What Now for the NHS?

Is the NHS at breaking point?

With a reported 400,000 new visits  to A & E last year, it would certainly seem that way in secondary care.

But of course, all of this has an effect on primary care. Hospitals don’t seem to want patients any more. They encourage you to keep them out, and can’t wait to get them back into your care once they are in. But therein lies the problem; there just isn't enough of you to manage. District nurse numbers have fallen by roughly 40% in the last 10 years. And those that are still in practice are 10 years older, 10 years closer to retirement!  You have to attempt to deliver full and appropriate care to patients in 15 minute slots, you have to cover sickness and vacancies, and you have to make sure your documentation is completed correctly. You have little time for your family and friends, let alone keeping up to date, attending conferences or indeed, enjoying a day off without being ‘phoned by a colleague.

To top all of this, the Government has stated that the ‘archaic’ nursing pay system is barrier to seven-day services, suggesting:

• that unsocial hours payments should be scrapped (that would be a blessed relief to Great Ormond Street Hospital who recently made some massive errors in unsocial payments and now wants staff to pay this back by working extra)
• paying a flat rate to all staff for working unsocial hours
• paying normal rates for Saturday working
• starting night shifts at 10pm rather than 8pm

No wonder community nurses are buckling under the strain.

Of course there is no easy answer. Policies are in place to urge staff back to practice and to increase district nurse numbers. Organisations are trying to save money by outsourcing certain services such as wound care to private organisations, who in turn try to save money by employing staff who aren’t necessarily the best because they are paying peanuts. But they are realising that healthcare is too complex to be priced in the way they want (e.g the issues at Hinchingbrooke).  

Let’s see what the next election brings – but I’m not holding my breath.