26th May 2015

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Dr Mark Porter

In conversation with Roy Lilley - this is warming up to be a really good 'conversation'!

Chair of the BMA - just how relevant is the BMA; does anyone listen to them
Is the BMA a busted flush?  The British Moaners Association or the British Machiavellian Army?

Let's find out.  Health Chat at the King's Fund 18th June Details here.

News and Comment from Roy Lilley

A long-time friend and I, last summer, did an HGV course. We've done off-road, skid-pan, track-days, rallying. We are yet to tackle the London Bus.


The lorry driving was 'an experience'! If you can imagine; patting your head, rubbing your tummy, hanging upside-down and blindfold; that gets near reversing an articulated leviathan. As for going forward; ratios, gears, hydraulics and deciding when to brake, three counties before you want to stop, it's a nightmare. Now, I always give way to lorry drivers.


Little wonder, for all normal circumstances you can't drive one for more than four and a half hours without a 45 min break and no more than 9hrs a day.


Flying a plane, which we have also done, is even more nerve racking; it's complicated (!) and because of the risks, commercial pilots can't fly more than about 1,000 hours a year with a plethora of rest-day rules in between.


What brought all this to mind was the coincidence of a newspaper headline and a conversation.


The conversation was with a nurse. With a complexion like an English Rose but with dark Panda eyes. She was tired.


She gets up at half five, cycles to the Trust for handover and on duty at seven thirty. All day, with a one hour break she works on a medical admissions ward caring, in the main, for the elderly; 70% of whom will have dementia and some form of behavioural challenge plus the usual co-morbidities.


She is on her feet all day until her shift ends at 8pm. She cycles home, eats a microwave diner and is in bed by 10.30. She does that three days a week. Because she and her man are trying to scrape together a deposit for a house, also works once, sometimes twice, on the bank at a neighbouring hospital, or a shift at a care home.  There are plenty of shifts going. 


Four years without a pay-rise has resulted in a living wage but not a wage to make a life. 


I'm exhausted writing about it.


The newspaper headline? The Telegraph; "NHS spending on temporary staff has risen by one third in a year, plunging the health service into "catastrophic" levels of debt." It's good to see the Telegraph catching up with the news.


If my English Rose had any sense she would work for an agency.  She'd earn, probably, three times what she earns now. She could make provision for her own pension and most likely claim a set of new tires for her bike from the taxman.


The NHS is in the grip of a work-force crisis. Why?


It's simple, we don't train enough nurses so we end up scouring the world to find some, or pay through the nose for them.


In the mid-nineties, when Trusts were being bullied and cajoled into becoming FTs, most of them, to balance their books, understated their biggest cost, their workforce requirements. Concomitantly, training places were aligned with the supposed demand and too few were trained.   It's all gone wrong from there.


Add to that; Francis and the confusion over what safe staffing levels are supposed to be and we now have temporary-workforce cost inflation and gold plated agencies. For every training place that is filled by wannabe-nurses, five equally qualified hopefuls are turned away. There's not enough money to fund the training place.


There are five points to come out of this:

  • We take more care of lorry-drivers and airline pilots than we do the people taking care of our grannies.

  • Nursing hours are probably too arduous to be safe. Nurses get frazzled, tired, make mistakes and become annealed to standards we would not otherwise expect them to accept.

  • Graduate only nursing is a gold standard, leave it alone.  However, because of the time scales involved and a 40% drop-out-rate, it is unsustainable to regard present nurse training as an homogenous resource and the only source.  'Enrolled training' introducing a variety of skills and a range of qualifications, without the bar created by academia, would open the doors to vocationally charged older people and a wider range of skill-sets derived from on-the-job experience. 

  • Wage-cost inflation, brought about by temporary fixes, has to be deflated. New regulations limiting Trust's pay-spend on agency costs, to a percentage of turnover, would bring costs into line; squeezing the percentage would leverage them downwards. This is not so much interfering with the market as ring-fencing it.

  • CQC inspections that 'fail' Trusts on, fundamentally, staffing issues have to be suspended. Unreasonable and impossible to meet demands create a spiral of decline.  We are in the grip of a national emergency on staff numbers. The CQC are turning it into a crisis by making it impossible for some Trusts to extricate themselves.  People, given the choice, won't work at an 'inadequate' Trust

Oh, and one more thing. Whoever the DH spokesman was, who told the Telegraph; ... Trusts were expected to "show tight financial grip and live within their means..." should be the recipient of a procedure, carried out by my English Rose, in the last half-hour of her three day shift...


I suggest an enema.    


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18th June 2015
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