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

[HomerJSimpson]

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

It's an option that has been looked at but if they were to run the assessment centres we run (not sure if it's unique to ours or if others do the same) and then to provide the level of checks we do, that's a big price bill to pay. In house we regulate who gets tested, (and if they fail the drugs test three times they can't apply for six months to give them a chance to improve their skills), the quality of the tests and ensure the interview panels are relevant to the role.

 

[Old Skier]

Being used in other areas of the public sector where large numbers are being recruited, only time will tell how successful it ends up but it would be a start to getting rid of the admin clutter that the NHS is famous for.

 

[Hobbit]

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.

Whilst I can understand the reason behind PFI's, i.e. there was no money available to build new hospitals, I can't for the life of me understand why someone would sign up for one. The typical PFI model sees the landlord, e.g. Balfor Beatty, holding landlordship for 30 yrs. As well as the rent from the Trust, they are guaranteed money for every little job the Ward Sister phones down to the now outsourced Estates Dept, usually a partner to the landlord,e.g. Sudexo.

And then there's the re-equiping of the hospital. In a 30 yr cycle the hospital will have signed up for new equipment in yr zero, 10, 20 & 30. A Typical PFI that was in the first tranche of 10 PFI's will be just about signing up for its 3rd round of re-equiping, and the theatre block in your average Trust will be purchasing somewhere in the region of £500,000 worth of anaesthetic machines, and a similar amount just for ICU vents. That's only the tip of the re-equiping. The re-equiping will be through the landlords original partners, agreed at the outset via a framework agreement, and purchased through the NHS Supply Chain - don't be fooled by the name. Its owned by DHL and skims a percentage from the equipment supplier and from the Trust its supplying to.

At the end of the tenancy the Trust can either purchase the hospital, but it still won't have access to that level of funding, or sign up for another period of tenancy - and so the game continues.

 

[SocketRocket]

SILH and Ethan. Do you honestly believe all the ills of the NHS are due to the Conservatives as opposed to Labour who make such a great job of things? Personally I find your vitreous attitudes sickening and childish.

My own opinion (of which you will of course consider ignorant) is that as much as possible in the NHS needs to become privatised so that we have people who have a need to be efficient and effective, rather than a bunch of 'Prima Donnas' (present company excepted) that don't have a clue about providing customer satisfaction or business management. We can have a Government Office and Ombudsman who oversees the service though.

 

[palindromicbob]

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...

SEN's haven't gone completely. Problem is that agenda for change when doing the job evaluation placed them at the same level as a RGN/RMN. This meant they are now on the same pay scale as the RN's who were more qualified. Really annoyed the hell out of the staff that took time and effort to upskill by doing an additional qualifications to become fully registered nurses. It also completely overwrote the cost advantages of having SEN's and has in some case left wards with a lower level of staffing than the salary cost might imply.

I'm not saying the SEN's are bad nurses but the fact they aren't professionally qualified to take on certain responsibilities and tasks meaning that their presence can in some cases put additional strains on the RN. You can imagine my shock when 3 months into the job I came into work to find my RN colleague had called in sick. Normal staff quota was 3 nurses (band 5), 3 nursing auxiliaries (band 3). The sick staff member was replaced with a bank nurse (in house not agency) and I found myself technically in charge of the ward despite the fact the SEN had 20+ years experience. Although the day ran well without many issues I could feel the pressure on my shoulders if anything had gone tits up.

I don't think a return to the SEN is truly necessary. I do think an increase in training and more careful selection for HCA's is a better avenue as well as more opportunities to increase skills and progress up the pay scale. Currently many HCA position are band 2 and the role isn't attractive. When they do work they find themselves bottom of the pile in an overstretched understaffed work environment. In previous years this a vocation but now it doesn't attract the highest quality staff or help with retention.

Band 2 HCA's should be able to progress to a band 3 or even a 4 as skills increase would give some form of meaningful career progression and top of a band 3 with pay enhancements is not a bad salary at all. In fact it's not far off (in fact I think most I know are probably higher) what I currently get as a band 5 community mental health nurse who carries a lot more responsibility.

 

[palindromicbob]

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.

Great idea. I did my nursing in Northern Ireland. Course was funded by the HSC and I even got a small bursary that helped me to be able to stay in the course with less financial pressure. As did all my nursing colleagues.

Worked my ass off for 3 years and got my PIN. Happy days I could get on with my life and my career. Now here's what happened.

Took 6 months to get a staff nurse post within the HSC. I could have gone to private nursing homes but too many horror stories about newly qualified nurses being put in charge with no experience made me decline because any mistake in that job could potentially cost my future career.

First job was a 6 month temp contract initially. All well and good this will get me on the ladder.
After this however I got a 3 month extension. Bought me a bit more time.

Then it went to monthly with chat that my job would be gone when X returned from maternity leave in 2 months time. No word of another in the hospital so I had to start looking else where. Again private nursing homes put me off but Jersey looked good, Canada and Australia looked even better.

Before I progress I managed to get a bit more security with a 12 month contract in a different area. I was asked by the manager to stay where I was but I jumped for the additional 12 month respite.

After this I was lucky to get a 6month contract in another area but I was planning to get married and start settling down. Temp contract with no long term stability weren't doing me much good here. Again immigration options started looking good. Maybe not as far because I wanted to settle closer to home but hey maybe Jersey would be nice.

And it went on until I got my permanent contract just over 3 years after starting with the trust. Weight of my shoulder because now at the very least I have some security (to an extent). I got very very lucky because I only got this because the person above me on the waiting list turned it down.

Other colleges of mine didn't stick around, they didn't get temp contracts, they worked in nursing homes and experienced the nightmares I heard about. Some even lost their PINs. Some are now on the mainland UK, Australia, others in Canada and I heard a few of my RGN colleagues went to the US (not an option for RMN's). They wanted jobs within the HSC but they simply weren't there and the recruitment agencies where able to make some very nice offers that appealed to them upping sticks and moving with a chance of longer term job security and decent salaries.

OK the ones that moved to England are at least still in the NHS but they are of no benefit to HSC that actually spent the money to get them trained and instead have to search for Portuguese nurses to fill their spaces in temporary posts.

Train the nurses, put in conditions that require them to work for X years or pay back if they leave the country. IF, however, this is done, it will also be necessary to ensure there are SECURE and STABLE jobs for them to walk into. Without that you'll have less uptake, less retention and the same problems will continue.

 

[SwingsitlikeHogan]

I hope Jeremy Hunt and Theresa May watched, or will watch, the new BBC2 fly-on-the-wall documentary series Hospital . First episode last night.

If I didn't know from my personal experience and that of my wife (a senior NHS nurse specialist of 40yrs) and friends that it showed the truth of the state of the NHS, I would have been shocked - as it was I was still shocked - and also moved almost to tears at the plight of Simon ( a cancer patient).

The calmness and strength of the surgeons and nurses, under almost unimaginable pressures trying to manage things, was frankly awesome - we almost don't deserve them.

This series is a must watch for anyone who cares for the NHS and wishes to understand the truth of what has happened to it.

 

[HomerJSimpson]

I hope Jeremy Hunt and Theresa May watched, or will watch, the new BBC2 fly-on-the-wall documentary series Hospital . First episode last night.

If I didn't know from my personal experience and that of my wife (a senior NHS nurse specialist of 40yrs) and friends that it showed the truth of the state of the NHS, I would have been shocked - as it was I was still shocked - and also moved almost to tears at the plight of Simon ( a cancer patient).

This series is a must watch for anyone who cares for the NHS and wishes to understand the truth of what has happened to it.

Yep, watched it last night open mouthed in parts and shows just how close to the brink most hospitals really are, despite whatever spin and PR is put on it all. This was a hospital that literally was full to capacity. Had there been another trauma or heaven forbid a major incident and it's fair to say they would not have been able to cope. Very worrying viewing and a must to see on catch up and again next Wednesday at 9.00 on BBC2

 

[Crazyface]

I don't think I have the answers but I was in A+E a couple of weeks ago. i was seen by the triage nurse after waiting 30 mins. This was too long. He took my details and filled out a form that was at least three pages long, WTF????? THEN put that info onto the computer system that I had been booked in on??????? If I was in charge, this double work would be stopped immediately!!!! Now then what else is causing unnecessary work? Cut out the duplication of work, that would help for a piggin' start!
Oh and four doctors stood about chatting does not give a good impression.

 

[SwingsitlikeHogan]

I don't think I have the answers but I was in A+E a couple of weeks ago. i was seen by the triage nurse after waiting 30 mins. This was too long. He took my details and filled out a form that was at least three pages long, WTF????? THEN put that info onto the computer system that I had been booked in on??????? If I was in charge, this double work would be stopped immediately!!!! Now then what else is causing unnecessary work? Cut out the duplication of work, that would help for a piggin' start!
Oh and four doctors stood about chatting does not give a good impression.

I'm not sure of the point you are making.

Please watch the programme - you will hear them talk about 'efficiency savings' and the number of reorganisations they have had to cope with whilst trying to deliver life saving care under the most intense pressures.

 

[IanM]

All the things that could be wrong seem to be...

- poor processes
- poor structures and leadership
- no way of estimating demand

....its surviving on the goodwill of the workers! (and I don't mean the Head of Diversity and Inclusion role advertised in the Guardian last week - £50-£60k)

 

[SwingsitlikeHogan]

All the things that could be wrong seem to be...

- poor processes
- poor structures and leadership
- no way of estimating demand

....its surviving on the goodwill of the workers! (and I don't mean the Head of Diversity and Inclusion role advertised in the Guardian last week - £50-£60k)

Which I agree are probably all true (not commenting on the HoDaI role). But I'm not sure how anything other having more ICU beds or having very significant funding towards better home care for the elderly would relieve the pressure and avoid the issues shown.

Bigger and better 'Hospital' isn't the solution to the NHS crisis - care out of hospital is. But it requires a lot of funding.

My wife had surgery for breast cancer just before Christmas. It was day surgery. Until fairly recently she would have been kept in for 3-4 days - but today that is just not necessary and so it doesn't need to happen. As it happens she had to stay one night as was being sick because of the Gen Anaesthetic and could have become dehydrated - but the actual surgery was such that she could have gone home as we can provide the appropriate follow-up care at home. But with the elderly with many conditions that care at home is just not there.

 

[ScienceBoy]

Biggest problem is that the majority only know of two ways to access care...

A&E and GPs

If we can change that then it will be a huge step to make the NHS better

 

[HomerJSimpson]

Biggest problem is that the majority only know of two ways to access care...

A&E and GPs

If we can change that then it will be a huge step to make the NHS better

But we've had things like 111 and other initiatives around for ages but we need to educate the public and to be honest unless GP access is greatly improved and we begin to get firm on people turning up for illness and injuries that don't require A&E treatment it won't happen. I actually like the notion of making non-emergency (decided via trained triage) patients wait and if that's longer than four hours so be it. Hard love and making them wait 6+ hours may slowly get the penny to drop

 

[Tashyboy]

Sorry not read all of the thread but enough for me to have a bit of a rant.

Missis T finishes as a specialist urology nurse in six months and she is more than ready. Been a nurse since she was 18 and seen all the changes. Her time as a patient last year opened her eyes to the state the NHS is in.

She once worked as a Bank nurse coordinator where she hired and fired, nurses and care assistants. She got rid of some crap nurses and care assistants and hired some fantastic ones. She trained care assistants to become excellent nurses. She trained people who had never seen an hospital to become excellent care workers and then nurses. Because they had paid for there own courses. They had worked nights. She saw things in others that would be a benefit to the NHS. She had blazing rows with staff because she would not employ people who could not speak English. The hospital when requiring bank nurses etc was running at 98%. The thanks she recieved was to make her role redundanct, saving the NHS £36k per year. Three years later The labour MP for the hospital ( Gloria del Piero ) asked under the freedom of information how much kings mill trust had paid in agency fees for the last three years. £6.2 million.

When I listen to people say that the NHS would not run were it not for foreign nurses I could flippin scream. For me it is an opinion based on nothing but ignorance, before we start applauding these foreign workers who are now working in the NHS in there thousands. My simple question is why are we now reliant upon nurses from abroad. Because there has been a massive under investment in training nurses for years and years. The government/NHS don't have to pay to train nurses and just ships them in from abroad. For me it stinks to high heaven. It is our kids that are missing out

Missis T is one of the last of the nurses that gets a good pension, it finishes within a year. This next year or so will see nurses leave in droves.

When missis T was in hospital last year, she was on a ward, it had one trained nurse and three care assistants. The nurse who was four months pregnant was assaulted by a patient and ended up in A and E. Another bank nurse ( surname Sithole) said she would not look after half the patients but could manage 12. The pregnant nurse who came back on the ward, said "if you think that I am looking after 20 patients including the sickest and doing the drugs you van bog off home". What narked the regular nurse even more was that said agency nurse was earning more.

The NHS is on its Ass and the managers are not helping the cause either.

 

[PhilTheFragger]

Before Christmas one of my daughters developed a cold, by new year it had developed into more of a chest infection.
Phoned doctors, closed call diverted to NHS111. Who assessed her and told her to go to A&E.
I stepped in and said she didn't need A&E, just an out of hours doctor, but they insisted.

So took her to Stoke Mandeville. And after a lengthy wait saw triage who basically tore into the 111 service as not having a clue and confirmed that we should never have been directed to A&E

This is part of the problem, better out of hours GP cover would releave pressure on A&Es.
Better GP access full stop will help, if you can't get an appointment for 2 weeks, what are you to do?
Better community care/support for the elderly (cottage hospitals). Would help stop bed blocking and free up beds for new patients.

Train up more nurses, pay them better, this will reduce the use of Bank nurses which cost a fortune.

The NHS is a wonderful thing, but it's being run by accountants who are not making a very good job of it

 

[Tashyboy]

Before Christmas one of my daughters developed a cold, by new year it had developed into more of a chest infection.
Phoned doctors, closed call diverted to NHS111. Who assessed her and told her to go to A&E.
I stepped in and said she didn't need A&E, just an out of hours doctor, but they insisted.

So took her to Stoke Mandeville. And after a lengthy wait saw triage who basically tore into the 111 service as not having a clue and confirmed that we should never have been directed to A&E

This is part of the problem, better out of hours GP cover would releave pressure on A&Es.
Better GP access full stop will help, if you can't get an appointment for 2 weeks, what are you to do?
Better community care/support for the elderly (cottage hospitals). Would help stop bed blocking and free up beds for new patients.

Train up more nurses, pay them better, this will reduce the use of Bank nurses which cost a fortune.

The NHS is a wonderful thing, but it's being run by accountants who are not making a very good job of it

That last sentance Phil, Missis T said that before people are allowed to become managers and accountants, there accountants and previous management history should be checked.
PS, Missis Ts role is to stop people going into hospital and blocking beds, also to stop ambulances being used as taxis. It cost Drs less and frees beds. At this moment in time most hospitals are on black alert. What is the management response to this. All specialist nurses will do one day a month on wards to save paying for an agency nurse. Smart so that day, ambulances will be taking more patients to hospital blocking more beds.

 

[HomerJSimpson]

Sorry not read all of the thread but enough for me to have a bit of a rant.

Missis T finishes as a specialist urology nurse in six months and she is more than ready. Been a nurse since she was 18 and seen all the changes. Her time as a patient last year opened her eyes to the state the NHS is in.

She once worked as a Bank nurse coordinator where she hired and fired, nurses and care assistants. She got rid of some crap nurses and care assistants and hired some fantastic ones. She trained care assistants to become excellent nurses. She trained people who had never seen an hospital to become excellent care workers and then nurses. Because they had paid for there own courses. They had worked nights. She saw things in others that would be a benefit to the NHS. She had blazing rows with staff because she would not employ people who could not speak English. The hospital when requiring bank nurses etc was running at 98%. The thanks she recieved was to make her role redundanct, saving the NHS £36k per year. Three years later The labour MP for the hospital ( Gloria del Piero ) asked under the freedom of information how much kings mill trust had paid in agency fees for the last three years. £6.2 million.

When I listen to people say that the NHS would not run were it not for foreign nurses I could flippin scream. For me it is an opinion based on nothing but ignorance, before we start applauding these foreign workers who are now working in the NHS in there thousands. My simple question is why are we now reliant upon nurses from abroad. Because there has been a massive under investment in training nurses for years and years. The government/NHS don't have to pay to train nurses and just ships them in from abroad. For me it stinks to high heaven. It is our kids that are missing out

Missis T is one of the last of the nurses that gets a good pension, it finishes within a year. This next year or so will see nurses leave in droves.

When missis T was in hospital last year, she was on a ward, it had one trained nurse and three care assistants. The nurse who was four months pregnant was assaulted by a patient and ended up in A and E. Another bank nurse ( surname Sithole) said she would not look after half the patients but could manage 12. The pregnant nurse who came back on the ward, said "if you think that I am looking after 20 patients including the sickest and doing the drugs you van bog off home". What narked the regular nurse even more was that said agency nurse was earning more.

The NHS is on its Ass and the managers are not helping the cause either.

Trust me, we are working flat out to recruit and retain new and experienced nurses. We have very strong ties with University of West London and so get a regular influx in February and September of newly qualified nurses and midwives. However that doesn't plug the gap of people leaving in the meantime and frankly there simply isn't the staff to go round and fill all of the vacancies in all of the trusts.

We are under huge pressure to reduce our agency spend as the trust is already in huge deficit. We have huge gaps in some areas at all levels from HCA, staff nurses, seniors, radiographers, midwives etc. We have been forced to look abroad and have recruited in numbers and successfully from Ireland and Portugal. It's not ideal, less so the fact we are now actively recruiting in the Philippines, but if you haven't got the numbers to nurse safely what else do you do.

 

[Tashyboy]

Trust me, we are working flat out to recruit and retain new and experienced nurses. We have very strong ties with University of West London and so get a regular influx in February and September of newly qualified nurses and midwives. However that doesn't plug the gap of people leaving in the meantime and frankly there simply isn't the staff to go round and fill all of the vacancies in all of the trusts.

We are under huge pressure to reduce our agency spend as the trust is already in huge deficit. We have huge gaps in some areas at all levels from HCA, staff nurses, seniors, radiographers, midwives etc. We have been forced to look abroad and have recruited in numbers and successfully from Ireland and Portugal. It's not ideal, less so the fact we are now actively recruiting in the Philippines, but if you haven't got the numbers to nurse safely what else do you do.

Homer totally understand what you are saying, but and this is a massive but, the fact you are having to recruit staff (from abroad), and being put under enormous stress and pressure to recruit the same staff that half of Englands trusts are after, is not of your doing or your blame.
My finger is pointed firmly towards successive governments of all political groups that quite frankly have been incompetent when it has come to running the NHS. They have not been helped by equally incompetent mangers including Cheif execs who continue to do nothing but finish after a couple of months or years on massive pay offs.

 

[Sweep]

Minimum 3 weeks waiting time to see a doctor at my surgery. This has not changed in more than 6 years. Yet it closes on Wednesday afternoons and all weekend. By any stretch of anyone's imagination that is not a 7 day NHS.
A close relative of mine has been hospitalised for the past 5 months. The nurses were amazing, in fact the entire team in the hospital were fantastic. So I have to disagree with the OP. We don't have a 7 day NHS in many areas where we need it and the standard of nursing care imho is very high indeed.
Clearly it's A&E that is struggling, probably because people cannot get to see a doctor. That is where the money and development needs to go. Surgeries and A&E and less on management.