The NHS - Decent basic nursing is what we need from it.

[SwingsitlikeHogan]

With the cost of hiring nurses from overseas in the news today (£3000 a throw for Addenbrooke's apparently) I realise that the government's big noise over getting the NHS to deliver a 7 day a week service has gone a little quiet of late. Maybe this is due to the dawning realisation in Cameron, Osborne and Hunt that the NHS already does deliver a 7 day a week service and what they are talking about is both actually not totally necessary and, as it happens, unaffordable.

Which takes me to the shortage of nurses, the cost of hiring nurses from overseas and basic care.

I suspect every single one of us has personal family or friend experience of poor or very poor basic nursing care in the NHS. One of my wife's patients was yesterday telling my wife how she (a breast cancer patient) has to go into hospital to provide aspects of basic care for her elderly mother. And we are talking making sure she is washed daily, gets to the toilet when she needs, has three meals, has drinking water always available, and someone to talk to from time to time. Not asking a lot one wouldn't think.

And while the NHS can't deliver THAT we have the sight and sound of Hunt and the Tory High Command demanding a 7 day a week service and upsetting HUGELY many thousands of NHS staff. What planet are these idiots in government actually on (other than Planet Pander to the Electorate - to divert gaze from really difficult stuff being dished out to the poor).

Get the basics sorted. Kick the Nursing Education fascists in the backside - those that say that nursing today is a complex business, is evidence lead - and so requires 3-4 yrs study for a degree. Stop this blocking from a caring career in nursing those that may not want to do a degree but who DO want to care for others. These folks are out there now. They can be on the ward TOMORROW - washing, feeding, toileting - caring - for our nearest and dearest, friends and relatives.

I don't NEED an extension to the 7 day service we currently have. I DO need to know that there is an NHS there that I can rely upon to look after my mother if she has to go into hospital, without me worrying about whether or not she is getting to the toilet and being fed.

 

[Rooter]

I would welcome free university fees for all courses that lead to being public servants (ie nurses, doctors etc) With a pay back clause should they go private before say ten years.

I have nothing but respect for anyone working on the NHS frontline. We as a family have used them a lot! and yes, sometimes it can be a nightmare with long waits, questionable 'service' but in the whole its been nothing short of fantastic.

 

[Hobbit]

Whilst I totally, 100%, agree with you with regards to the (re)introduction of the SEN grade to supplement the SRN grade, i.e. two levels of nursing. One more clinically based and one more creature comfort based. I do disagree with you with regards to the 7 day service you think exists. Basically, it doesn't. Are all the operating theatres in use 7 days a week? No they're not. Are they in use 6 days a week? Not far off. Are they in use Monday to Friday? Absolutely. And there is your argument shot down in flames. I know, my staff go in at weekends when its quiet.

So if someone has elective surgery on, say, Tuesday, they might be discharged Friday. Wednesday op might discharge on Saturday, and a Thursday op might discharge on Sunday, if you can find a Doc to do the discharge as opposed the a trainee Doc who might say you're doing fine we'll make a decision tomorrow. So you've now got someone being kept in an extra day. And then there's the very quiet theatre block, with only emergency cases being dealt with.

You MIGHT want a top Doc in there on the Sunday when your mum goes in, instead of the spotty trainee. And before she gets anywhere near a theatre you might just want some decent imaging staff in there too, and maybe some lab staff. Great, there's a skeleton staff in but...

 

[Jacko_G]

Government has ruined the emergency services period. Cut them and their funding to the bone yet expects the same level of service. The insults to doctors and nurses disgusts me from parasites who have just given themselves a further 11% pay rise.

 

[SwingsitlikeHogan]

I would welcome free university fees for all courses that lead to being public servants (ie nurses, doctors etc) With a pay back clause should they go private before say ten years.

I have nothing but respect for anyone working on the NHS frontline. We as a family have used them a lot! and yes, sometimes it can be a nightmare with long waits, questionable 'service' but in the whole its been nothing short of fantastic.

Nursing degrees are paid for by the NHS - though I'm not sure of the commitment nurses have to give to the NHS once qualified. But why would a highly qualified individual - such as nurses with degree are - or certainly think they are - waste their valuable time wiping an old blokes backside and sitting doing nothing other than having a chat for a bit. Nah. Not for them.

And so as my wife's patient noted yesterday - the care assistant brought the food to the bed but wasn't allowed by her job to feed the patient - and it wasn't the nurses job to feed the patient. Well who the heck's job was it - yes - it was the daughter of the patient. What a shambles.

 

[SwingsitlikeHogan]

Whilst I totally, 100%, agree with you with regards to the (re)introduction of the SEN grade to supplement the SRN grade, i.e. two levels of nursing. One more clinically based and one more creature comfort based. I do disagree with you with regards to the 7 day service you think exists. Basically, it doesn't. Are all the operating theatres in use 7 days a week? No they're not. Are they in use 6 days a week? Not far off. Are they in use Monday to Friday? Absolutely. And there is your argument shot down in flames. I know, my staff go in at weekends when its quiet.

So if someone has elective surgery on, say, Tuesday, they might be discharged Friday. Wednesday op might discharge on Saturday, and a Thursday op might discharge on Sunday, if you can find a Doc to do the discharge as opposed the a trainee Doc who might say you're doing fine we'll make a decision tomorrow. So you've now got someone being kept in an extra day. And then there's the very quiet theatre block, with only emergency cases being dealt with.

You MIGHT want a top Doc in there on the Sunday when your mum goes in, instead of the spotty trainee. And before she gets anywhere near a theatre you might just want some decent imaging staff in there too, and maybe some lab staff. Great, there's a skeleton staff in but...

My understanding is that if anyone has NEED of a Consultant at the weekend there will be one available. They don't hang around wards waiting to see if anyone needs them. Ands as I said - what's actually more important. I'd say get the basics right. There may be gaps in weekend service - though I'm seeing and hearing much that tells me that gaps are not that significant. And why to Junior Doctors, House Doctors and Registrars work many weekends? Because they have to as the pay is not that great and their costs for training etc are horrendous - and they have to fund it themselves.

And as far as Operating Theatres are concerned - fine - have them all operating - but the cost will be huge.

 

[CheltenhamHacker]

SILH, are you involved in the NHS? Because basically you've described the job role of a HCA, a health care assistant...

You don't have to go to uni for this job.

 

[SwingsitlikeHogan]

SILH, are you involved in the NHS? Because basically you've described the job role of a HCA, a health care assistant...

You don't have to go to uni for this job.

No - but my wife and many relative are - and I don't know what HCAs are doing but they ain't providing the full basic care.

 

[CheltenhamHacker]

No - but my wife and many relative are - and I don't know what HCAs are doing but they ain't providing the full basic care.

Are they not? Because my partner is a nurse, and she is supported by a HCA every shift, and they do a lot of the work you're talking about. I get that they aren't doing it all the time, everywhere, but this is likely due to lack of people to do it. Why de-skill nurses? The issue is recruiting more of these HCAs to do what you want (who are cheaper than nurses and don't need a uni education). Why do you think we don't have enough? Because people aren't as selfless as you make out, there aren't thousands of people out there wishing they could help look after patients, but can't because of a lack of education...

 

[Hobbit]

My understanding is that if anyone has NEED of a Consultant at the weekend there will be one available. They don't hang around wards waiting to see if anyone needs them. Ands as I said - what's actually more important. I'd say get the basics right. There may be gaps in weekend service - though I'm seeing and hearing much that tells me that gaps are not that significant. And why to Junior Doctors, House Doctors and Registrars work many weekends? Because they have to as the pay is not that great and their costs for training etc are horrendous - and they have to fund it themselves.

And as far as Operating Theatres are concerned - fine - have them all operating - but the cost will be huge.

You're right, the Consultants don't hang around waiting to see if anyone needs them at weekends, nor do they staff the Outpatients Clinics as they would Monday to Friday. If you take a walk through O/patients on a weekend it's like the Marie Celeste, as are the theatre blocks.

We have waiting lists, and we have the lottery of care that sees a greater chance of you dying on a weekend emergency admission than you would do if admitted through the week. You might think the chance of death is insignificant but I'm inclined to say it is a 'fail.'

Why can Debenhams, M&S and John Lewis provide a 7 day service but the NHS can't? I'm not sure being able to buy a shirt is more important than having that cancerous lump removed... are you?

Yes there would be an increased cost but do you honestly have an ambition for a part time NHS? I'd like to see better access to care that includes a better chance of a decent outcome if it was a Sunday admission.

 

[Ethan]

The current political stuff about 7 day working is nonsense. The NHS has always operated, seen patients, had Consultant availability at weekends. Trouble is that if you want to offer the same service on Sunday as you do on Wednesday, then you need a fully staffed hospital, maintenance people, IT people, admins etc etc. It will cost another £20-30 billion a year to offer that. David Cameron's figures on weekend deaths were wrongly and knowingly wrongly attributed to the availability of senior staff. expert analysis has shown it is because these patients are simply sicker. They would still have died if they had been admitted on Wednesdays. Sticking Consultants in at weekend simply removes them from weekdays.

My wife is an NHS Consultant and I know many others in loads of specialties and they are all totally pissed off at the characterisation of their work. Jeremy Hunt said that many Consultants have opted out of weekend working. He is a liar. FOI data from NHS England shows that in regions they surveyed, out of 3700 Consultants, exactly 1 (one) had opted out, and there may be a health or other good reason for doing so.

What is going on here, and what has been going on for several years, is a process of softening up the medical profession and nurses and midwives for future changes. Their pensions, pay, working hours and the level of clinical autonomy they have been allowed to exercise have all been reduced. They now spend much more time doing the sort of record keeping that would be needed in a health insurance company, because, guess what, the NHS is heading that direction. The current NHS England CEO Simon Stevens came from a US insurance company (actually HMO, but same thing) and has a number of projects going which will cause irreparable change to the NHS. 7 day working is wanted bye the insurance companies who like to 'sweat the assets', i.e. keep the shop doors open longer.

The issue of agency staff is a commentary on how badly the NHS treated permanent staff and cuts staffing levels down so low that crises are constant. Hunt complains about doctors earning high rates for agency work, but seems to be OK with many more management consultants earning far more for coming up with hair brained ideas about how to further screw up things. But they are his kind of people, so that is OK. His picture sent on Twitter last Saturday of him in a hospital was taken on Friday.

As for 7 day GP services, I know local GPs who opened at the weekends for routine clinics and found themselves with loads of free appointments and 50% DNA rates, so they stopped because it was a waste of their time and the patients didn't really want it.

To answer Hobbit's rather silly question, Debenhams can offer 7 day working because they are not open all bloody night and only sell stuff, not perform operations on sick people.

 

[Hobbit]

The current political stuff about 7 day working is nonsense. The NHS has always operated, seen patients, had Consultant availability at weekends. Trouble is that if you want to offer the same service on Sunday as you do on Wednesday, then you need a fully staffed hospital, maintenance people, IT people, admins etc etc. It will cost another £20-30 billion a year to offer that. David Cameron's figures on weekend deaths were wrongly and knowingly wrongly attributed to the availability of senior staff. expert analysis has shown it is because these patients are simply sicker. They would still have died if they had been admitted on Wednesdays. Sticking Consultants in at weekend simply removes them from weekdays.

My wife is an NHS Consultant and I know many others in loads of specialties and they are all totally pissed off at the characterisation of their work. Jeremy Hunt said that many Consultants have opted out of weekend working. He is a liar. FOI data from NHS England shows that in regions they surveyed, out of 3700 Consultants, exactly 1 (one) had opted out, and there may be a health or other good reason for doing so.

What is going on here, and what has been going on for several years, is a process of softening up the medical profession and nurses and midwives for future changes. Their pensions, pay, working hours and the level of clinical autonomy they have been allowed to exercise have all been reduced. They now spend much more time doing the sort of record keeping that would be needed in a health insurance company, because, guess what, the NHS is heading that direction. The current NHS England CEO Simon Stevens came from a US insurance company (actually HMO, but same thing) and has a number of projects going which will cause irreparable change to the NHS. 7 day working is wanted bye the insurance companies who like to 'sweat the assets', i.e. keep the shop doors open longer.

The issue of agency staff is a commentary on how badly the NHS treated permanent staff and cuts staffing levels down so low that crises are constant. Hunt complains about doctors earning high rates for agency work, but seems to be OK with many more management consultants earning far more for coming up with hair brained ideas about how to further screw up things. But they are his kind of people, so that is OK. His picture sent on Twitter last Saturday of him in a hospital was taken on Friday.

As for 7 day GP services, I know local GPs who opened at the weekends for routine clinics and found themselves with loads of free appointments and 50% DNA rates, so they stopped because it was a waste of their time and the patients didn't really want it.

To answer Hobbit's rather silly question, Debenhams can offer 7 day working because they are not open all bloody night and only sell stuff, not perform operations on sick people.

I agree with pretty much everything you've said, apart from your last sentence which pretty much sums up the arrogant to$$er you are. My point was for clinics 7 days a week during the typical daily times that clinics are open. And to take the point of opening the clinics on a 7 day basis, there's actually a down side to that too. Once diagnosis has been made there could be an issue with access to theatres/imaging and availability of beds let alone more clinical staff that would be needed etc. Shortening the time for diagnosis only move the log jam tothe next step in the clinical process.

And as you say, for that level of resource you'd have to find another £20 billion minimum.

However, I'm impressed with your silly point that sicker people only turn up at weekends...

 

[Ethan]

I agree with pretty much everything you've said, apart from your last sentence which pretty much sums up the arrogant to$$er you are. My point was for clinics 7 days a week during the typical daily times that clinics are open. And to take the point of opening the clinics on a 7 day basis, there's actually a down side to that too. Once diagnosis has been made there could be an issue with access to theatres/imaging and availability of beds let alone more clinical staff that would be needed etc. Shortening the time for diagnosis only move the log jam tothe next step in the clinical process.

And as you say, for that level of resource you'd have to find another £20 billion minimum.

However, I'm impressed with your silly point that sicker people only turn up at weekends...

Well, I have been called worse by people I respected more. But you have changed your point, so not sure what descriptive best suits.

Anyway, you said above that you were referring to clinics with the Debenhams point. But what you actually said was:

"Why can Debenhams, M&S and John Lewis provide a 7 day service but the NHS can't? I'm not sure being able to buy a shirt is more important than having that cancerous lump removed... are you?"

I didn't see any mention of clinics there. If you had said 'why is buying a short more important than a routine checkup for diabetes ....' then that would have made more sense.

I didn't say that sicker people only turn up at weekends, but that the average level of sickness was higher at weekend. Here is a study from Ireland, but same point:

http://www.ncbi.nlm.nih.gov/pubmed/22111090

and an episode of BBC More or Less which covered the issue: http://www.bbc.co.uk/programmes/b05w8dnj

 

[Old Skier]

Not a fan of the Tory's are we. The decline of nursing staff has been going on for decades. There are issues of training, when cuts hit in the first thing that goes is the training budget.

The training universities only have x amount of places and if a candidate drops out after just a couple of weeks that place is lost. Personally speaking it's about time they had a real honest look at the amount of admin staff are about and how the back office systems can be revamped. To many trained nurses seem to be going over to the other side leaving short staffing in wards. Another side of the problem is to many nurses disappear onto the bank nursing system allowing them to pick and choose when and how they work.

Nurses that get state funded qualifications should have a time limit on long they work for the NHS and if they leave early there should be a pay back scheme.

 

[Ethan]

Not a fan of the Tory's are we. The decline of nursing staff has been going on for decades. There are issues of training, when cuts hit in the first thing that goes is the training budget.

The training universities only have x amount of places and if a candidate drops out after just a couple of weeks that place is lost. Personally speaking it's about time they had a real honest look at the amount of admin staff are about and how the back office systems can be revamped. To many trained nurses seem to be going over to the other side leaving short staffing in wards. Another side of the problem is to many nurses disappear onto the bank nursing system allowing them to pick and choose when and how they work.

Nurses that get state funded qualifications should have a time limit on long they work for the NHS and if they leave early there should be a pay back scheme.

Labour under Blair were just as bad. They accelerated the PFI programme which pushed Trust budgets to the brink (or beyond). I didn't trust Alan Milburn with the NHS any more than I trust Jeremy Hunt.

In the old days, NHS hospitals reported to the Regional NHS office, who provided budgets. Hospitals were run by Unit Administrators who were instructed by a senior staff of doctors, nurses, other key personnel who knew what the hell went on in hospitals. Then the NHS decided it needed external management, so managers from Marks or Vauxhall were brought in. Now we have a giant apparatus of staff and a huge Trust structure. As junior doctor, I decided that anyone whose job title did not tell me exactly what they did was not to be trusted. I think that was after meeting a Director of Strategy or something similar. Now there are dozens of these people around, spending money and sucking up other people's time. Every hospital has its own drugs committee which reviews new medicines and decides which ones to use in their hospital. Waste of time and money. A medicine works as well or as badly in Bracknell as it does in Burnley.

I was talking to a Consultant Oncologist last week. He told me that it used to be that if he saw a patient with, say, a neurological problem, he called the neurology clinic and asked if someone could see the patient. They often said, sure, send him round to Block C or whatever, patient seen there and then. Now he has to write to the GP and ask the GP to refer to neurology and the patient has to come back to be seen 4 or 6 weeks later. Why? 2 chargeable episodes for the Trust. Big waste of everyone's time, including the patient's. Hospitals routinely screen referrals and reject those with incomplete information on technicality, even if irrelevant and they already have it somewhere else. Why? Helps manage OP waiting times. Likewise delaying surgery, especially at the end of the financial and calendar years.

 

[Siren]

My wife has been an Auxiliary Nurse for 12 years, her dream honestly is to become a qualified Nurse however we can not afford to lose her wages so at the moment the dream is unrealistic. A couple of years ago the NHS dangled a carrot of hope by way of a two year part time university course that was a diploma in Nursing which is half of the degree. The NHS paid for the fees but course had to be taken in my wifes own time which is fair enough shifts were arranged out her one day a week etc.

The promise at the end was that they would then look at those who did well on the course and with the right attitude and experience and look to pay those their basic Salary while they then went on to University full time to finish their degrees in adult nursing provided they signed a contract that would tie them to a specific job within the NHS for 3 years afterwards.

They took on four people to do the degrees. for the other 26 who passed with Merit and above grades there seems to be no hope for them to become qualified.

When we talk about 7 day NHS and levels of care, think about how much money the NHS wastes on Agencies and foreign nurses/doctors when we have people ready and willing to step up and help but have no platform to do so. Can anyone really say that someone who has spent 20 years (not my wife) can not do the same job who has just walked out of university after 4 years of "training" In what kind of world does anyone believe it would be anything other than a very short space of time for that type of people to show the correct type of competency that would allow them to do the same job and then save money which can be spent on other areas.

And so as my wife's patient noted yesterday - the care assistant brought the food to the bed but wasn't allowed by her job to feed the patient - and it wasn't the nurses job to feed the patient. Well who the heck's job was it - yes - it was the daughter of the patient. What a shambles.

The problem is and I agree its madness, if the Auxiliary had fed the patient it goes against their guidelines and they genuinely can get into trouble. 90% of Auxiliary/qualified nurses want to do more, they are just not allowed. The NHS is a shambles 2 nurses to twelve patients it just doesnt work and its at breaking point.

Sorry for the rant

 

[HomerJSimpson]

I work in recruitment in the NHS. We are in a catch 22 situation. We run monthly assessment centres for midwives, staff nurses and healthcare assistants where they come in en masse, having been shortlisted initially. The midwives sit a drugs calculation test and must get 100% to progress although if they score 8 or 9 out of 10 initially they can go back over the two they got wrong.

They then go through to either one to one interviews with a panel (usually a sister and SSN) or in the case of the midwives take part in group assessments first. The biggest issue we have is that we attract a lot of newly qualified but even more students not even out of uni yet. We cannot attract staff with experience and we've been forced to go to Ireland, Portugal and Spain and run large campaigns to get experienced staff in. It's an expensive process (usually involving agency costs to do a lot of the checks).

As a result, I agree a lot with the OP. We (well my own trust at least) is committed to giving patients the best experience and best outcome possible but of course there will be times when they fall short. With a shortage of experienced nurses to develop and nurture the newly qualified ones, even those with a year behind them, it puts a huge burden on pressure on these to do more and more advanced nursing and get it right all the time.

In terms of the healthcare assistants, it is largely their responsibility, where clinical restraints permit, to ensure the patient is fed, watered and to ensure they are able to go to the loo with dignity, either to a facility or with a bed pan, curtains firmly shut. Having shortlisted candidates (we usually get in excess of 70 applicants per advert) we then test them for English, maths and IT skills. We tend to lose a lot (and I might be stereotyping but definitely not being racist) of those from East Europe and Asia where their basic English in particular isn't good enough. From there, they are invited in to interview.

What you also have to bear in mind, is that even when we make a conditional offer, it's still subject to the student nurses passing the course (not a given) and for the checks to come back clean, particularly the references and occupational health. We do take people with DBS convictions (subject to the crime) and to be honest we work hard with managers across all areas of the trust to do what we can when there is an issue to resolve these rather than lose a prospective candidate. Some of those we've had the biggest issues with in the process have gone on to make a fine career in the hospital and grown into staff nurses and beyond.

Patients and relatives have an absolute right to the best care available. That will never change and I, my colleagues and those doing this role in other trusts, try hard to get the right people in to provide this. However we only have a finite pool and we want the very best in our trust and thats hard to do. We don't have a magic wand and can only work within the pay structure and do what we can despite budget restrictions and government interference

 

[Old Skier]

(usually involving agency costs to do a lot of the checks).

And here is the problem with the public sector - they have recruiting staff but still pay outside agencies and consultancy to do their job. It's so common in Health, Education and the Civil Service.

 

[HomerJSimpson]

And here is the problem with the public sector - they have recruiting staff but still pay outside agencies and consultancy to do their job. It's so common in Health, Education and the Civil Service.

But still cheaper than sending one of the team out to Ireland, Portugal or Spain and doing the checks. What is the option? Not recruiting these at all? That just leads to a bigger shortfall in numbers. Also, we can negotiate rates with these agencies and if we were to go out (airfare, hotels, subsistence etc) these costs would be even higher but the checks have to be in place before they can start

 

[Old Skier]

But still cheaper than sending one of the team out to Ireland, Portugal or Spain and doing the checks. What is the option? Not recruiting these at all? That just leads to a bigger shortfall in numbers. Also, we can negotiate rates with these agencies and if we were to go out (airfare, hotels, subsistence etc) these costs would be even higher but the checks have to be in place before they can start

Farm all of the job out. No need for any in house recruitment apart from one specialist team dealing with final selection.