Friday, 15 April 2011

Honesty about cuts in the NHS

The need for the NHS to make efficiency savings of £20bn to pay for growing demands for services will inevitably lead to cuts in existing staffing levels. That process is already generating the usual hysterical response from the usual quarters. Research published by the Royal College of Nursing suggests that (based on a survey of just of 21 NHS Trusts in England), 54% of the cuts would be “front line” staff (code for doctors and nurses) with 46% of almost 10,000 posts to be cut being nursing jobs. We are further told that:

“Cutting thousands of frontline doctors and nurses could have a catastrophic impact on patient safety and care….”

This is shroud waving of the worst possible kind. Let’s just deal with a few facts:-

• Doctors and nurses account for almost 40% of NHS staffing and well over 40% of NHS staffing costs. Furthermore, between 1997 and 2006 the Royal College of Nursing’s own figures (http://www.rcn.org.uk/__data/assets/pdf_file/0016/107260/003203.pdf) show that the numbers of qualified nurses in the NHS grew by 25% in England and around the same in the rest of the UK. It is inevitable that given the size of these figures there will be substantial cuts in their staff numbers in the current fiscal climate. The Government is already protecting the NHS budget from the sorts of cuts happening elsewhere in the public sector. Surely we don’t expect all doctors and nursing jobs to be protected as well
• The NHS can’t just run on doctors and nurses. Even the Anglican Church has institutionalised this view by having a special section in its prayer book for doctors and nurses while ignoring the huge clinical contribution of a vast army of other health professionals such as: speech therapists, physiotherapists, pharmacists, dieticians etc. In addition there are also the other essential workers that the NHS must have. Catering staff to feed the patients, cleaning staff to clean the wards, maintenance staff to keep various systems operational etc. What is more, even the dreaded administrators have their uses. Without them who would pay the wages, who would order the supplies etc. A hospital comprising just doctors and nurses wouldn’t do very much and if the cuts being imposed were to exempt doctors and nurses the NHS would soon grind to a halt.
• Where is this evidence that the cuts in doctors and nurses would have a “catastrophic impact on patient safety”? I seem to recall that it wasn’t that long ago that the Mid Staffordshire NHS Trust and the Maidstone and Tunbridge Wells NHS Trust suffered catastrophic impacts on patient safety during a period when the NHS was obtaining record growth in resources. These failures seemed to be more to do with culture and leadership (or lack of) in the organisations than resources.

Clearly the process of generating savings of the magnitude proposed will be difficult and painful but let’s have a balanced discussion about how this should be done not hysterical headline chasing. I suggest that the various nursing and doctors unions should start looking at what their members actually do and how that can be improved not just how many of them there are.

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