What exactly is going to happen to the £35m that the Chancellor has earmarked for the NHS? How will patients feel the benefit, and how soon?
Just throwing money at the NHS is not the cure. What keeps staff morale high is patient satisfaction. What keeps patient morale high is positive staff attitudes. Both rely on the total experience patients have.
An example. You go to hospital to have a baby. Your antenatal care helps ensure your child is delivered healthy and well, and you are left in good shape, too. Do you accept everything else that happens to you as unimportant, because you’re alive and well and have a healthy baby?
No, you do not. You complain, more or less vociferously, about the long waits you had in the antenatal clinic. You complain because the midwives never had time to stop and explain things to you. You (and your GP) complain about the difficulty of getting information out of the obstetric department secretary who is running three weeks behind on letters and case summaries. You complain about the food they gave you, about the grubby state of the bathrooms, about the noise that kept you awake at night. You do this because every patient, from one having a run-of-the-mill hernia to one going through the most fiendishly complicated heart bypass graft, judges the quality of the NHS on the basis of the experience they have from the day they set foot into the hospital to the day they come out.
I know just how I would improve the quality of that total experience if I had my hands on the moneybags. I would simply reverse some of the more stupid economies initiated by the Tory reforms and left untouched by the present administration.
Staff costs are always the highest in any business: staff, therefore, were prime targets for “efficiency” cuts during the early 1990s. Nurses and doctors were, then as now, regarded as too precious to cut. Instead, secretaries and porters, cleaners and clerks, receptionists, laboratory technicians, pharmacy assistants, operating-theatre technicians, electricians, maintenance men and, yes, managers too, received their marching orders.
The result was an immediate increase in pressure on nurses and doctors. When there are no clerks to ensure that vital case records are sent up from the registry for a doctor’s round, it is a nurse who has to go scurrying to get them (and don’t be amazed that they can’t be called up on the ward computer: IT was another area where heavy budget reductions were made). When the staff-starved pharmacy is late with vital drugs, a social worker needs tracking down or an irate GP needs vital information about a recently discharged patient, there is no longer a secretary or ward clerk available. Nowadays, it is the nurse who spends ages on the phone, trying to sort the matter out.
And when blood samples have to be taken for the path lab, the shortage of lab staff such as phlebotomists means that doctors have to collect the blood samples. When essential machinery goes wrong and the few technicians the hospital still employs are backed up with several hours’ worth of emergency work elsewhere, guess who has to step in and do what they can to sort it all out? Right. The net result is less time for patients, more stress for everyone, more irritability and a lousy total experience.
The scene is even more depressing when you consider the basics like cleaning hospitals, moving patients around from place to place, feeding them and bathing them. Cleaning in almost all of the new hospital trusts was contracted out to firms that generally paid as little as possible to as few workers as possible to get the contract down to an “attractive” price – only, in far too many cases, then to carry it out badly.
The Patients’ Association helpline reports this as one of its commonest complaints. “How can they prevent the spread of infection when the floors and walls and everywhere are so filthy?” patients ask. They also complain of peeling paint and rusty window-frames, battered trolleys and “things left lying around all over the place; it’s so depressing . . . “
Patients further report that there is nobody to feed the helpless, nobody to give blanket baths, nobody to hold their heads when they throw up – all those important details of ward life that mean to so much to the sick. These were once nursing duties, but nowadays nurses are much more academic and technological, and have less opportunity to provide such hands-on care.
The remedy could be inexpensive apprenticeship schemes offering bedside training of intelligent young people interested eventually in a medical or nursing or other health professional career, willing to put in a year or so at the bedside with qualified supervision before going off to university. This would not only benefit patients now; it would aid recruitment, give students excellent pre-academic experience, and provide jobs for young people currently unemployed.
It would not be excessively costly to put back this lost infrastructure and increase it by recruiting apprentice ward assistants – and it would have an immediate impact on staff pressures. Morale would rise and more and better care could be given as a consequence. Patient satisfaction would improve.
As more doctors, nurses and other professionals once more fill our wards and departments, patients will be well-tended and happy. The National Institute for Clinical Excellence and the National Frameworks, which are being developed for all forms of care, will tidy up the present anomalies in treatment; postcodes will no longer determine your health. What a difference a few million spent this way could make . . .
The writer is president of the Patients’ Association
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