Saturday, March 03, 2007

As NHS staff protest against hospital cuts

Hospital staff throughout Britain have been protesting today about cuts in jobs and services.

One nurse is quoted on the BBC website as saying "I have been in nursing for 23 years and have never known morale to be so low"

Morale is an absolutely fundamental issue, because maintaining good hospital services is not just a matter of spending money or of keeping hospital buildings open, important as those things are. It is necessary to recruit, train and retain a skilled, professional work force, and this in turn is much easier if they are motivated, feel valued, and believe the people running the NHS have a positive vision for the future.

It is quite extraordinary that, at one and the same time, taxpayers are paying massive and enormously increased amounts of money for the NHS, and yet the experience of both patients and staff in many parts of the country is threatened or actual cuts in services, ward closures, and job losses.

Two of the reasons for this apparent conflict, which has applied under both this government and the previous one, are the consequences of good things - the availability of new (though sometimes expensive) drugs and treatments and the fact that people are living longer.

People who would once have died at fifty or sixty are now living to eighty, or are having a much improved quality of life due to better health because of new treatments: this is an excellent thing but in the process there is a huge extra demand on the resources of the NHS which is constantly having to review how it uses money and people to meet that demand.

Some of the other problems of the NHS are less easy to defend. Vast resources are going on administering the government's 400+ NHS targets and their complicated regime for inspections and awarding stars. And although I am in favour of the principle of working with the private sector to improve NHS services, the practice has not beeen as succesful as patients and taxpayers need and deserve. PFI initiatives such as the PFI hospital, the Cumbrerland Infirmary at Carlisle, have not always delivered what was required, and have often meant that future taxpayers over the next thirty years are being landed with cumulative bills for PFI hospitals which are many times what those hospitals are worth.

A strategy to deliver a better NHS must include at least the following three elements.

First, there must be a dramatic simplification of the targets and inspection regime, and the targets which are retained should concentrate more on outcomes (such as survival rates) than process (such as number of operations. Resources taken away from administration must be concentrated on the patient-facing services.

Second, we need a more realistic approach to hospital beds. It may well be that in a more ideal world in which hospital services were perfectly efficient, we could deliver a better service with fewer hospital beds. But the NHS is not perfectly and efficient and mortal human beings will never make it so; and failures in other services will mean that there will always be "bed blockers" in hospital beds who should be supported in other ways.

If we provide NHS hospitals with the number of beds that a perfectly efficient service would require, rather than the number of beds needed given the level of effectiveness which is humanly attainable in practice, there will be dire consequences of which continued high levels of deaths due to MRSA and other hospital acquired infections, and poor morale among the nursing staff who have to try to fit a quart into a pint pot, will be only two of the most obvious.

Third, we must give doctors and nurses as much freedom as possible to run their hospitals in a way which fits the specific needs of their patients and listen to their expertise. Too many health ministers have the idea that anyone who disagrees with them is at best misguided and at worst sabotaging the service. We need a less stalinist approach to NHS management.


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