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

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

Stop Lying Jeremy

“Oh Jeremy, stop lying!”, is the edited version of what I shouted at the television, on Monday evening, as yet again they reported another ridiculous statement from Jeremy Hunt (1).

This time Hunt was hinting that the government could redefine the 4 hour waiting time target in Accident and Emergency. He said that the 4 hour target should only apply to patients with “urgent needs” (1). Again, Hunt was faced with a crisis in the NHS and he responded with weasel words. The NHS is in crisis, it needs strong leadership, it needs help and understanding, it needs resources and funding, all it gets from this Health Minister in an attempt to wriggle out of the crisis. Again Jeremy Hunt fails in his job.

This January hospitals are facing huge demands on their services and Accident and Emergency Departments are breaking under the strains (2). A third of NHS trusts in England had issued alerts that they needed urgent action to cope with demand (3). More than one in ten patients faced long delays, well over four hours, waiting for a hospital bed after being admitted via A&E (4). NHS hospitals are full, no spare beds, patient beds are being placed in day rooms and staff rooms and even treatment rooms, places that were never designed to house patient beds. New patients cannot be admitted until other patients are discharged, the system is blocked.

Two patients died while waiting in a corridor for treatment, at the Worcestershire Royal Hospital (5). Their deaths are currently being investigated by I can’t help but ask, would they have died if they had been sitting on a hospital trolley in an A&E bay?

This whole terrible situation has been called a “humanitarian crisis” by the British Red Cross (6). Mike Adamson, the charity's chief executive, said that the British Red Cross is currently providing support in twenty different A&E Departments (6). Their assessment of the current situation is damning, but what is more damning is that a charity is helping to prop up our A&E departments. What has gone wrong?

Our press is full of claims of mismanagement and over spending, but the truth is this crisis should be firmly laid at the feet on this government.

Jeremy Hunt also said of people attending A&E that “30% of whom do not need to be there” (1). Figures from The Kings Fund show this isn’t true (9). from the Patients’ Survey in 2015, they found that of the 11% of patients who couldn’t get GP appointments when they wanted one, 4% of these people went to A&E. That is 4% of 11%. Not the 30% of all A&E attendees that Hunt was claiming. But the number of patients using A&E because their GP is unavailable could be increasing. Dr Helen Stokes-Lampard, chair of the Royal College of GPs Council, has warned that many patients have to wait four weeks or more for a routine GP appointment, because of the pressures on and short falls in GP Practices (10). In that time a non-urgent problem could easily become an urgent one.

Local Authority budgets have been cut 40% since 2010 (7). This has left social care at

breaking point, it is now very difficult to get new someone home care, and finding a bed in a Care Home is nearly impossible, because there isn’t the funding for it any more. This creates a bottleneck in healthcare, elderly patients cannot be safely discharged because there isn’t the home care available and neither are the Care Home places. But this lack of social care creates another pressure on the NHS, there are elderly people at home who are not getting the social care they need. Because of this lack of social care their health deteriorates and they have to be admitted to hospital. My own local council has seen their social care budget “outrageously” cut (8)

NHS budgets are also suffering too. 64% of trust finance directors and 88% of acute trusts are forecasting a deficit at the end of the financial year (11). This is not due to any mismanagement on behalf of these NHS organisations, this is due to the financial cuts, in real terms, in NHS budgets. Demand on NHS services has increased far higher than the current inflation rate, which is 1.2% (12), yet the NHS’s funding is only increasing 0.9%  a year (13), and this doesn’t take into account the £22 billion of “efficiency” savings the Department of Health is demanding from the NHS by 2021 (14). (The second half of my blog posting Four Corners of the Same Room goes into this in much more detail)

So what has our Government done about the crisis overtaking the NHS? Simply put, not much.

In last year’s Autumn Statement Philip Hammond, the Chancellor, announced no extra funding for the NHS or social care (15). it was not as if he couldn’t see this year’s winter’s crisis, the target for treating 95% of patients attending A&E within 4 hours was missed throughout all of last winter (16), and last winter we knew that the cuts in social care was preventing hospital discharges. Even Andrew Lansley, the Conservative architect of the 2011 reforms of the NHS, warned that the NHS and social care needed more funding (17).

Jeremy Hunt told parliament that the 4 hour A&E target might be revised and claimed 30% of people visiting A&E were not appropriate (1) (In 2014, again in parliament, Hunt admitted he took his children to A&E at a weekend because he couldn’t be bothered to wait for an Out of Hours GP appointment (18)). That’s as far as his leadership has gone.

Theresa May criticised the British Red Cross for calling this a “humanitarian crisis” (19). Neither her of Hunt have offered any political leadership or responded practically to this crisis. We cannot expect any more from Hunt, he has show poor or non-existent leadership in the face of previous NHS problems. Theresa May showed how low a priority the NHS was to her when she became Prime Minister and left Jeremy Hunt as Health Minister. Her priority is Brexit and she seems to have so little interest in the NHS.

Again we are faced by a winter crisis in the NHS, this is not a new crisis, it has been happening for several years now, and still we are here again. Our government could have prevented it, instead they react like they were caught off guard by this very predictable crisis. What are these people being paid for?

Drew Payne