The demands on the nursing profession continue to increase as the pressures on the NHS begin to take their toll
Another New Year is upon us – but the same old health crisis media stories have followed into 2015. You know them: long waits in A&E departments, bed blocking by elderly patients, increased risks from reduced social care budgets, not enough nurses, decisions being made by non-qualified call handlers and GPs appointment delays. The list goes on.
The gloves are off and punches are being distributed across the NHS. The public have been watching a drama unfold. It started with 17 hospitals declaring a ‘major incident’ that called for closure of admissions to their A&E dept. Across all 181 A&E depts only 79.8% of patients were seen within the four-hour target. Respected clinical leaders began to voice their concerns at the planned closure or downgrading of A&Es when attendance has actually increased by 13% over the past years.
The government responded that ‘hospitals were busy but not in a crisis’, provoking an A&E consultant from Brighton to write an open letter challenging the Prime Minister David Cameron to reconsider his understanding of ‘crisis’ citing some wretched experiences A&E staff face every day – and challenged him to a real debate with real workers at the frontline.
What are causes of this growing healthcare discontent?
Bed blocking has never been so high involving a record number of patients and bed days lost. If you can’t discharge patients you can’t admit: elective procedures are cancelled. Dramatic Government budget cuts to social care support are blamed for the situation where patients ready to be discharged end up blocking beds because suitable care packages cannot be put in place. Market factors have an impact: The Guardian outlined where private homecare providers are unwilling to take on clients that require a number of visits in a day and are geographically isolated: it is not economically viable for the business.
A South Coast hospital has been considering charging relatives for the care of delayed discharge patients. Are relatives really unable or unwilling to support their family members discharged back into the community? Although this is incredibly sad it’s not untrue. We know that the demands of frail confused convalescents can challenge paid, able bodied professionals.
GPs were accused of being unavailable or not offering timely appointments, so patients went to A&E for their colds, minor ailments and repeat prescriptions – a four hour wait is better than a four day wait. GPs report being ‘burnt out’ with CQC inspections, DH targets and demanding patients are taking early retirement leaving virtually 34% of practices with a GP vacancy unable to be filled. Add to that, 12% of GP trainee places remain vacant. Patients are now used to seeing locums.
Ambulance and paramedic crews voiced frustration at queuing for hours to discharge sick patients at A&E finding themselves in the middle of dysfunctional primary and acute care. The new telephone triage service 111 was blamed for their unqualified call handlers being over cautious and sending more patients to hospital that the previous provider, NHS Direct, did. Why did we ever disband the nurse-led NHS Direct?
Nurses got a bruising in the turmoil. There were calls that there are not enough of us to open more or maintain bed capacity, too many of us are foreign, too many of us are agency staff or we have got degrees or we have not got enough training or compassion for the role. A chief executive interviewed on BBC Radio 4 suggested we need to widen recruitment by reducing training of the A level educated 18-year-old to the more mature, less academically gifted, who would make fantastic nurses and who would stay in nursing longer. I despair at the ‘football’ this profession has become in the failing NHS.
Regretfully, I forecast things will get worse and nursing will be affected by the impending row. The reason? There will be a need for more nurses to meet patient demand in a seven-day acute service along with the continued shift to the community setting for long term conditions. The Government has warned that enhanced pay for weekend and unsocial hours is archaic and unsustainable in the 21st Century. They cite most 24-hour providers have staff that work flexibly without additional remuneration. Apparently, it cannot afford increased staffing levels and pay higher rates for unsocial hours. Reducing overall take-home pay is unlikely to improve recruitment.
Keep calm and carry on nursing - 2015 is poised to challenge the profession further.
BA(Hons) PGCE RN RM RHV FWT NP
Nurse Adviser and Independent Trainer
As well as working on the Nursing in Practice advisory board, Marilyn is also Lead Nurse for a teaching PCT, supporting nurse-led services and the development of practice nurses and healthcare assistants. She enjoys being a respiratory trainer and a nurse opinion leader and is passionate about expanding and blurring nursing boundaries in primary care.
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