing? 

As I said, my vote is very important to me, as a voter and also as a nurse. Why should I vote for you in this coming election?

Yours,

Drew Payne (Mr),

(Email address) – to make sure they can reply to me

(Postal address) – to show that I live in their constituency

Just Another Occupational Hazard?

The RCN surveyed 1,300 community nurses (1) and their results weren’t comfortable reading for me, a community nurse myself.

A half of those community nurses surveyed had been the victim of abuse at work, and one in nine had been physically and verbally attacked. Yet only 13% of them have personal alarms (even though they were widely available in 2009 for lone workers and originally government funded).

Cost-cutting measures are putting community nurses’ safety at risk but it goes further than the lack of personal alarms, it is the increased pressures being put on community services without extra resources. 

Hospitals have to treat more patients for less money (The yearly increase to NHS funding being only 0.9% [2], well below even inflation), so they are discharging patients earlier and earlier, and more and more ill patients are being treated in the community, but there hasn’t been the extra resources put into the community to meet this increasing demand.

Community health services have around 100 million patient contacts each year, and account for about £10 billion of the NHS budget (or 8.3% of all NHS spending) (3). There has been a 15% increase in District Nursing workload between 2011 and 2015 (4) yet the NHS only plans to increase spending on Primary Care as a whole between 4% and 5.5% year-on-year for the next five years (5). There has already been a 15% increase in the workload and it shows no sign of decreasing, this planned increase in spending will be far outstripped by demand. This does not take into account the £2.5 billion cut in Social Care funding, 20% of their funding (6); which also has a severe knock-on effect on District Nurse caseloads.

There has also been a huge fall in the numbers of District Nurses and Community Nurses. Since 2009 there has been a 28% fall in District Nurses numbers and the Community Nurse workforce has shrunk by 8% to 36,600 (4). This alone puts a huge strain on the service.

Patients’ expectations of what can be provided in the community are often unrealistic, measuring it against the very public targets of A&E Departments, and expecting instant access to services. More people want medical input for things that they can manage themselves (“It’s a nurses’ job to give my granny her tablets. The nurses did it in hospital”). The community isn’t an acute service and many patients are reacting with anger and frustration when they are faced with its limitations.

Also, patients in the community are often not aware of shortages of Community Nurses. Sometimes the only time they are aware of it is when they have a visit cancelled. Patients on hospital wards can see how many or how few nurses are on duty and how busy they are. Patients in the community only see a Community Nurse when they visit that patient’s home, they cannot easily see how few nurses are available and how busy they are. Patients are isolated away from the stresses that many Community Nurses are under.

More and more working practices are also putting community nurses at risk, nurses working on their own on late shifts until ten o’clock at night, twilight and night time community nurses working on their own, community nurses working in uniform, poor or unrealistic Lone Worker Politics, staff working without easy access to senior nurse support, working with unrealistically large caseloads and lack of time to do full risk assessments.

Often senior manager’s poor handling of abusive patients makes the situation worse. Senior managers who are reluctant/afraid to confront abusive patients, managers’ fear of generating complaints (“Don’t upset Mrs. ____, because she’s only put in another complaint”), also the pressure to meet targets and numbers of patients treated.

The NHS has always been poor with dealing with abusive patients, but worst so in the community because the argument always comes back, “They’re housebound, who else will see them if community nurses won’t.” A friend of mine, another community nurse, was punched by a patient at work. The same patient had slapped another nurse and been racially abusive to other nurses. Senior management wouldn’t remove treatment from this patient, still requiring nurses to see her. They were only spared further abuse when the patient went into hospital.

NHS Improvement has produced “Safe, sustainable and productive staffing in district nursing services” (7). These draft guidelines are designed to identify “the organisational, managerial and contextual factors that support safe staffing” in the community. But these guidelines do not make any recommendations as to what are safe staffing levels or safe caseloads numbers, instead recommending that that these numbers be agreed “locally”. This fudge could easily lead to poor staffing levels being accepted as the norm, and asks the question what is the point of these guidelines?

Cuts have put community nurses safety at risk but it goes deeper than just lack of personal alarms. We know of the problems caused by under staffing on hospitals wards, no one in the NHS can forget the Mid Staffs scandal (8), why aren’t we more concerned about the same problems in the community?

Drew Payne