Did you say Yes? Then you are too bright to be working in the NHS.
If you said No, you should be working for the department of health.
So is there a staffing numbers issue in the NHS? Of course Yes, because that is always the right answer. There has always been and always will be a staffing problem in the NHS. A government organisation of massive proportions with the fourth largest employee list in the world will always have staffing issues. Not because it is unmanageably big and complex, but because it has been managed to death from all sides. Has Virgin, Apple or Microsoft been complaining about staffing issues? Maybe I don’t read tech news column enough, but I suspect you agree with a resounding NO. One more reason to privatise? I wouldn’t blame you if you said yes, but I would be wary of you for the rest of this blog.
So where is the staffing issue a problem? In the community? No, GPs run privatised services and one or sometimes a maximum of ten GPs agree that they have enough nurses to click on the computer popups to bring in the QOF monies. No staffing issues there. We don’t want so many nurses. Bye bye dear. Find some other surgery. We will try to see less patients but click more on the patients that we see. After 60% have been clicked on, we don’t need nurses as we will have already achieved the maximum achievable QOF monies. Hard to believe the GPs are part of the NHS. They are contracted for service, with no contract of service. By the people, for the people, but not of the people or something like that.
Hospitals on the other hand truly represent the complexity of the benevolent NHS. Enter past the perimeter of the hospital walls and you are in secondary care land. Never land for some. Ever land for others. Point being, these are big organisations trying to stay afloat in the current financial climate, looking towards their neighbours with envy at everything ranging from their PBR rake-in money and SHMI league status to recently conferred foundation status and better recruitment potential due to geographical advantage. It is a dog eat dog world. Not visible on the surface as everyone goes about doing their jobs to their fullest potential, but underneath it all, everyone realises that they are 84th in the league table of shame because of the blessed 83 above them, hospitals strategically placed in enchanted locations, with every junior doctor and nurse, trainee or otherwise, pining to be part of university edifices, trying hard to mingle with the crowds that matter, both at work as well as during the dark pleasurable night life hours in the gay cities nearby.
So your local hospital is 145th on the mortality table. Nobody knows how that happened but everyone seems to know that it means that the hospital is dangerous. How do they know? Because the well-meaning politicians of Whitehall have publicised this "death list", to raise awareness among the public about the hideous crimes that go on within hospital grounds up and down the country where sick people are quartered and tortured to death, needlessly. Every day. Even as we speak. And your hospital is 145th on the list. You are told it cant get any lower than that, unless new hospitals are made. There is still hope you say.
So you seem to have two options now. One, Register in rightmove and move your family elsewhere to start savouring city life and night clubs like the doctors who chose the bigger cities did and leave your local hospital to perish in shame and let "market forces factor" decide it's future as Virgin and CareUK move in beating their wings, to pick at the cadavers. (I didn’t say vultures, you just conjectured them up). Second option, stay put and ask why your local hospital is performing poorly on the league table and can I stand by it to tell those politicians to get their facts right. I see you chose night life. Low life.
Anyway, this is not about you, it is about the hospitals. Focus. There are not enough doctors in the hospital! Would you believe that? We sent 10,000 foreign doctors back just recently (see junior doctors numbers between 2006 and 2007 on the linked excel sheet) because we were apparently in surplus. Some health select committee suggested that that was inappropriate, but you dont have a clue who they are and dont care do you?. So now that we are gaining independence from foreign countries (rather than the other way round as has been historical), and are increasingly recruiting indigenous population to do the job, why are hospitals saying they are not having enough doctors? You still continue to hear about too many consultants, not enough consultant jobs for all the registrars who are coming out, More F1 jobs than CT posts, too many medical students coming out soon..etc. etc., and still hospitals don’t have enough doctors..
But did you know that.....
.......EWTD introduction in 2009 has effectively doubled the requirement for doctors' numbers at a time when numbers were already dwindling?
......68,880 nursing jobs have been earmarked to go between April 2010 and April 2015 with 24,836 of these already gone? Forget trying to meet RCN recommendations on safe nursing staffing levels!
......Increasing proportion of female doctors are coming out from medical schools and soon will adopt less than full time working posts, thus doubling requirements further, along with maternity leaves and child care, all requirements of a "compassionate society" which is paradoxically intolerant of the NHS in its current shape and form?
......Recruitment of doctors continues to be a nightmare in district general hospitals that are far away from the glittering cities, and yet offering posts with lower banding thus providing lower salaries, combined with travel money cuts?
..... it is hard for a newly qualified doctor to look after patients well, if half of the junior doctors posts are not filled? Rushed off one's feet while trying to find ones' feet is hardly safe and trying to do two doctor's jobs when you are not even qualified to do one is even more ridiculous. It then seems funny when the government and public keep wondering what the reasons for increasing hospital mortality could be. Staffing issues? You heard it here first.
Add injury to this insult. The one doctor who is trying to do the job of two has never worked in the UK before. What is he then doing in the NHS you ask. Well, there was no one else. Someone was needed to be a body in an empty rota. Scant 15-minute long distance telephonic interview later, doctor from non-English speaking country arrives to do a job in a country and a hospital he has never been to before. His only qualification to do the job safely is the 5 minute induction pack handed over to him at the entrance of the hospital with the general direction of the mess room being pointed out by a benevolent health care assistant.
Ok, but before you think that the problem is only with the foreign doctors who have come to sort this problem ad hoc, what about educational standards in this country? Tomorrows doctors 1993 document. Life changing for doctors qualifying since, life taking for patients. The beginning of the dumbing down of medical education. Why? Because the new doctor of tomorrow basically only needs to smile and talk sweet little nothings to reassure patients. Knowing the biochemistry and physiology of their bodies was not so crucial. Knowing too much was the problem in the 40 s and 80s. Knowledge makes doctors arrogant. Dumb them down and they are docile and easily manipulated. Doctors in hospitals thought they knew more than those in the community. Solution, dumb down hospital doctors so that they can be moved into the community as required to be whatever role required of them. None of the basics of medical education to be taught anymore! This has been identified as a problem by clinicians (but who listens to them anyway?) and even the backbench MPs of the health select committee highlighted this as a current threat in 2008-2009 report on patient safety (see page 7) . The junior doctor thus qualifying with only communication skills and some pleasantries to get by in daily ward life, hopes to learn most of medicine, post-qualification on the wards. Sadly, she is disillusioned to find that when she is the only doctor in the ward, teaching is unlikely to happen because someone has to rewrite charts and take blood and send blood and give blood as well as leave at the stroke of 5 pm to abide by EWTD regulations.
So if anyone asks you what is the cause of increased mortality in the NHS, feel free to boldly say, quantity and quality of nursing and medical staff. But word of caution: Ask them for solutions before they ask you.....