You I dismissed political hands on the NHS but I think he at least is trying, it is such a monumental task and I think he does have a point of the route to hospital needs to be clean and also the route home needs to be cleared up too.
God help him, he will be in for flack no matter what he tries.
The evidence...my personal experience of working in the NHS for 38 years. I am a nurse and we undertake clinical audit of everything. We are snowed under with audits of every kind. Ordering of supplies is audited and has to go through about two different people....simply trying to get a replacement uniform is a nightmare and takes for ever.
We share our office with clerical staff and I know all their work is audited too. Each department has it's own budget which is audited. For example we share a fax machine with a treatment room service (we are the district nursing service) separate budgets. Recently, we needed to buy a few toners - of course they were in stock up at the hospital but it was the departments budget which paid for them. There was a bit of an argument (which I kept totally out of - my business is patients) between staff as whose budget was going to pay for these. I thought it totally laughable and sad. Not only did we all work for the NHS we all worked for the same trust.
However, each item had to be audited down to the last toner for the fax machine.
The evidence will be somewhere because the audits are done.......clinical audits by frontline staff. We sometimes see evidence of these - which usually tell us what we already know, but are very useful for occasionally they don't. The rest seem to disappear into the ether...
You know better than anybody on here, I admire your fight after what you have gone through. I want any party to be honest about the NHS.
Its actual political suicide going on here. Llanelli is supposed to be a labour stronghold so what have they gone and done. Even Nia Griffith is being ignored the local hospital's A&E was first being closed now its being "modified" to be run by nurses and GP's. with other cases being sent to Carmarthen and Swansea.
Trouble is Carmarthen is already at breaking point and Swansea being out of the Hywel Dda trust area means it costs just as much sending a patient there as it would to Glasgow or London etc. The entire plan is a shambles the locals are in uproar but the welsh assembly see it an amazing idea and carrying on regardless.
mark drakeford is an idiot he was brought in to try and sort the mess out and there's no sign of it. Ed Miliband can face the reality the assembly here in Wales couldn't have made more of a mess if they tried. And instead of passing the entire thing off as some political stunt he needs to send a team down and see the proof on the ground they have got it so badly wrong.
In the assembly elections next time I can see Labour taking a hammering simply over the NHS issue they seem totally clueless there is really deep local anger and I suspect that's why Nia Griffith has been so vocal she knows this isn't going to play out well.
The evidence...my personal experience of working in the NHS for 38 years. I am a nurse and we undertake clinical audit of everything. We are snowed under with audits of every kind. Ordering of supplies is audited and has to go through about two different people....simply trying to get a replacement uniform is a nightmare and takes for ever.
We share our office with clerical staff and I know all their work is audited too. Each department has it's own budget which is audited. For example we share a fax machine with a treatment room service (we are the district nursing service) separate budgets. Recently, we needed to buy a few toners - of course they were in stock up at the hospital but it was the departments budget which paid for them. There was a bit of an argument (which I kept totally out of - my business is patients) between staff as whose budget was going to pay for these. I thought it totally laughable and sad. Not only did we all work for the NHS we all worked for the same trust.
However, each item had to be audited down to the last toner for the fax machine.
The evidence will be somewhere because the audits are done.......clinical audits by frontline staff. We sometimes see evidence of these - which usually tell us what we already know, but are very useful for occasionally they don't. The rest seem to disappear into the ether...
I am beginning to think what these audits are is smoke and mirrors. The layers of paperwork is ridiculous, what I think they are calling audit is nothing of the sort. In the real world Audit puts together all the accounts and then sorts out all the information regarding each area where the money has been spent etc.
What appears to be happening is just getting people to run around with bits of paper like headless chickens.
Those trusts have a lot to answer for, they are producing these ridiculous "audits" aka diversionary tactics to hide goodness alone knows what. I hope Jeremy Hunt before he leaves does a root and branch proper audit so the nation can see where the money goes, because we know for sure it is not going where it should.
I think there is a lot of skullduggery and I wonder if it is from the ones who do the least, know they have non-jobs and produce any tactics to divert attention from themselves, whilst spouting, not enough money, knowing they are the thieves taking money under false pretences, it makes me mad because it is everyone other than them that suffer.
I am beginning to think what these audits are is smoke and mirrors. The layers of paperwork is ridiculous, what I think they are calling audit is nothing of the sort. In the real world Audit puts together all the accounts and then sorts out all the information regarding each area where the money has been spent etc.
What appears to be happening is just getting people to run around with bits of paper like headless chickens.
Those trusts have a lot to answer for, they are producing these ridiculous "audits" aka diversionary tactics to hide goodness alone knows what. I hope Jeremy Hunt before he leaves does a root and branch proper audit so the nation can see where the money goes, because we know for sure it is not going where it should.
I think there is a lot of skullduggery and I wonder if it is from the ones who do the least, know they have non-jobs and produce any tactics to divert attention from themselves, whilst spouting, not enough money, knowing they are the thieves taking money under false pretences, it makes me mad because it is everyone other than them that suffer.
On a previous NH thread I wrote that a 10% reduction in paperwork would result in a 25% increase in time given to care and treatment. Some disagreed, others thought it was a reasonable analysis. It would also make a lot of NHS nursing staff a lot happier and lead to a better job satisfaction.
On a previous NH thread I wrote that a 10% reduction in paperwork would result in a 25% increase in time given to care and treatment. Some disagreed, others thought it was a reasonable analysis. It would also make a lot of NHS nursing staff a lot happier and lead to a better job satisfaction.
I am all for that, and listening to J.Hunt on QT last week i think he said they have cut a lot of the paperwork, but the NHS trusts know how to sneak more in when they want, I hope he can sort some of that out, it would be the biggest gift to nursing staff.
I think 10% is not enough, a lot of the pen pushers who pass their work over to frontline staff need to go. I wonder what % that would make in difference to the wages we could use for frontline staff rather than admin who hide in offices dreaming up new ways to justify the useless jobs they do.
I also blame the Registrars for taking and not producing world class systems which would help their staff on the ground.
NHS rules state critically ill patients should have an ambulance with them within eight minutes
But some suffering heart attacks and strokes are waiting around 30 minutes for an ambulance to arrive
Statistics show response times over the past three years have worsened
One of the key issues with Wales.
It goes from GP/Dentist/Ambulance right through the NHS services.
Routine follow up's the doctor says come back in 6 weeks when you reach the appointment desk the best they can do is 13/14 weeks.
My hospitals are based in London because the local health board finally admitted owing to the rare nature of it they simply don't have a doctor down here. so the funding issue after being taken to court 3 times and winning they finally accepted.
one of the understandings was if anything like MRI's etc could be done local they would which is fair enough. I needed one to keep a track on the pelvis area. down here 18 months. the doctors in London said that's was completely unacceptable and got it up there within 14 days.
you name a service and unless you pay private the waiting times are just horrendous.
they had a walk in and out blood place it was brilliant 5 minutes waiting all done. it was allowed to go bust a few months ago now blood tests you can wait upto 4 hours with people waiting there at 6am so they know when they open at 9am.
As a nurse from the 'when we trained it was better' era in the 70's, I can pinpoint when the whole service went into a downward spiral. The GNC [UKCC] and the RCN decided we should all become 'research based' and be graduates, having degrees to be able to be published in the Nursing Times and Mirror. We could be seen as 'proper professionals'. Unfortunately in this drive for acceptance, they lost sight of what we were trained to actually do. We went through the Project 2000 rubbish and all other kinds of reports and ended by saying 'Let's get rid of student nurses', forgetting that students we were the workforce and actually looked after people instead of being supernumerary people walking around looking lost.
I left the profession a few years ago, but give me a week back on the wards and I would sort it out quite easily. Reminding nurses to wash their hands?
As a nurse from the 'when we trained it was better' era in the 70's, I can pinpoint when the whole service went into a downward spiral. The GNC [UKCC] and the RCN decided we should all become 'research based' and be graduates, having degrees to be able to be published in the Nursing Times and Mirror. We could be seen as 'proper professionals'. Unfortunately in this drive for acceptance, they lost sight of what we were trained to actually do. We went through the Project 2000 rubbish and all other kinds of reports and ended by saying 'Let's get rid of student nurses', forgetting that students we were the workforce and actually looked after people instead of being supernumerary people walking around looking lost.
I left the profession a few years ago, but give me a week back on the wards and I would sort it out quite easily. Reminding nurses to wash their hands?
Please - the training is basically wrong
I trained in the early to mid eighties and I certainly do not believe things were better back then.
There has always been bad nursing care and uncaring nurses but it wasn't so visible to the general public back then, probably because most of the actual hands-on nursing care was carried out by pre-reg students (nowadays mainly by HCAs, some of whose background is non healthcare related). There was also, commonly, poor infection control. There were a lot less HAIs (hospital acquired infections) back then, admittedly, but many of today's infections are related to indwelling devices such as catheters, cannulae, invasive lines etc which were not so common back then, plus C Diff is associated with over-use of antibiotics which kill normal gut flora. Intravenous antibiotics were a rarity, not the norm of today, so drug resistance was not such an issue. We students were used as cheap labour and received a very basic academic training. Luckily for me, I had received a very rounded school education in Ireland and was ambitious and motivated enough to continue my professional development post qualification, undertaking critical care courses, a BSC and a management course which has enabled me to progress in my career.
The new nurses of today have a much better attitude, overall, than many of the nurses of the past. Times have moved on, the workload has risen enormously and the paperwork increases on a daily basis.
As Winterlily has said, absolutely everything a nurse or a doctor does is audited - and then the audits are audited! I don't know who's going to put a stop on those audits because they are the evidence that the work is being carried out following correct procedures and protocols. Every single procedure that is carried out, whether it be inserting a naso-gastric tube, performing a catheterisation, inserting a cannula etc generates a whole care bundle and care-plan. These are then audited periodically and are used to provide evidence to inspecting bodies such as the CQC that we are performing to national standards (or not, as the case may be). I personally hate auditing, it is a tedious task, but necessary in the NHS of today when everything must be benchmarked.
Nurse training is not going to change, no matter how many old-school nurses of the past, may wish it to. There is nothing fundamentally wrong with educating our nurses to a high standard as long as we recruit the right type of caring, compassionate, hard working and dedicated people into our profession. It would certainly help to have the right skill mix, more registered nurses and less health care assistants. HCAs are not trained but often have the most contact with the patients and are given roles that should really be the remit of the RN.
As a nurse from the 'when we trained it was better' era in the 70's, I can pinpoint when the whole service went into a downward spiral. The GNC [UKCC] and the RCN decided we should all become 'research based' and be graduates, having degrees to be able to be published in the Nursing Times and Mirror. We could be seen as 'proper professionals'. Unfortunately in this drive for acceptance, they lost sight of what we were trained to actually do. We went through the Project 2000 rubbish and all other kinds of reports and ended by saying 'Let's get rid of student nurses', forgetting that students we were the workforce and actually looked after people instead of being supernumerary people walking around looking lost.
I left the profession a few years ago, but give me a week back on the wards and I would sort it out quite easily. Reminding nurses to wash their hands?
Please - the training is basically wrong
Two of my sisters were trained and started nursing in the late 60's, the ethos was fantastic back then and they both concur with you. I think the NHS is now paper based and has forgotten there are patients out there because most of the managers are behind desks or hiding in stock rooms making up reasons for their existence. The nurses and porters are almost wasting away wanting help and all the managers can do is produce more paperwork.
When did physical hands on care for a patient become dependent on which piece of paper was lodged.
I remember in 1997 when my niece was pregnant and during a visit to see her I took her for a routine ante natal appointment. The midwives were fantastic but looked really flustered after some young lady in clacky court shoes came strolling into the room and said you two have to move on now and wrote something down. The appointment was not finished as my niece had some concerns about the birth and the midwives answered her. Two minutes later said Clacky heels came back and asked them to hurry up. So I asked her if there was a problem, the answer was a swift turn and out the door she went.
The midwives told me that was the new format for attending appointments in a 6 minute slot.
Have to tell you it sent shudders down my spine, if I told my staff to spend X time on a client I would have gone belly up in no time.
So I do wonder, what exactly do these graduates do all day other than hamper the care of patients?
It is a scandal and no one will address it.
You are right what you learned as a student nurse is with you for life, it isn't like a rota but it learned by rote almost and those ethics remain with you for life. Nowadays it is all action plans and stupid things which have absolutely no bearing on the common sense of a good nurse. Maybe before these graduate managers enter a workplace they should be trained by frontline staff for six months before they are allowed anywhere near their action plans.
I trained in the early to mid eighties and I certainly do not believe things were better back then.
There has always been bad nursing care and uncaring nurses but it wasn't so visible to the general public back then, probably because most of the actual hands-on nursing care was carried out by pre-reg students (nowadays mainly by HCAs, some of whose background is non healthcare related). There was also, commonly, poor infection control. There were a lot less HAIs (hospital acquired infections) back then, admittedly, but many of today's infections are related to indwelling devices such as catheters, cannulae, invasive lines etc which were not so common back then, plus C Diff is associated with over-use of antibiotics which kill normal gut flora. Intravenous antibiotics were a rarity, not the norm of today, so drug resistance was not such an issue. We students were used as cheap labour and received a very basic academic training. Luckily for me, I had received a very rounded school education in Ireland and was ambitious and motivated enough to continue my professional development post qualification, undertaking critical care courses, a BSC and a management course which has enabled me to progress in my career.
The new nurses of today have a much better attitude, overall, than many of the nurses of the past. Times have moved on, the workload has risen enormously and the paperwork increases on a daily basis.
As Winterlily has said, absolutely everything a nurse or a doctor does is audited - and then the audits are audited! I don't know who's going to put a stop on those audits because they are the evidence that the work is being carried out following correct procedures and protocols. Every single procedure that is carried out, whether it be inserting a naso-gastric tube, performing a catheterisation, inserting a cannula etc generates a whole care bundle and care-plan. These are then audited periodically and are used to provide evidence to inspecting bodies such as the CQC that we are performing to national standards (or not, as the case may be). I personally hate auditing, it is a tedious task, but necessary in the NHS of today when everything must be benchmarked.
Nurse training is not going to change, no matter how many old-school nurses of the past, may wish it to. There is nothing fundamentally wrong with educating our nurses to a high standard as long as we recruit the right type of caring, compassionate, hard working and dedicated people into our profession. It would certainly help to have the right skill mix, more registered nurses and less health care assistants. HCAs are not trained but often have the most contact with the patients and are given roles that should really be the remit of the RN.
What would you do if you were J Hunt? Maybe what we should do is get every nurse, porter or any frontline staff to write to him and fill him in about life in the NHS, that would be the best information any government could possibly be given to make a real decision on where the improvements could be made. Imagine if that gives you more time with your patient and less time auditing? I refuse to use that word, it is CYA for those frauds who live in la la land above you and add nothing of any worth.
I am all for that, and listening to J.Hunt on QT last week i think he said they have cut a lot of the paperwork, but the NHS trusts know how to sneak more in when they want, I hope he can sort some of that out, it would be the biggest gift to nursing staff.
I think 10% is not enough, a lot of the pen pushers who pass their work over to frontline staff need to go. I wonder what % that would make in difference to the wages we could use for frontline staff rather than admin who hide in offices dreaming up new ways to justify the useless jobs they do.
I also blame the Registrars for taking and not producing world class systems which would help their staff on the ground.
I assure you the paperwork, for nurses at least, has not been cut. In fact it is increasing more than ever. For example, for pressure area care alone (prevention of pressure ulcers) there are pages and pages of forms one needs to complete. We are required to do these for if a patient develops a pressure ulcer and the required documentation is not completed we are hauled before a meeting and have to justify what went wrong and why. If we cannot produce a documented paper trail we are in the wrong. When someone does develop a pressure ulcer there is then a whole load of other paperwork to complete.
Of course there needs to be good record keeping as several different nurses will care for any given patient and need to be updated about a patient's progress. Nurses need to formulate care plans from their assessments and continually evaluate these care plans. However, it is the amount we have to do which we find so demoralising. What also makes us angry is it's presented as a means to improve the quality of care - when in reality it takes us away from patient contact and does nothing to improve care - the phrase is of course 'if it has not been documented it hasn't been done'. It's about fear of litigation and covering backs not about improving patient care...:(
Our district nursing service is creaking at the seams. No money appears to come to the front line, we have had no extra nurses - although I know they have recently taken on 40 or so foreign nurses at the local hospital.
I can only comment regards clinical audit. However, there are restrictions as to what clinical stock we can order, for example. It is all itemised and ordered electronically. Staff are only allowed to order from a restricted itemised stock. Once ordered, it has to be authorised by our manager before being sent on to the hospital to be sorted. Our stock room is never well stocked and we usually carry stock around in our cars to ensure we do not run out.
I can only speak of my experiences. However, I know a lot of nurses not only within my trust but others in neighbouring trusts and around the country. They all say the same. If the money is there it is not getting to the frontline. Yes there have been improvements but they have been patchy and piecemeal. For example, our trust recently got rid of a whole tier of management. However, about half of these managers were then redeployed undertaking similar roles as previously. At the same time the district nursing teams are working under great stress.
Everyone is demoralised. We feel undervalued and blamed for all the ills within the NHS...for me personally the worst insult is that nobody appears to be listening to what we have to say. Morale is rock bottom. I have never seen so many nurses so demoralised in all my years in the NHS.
The target culture that has been brought in to the NHS does not work, cannot work, and has a negive effect on patient's care, and fineing hospital for not reaching these targets only takes more money away from patient's care, and ends up not enough money to employ the staff to even come close to hitting these silly stupid targets. "Quality over quantity"- means that a better product/ service
I assure you the paperwork, for nurses at least, has not been cut. In fact it is increasing more than ever. For example, for pressure area care alone (prevention of pressure ulcers) there are pages and pages of forms one needs to complete. We are required to do these for if a patient develops a pressure ulcer and the required documentation is not completed we are hauled before a meeting and have to justify what went wrong and why. If we cannot produce a documented paper trail we are in the wrong. When someone does develop a pressure ulcer there is then a whole load of other paperwork to complete.
Of course there needs to be good record keeping as several different nurses will care for any given patient and need to be updated about a patient's progress. Nurses need to formulate care plans from their assessments and continually evaluate these care plans. However, it is the amount we have to do which we find so demoralising. What also makes us angry is it's presented as a means to improve the quality of care - when in reality it takes us away from patient contact and does nothing to improve care - the phrase is of course 'if it has not been documented it hasn't been done'. It's about fear of litigation and covering backs not about improving patient care...:(
Our district nursing service is creaking at the seams. No money appears to come to the front line, we have had no extra nurses - although I know they have recently taken on 40 or so foreign nurses at the local hospital.
I can only comment regards clinical audit. However, there are restrictions as to what clinical stock we can order, for example. It is all itemised and ordered electronically. Staff are only allowed to order from a restricted itemised stock. Once ordered, it has to be authorised by our manager before being sent on to the hospital to be sorted. Our stock room is never well stocked and we usually carry stock around in our cars to ensure we do not run out.
I can only speak of my experiences. However, I know a lot of nurses not only within my trust but others in neighbouring trusts and around the country. They all say the same. If the money is there it is not getting to the frontline. Yes there have been improvements but they have been patchy and piecemeal. For example, our trust recently got rid of a whole tier of management. However, about half of these managers were then redeployed undertaking similar roles as previously. At the same time the district nursing teams are working under great stress.
Everyone is demoralised. We feel undervalued and blamed for all the ills within the NHS...for me personally the worst insult is that nobody appears to be listening to what we have to say. Morale is rock bottom. I have never seen so many nurses so demoralised in all my years in the NHS.
I can only imagine what you go through as I have never been in the profession, It is the (see bold) that winds me up, how thick do they think everyone is?
Why is this not picked up, the fact that that particular tier of management was got rid of was because it was useless, so they then deploy some of the same elsewhere, all the time holding back money from the frontline where it belongs.
It appears to me that they deliberately keep the frontline starved so they can bleat about not enough frontline staff during their election campaigns and in previous years that has been believed, but now people can see the blatant politicising of the NHS hopefully some bright spark out there can get it to the media. It seems the media once onto a story will prompt the politicians to do something, this is something big and yet no one wants to know.
The solutions are probably staring us in the face but none can see and no one has the nuts to go public with it.
It will come down to whistleblowers in the end because those managers have everything sewn up, it should be the NHS club.
And all the while the real workers, and patients are left to suffer so they can sit in their offices thinking up new ways to hang on to their ill gotten pensions.
What would you do if you were J Hunt? Maybe what we should do is get every nurse, porter or any frontline staff to write to him and fill him in about life in the NHS, that would be the best information any government could possibly be given to make a real decision on where the improvements could be made. Imagine if that gives you more time with your patient and less time auditing? I refuse to use that word, it is CYA for those frauds who live in la la land above you and add nothing of any worth.
To be honest, I can't abide J Hunt and am looking forward to a time when the Tories are out of office. J Hunt just makes me cross when he is interviewed, he is so clueless. Whenever he gets asked why the review body's 1% pay increase for nurses is not being honoured, he comes up with the same response that it's either a pay-rise or nursing redundancies.
I can't see the benefit of paying out redundancy packages to nurses only then to use agency staff to fill the shortfall There are minimum safe staffing levels - is he saying if we take just a 1% pay-rise (after a 4 year pay freeze) then we will have to do the same job with less staff? I don't think the CQC (or anyone sane) would accept that when we are already so short-staffed!
However, at this present time, myself and many of my colleagues wouldn't mind too much accepting a redundancy package, which at this stage in my career, would not be too shabby. Many of us ITU nurses are so well qualified, we can earn a lot more doing agency work anyway. So I would say to J Hunt, go ahead and honour the 1% rise, many nurses like myself don't mind being made redundant - we'll only be coming back to the same unit in an agency capacity - and costing you more ;-)
I trained in the early to mid eighties and I certainly do not believe things were better back then.
There has always been bad nursing care and uncaring nurses but it wasn't so visible to the general public back then, probably because most of the actual hands-on nursing care was carried out by pre-reg students (nowadays mainly by HCAs, some of whose background is non healthcare related). There was also, commonly, poor infection control. There were a lot less HAIs (hospital acquired infections) back then, admittedly, but many of today's infections are related to indwelling devices such as catheters, cannulae, invasive lines etc which were not so common back then, plus C Diff is associated with over-use of antibiotics which kill normal gut flora. Intravenous antibiotics were a rarity, not the norm of today, so drug resistance was not such an issue. We students were used as cheap labour and received a very basic academic training. Luckily for me, I had received a very rounded school education in Ireland and was ambitious and motivated enough to continue my professional development post qualification, undertaking critical care courses, a BSC and a management course which has enabled me to progress in my career.
The new nurses of today have a much better attitude, overall, than many of the nurses of the past. Times have moved on, the workload has risen enormously and the paperwork increases on a daily basis.
As Winterlily has said, absolutely everything a nurse or a doctor does is audited - and then the audits are audited! I don't know who's going to put a stop on those audits because they are the evidence that the work is being carried out following correct procedures and protocols. Every single procedure that is carried out, whether it be inserting a naso-gastric tube, performing a catheterisation, inserting a cannula etc generates a whole care bundle and care-plan. These are then audited periodically and are used to provide evidence to inspecting bodies such as the CQC that we are performing to national standards (or not, as the case may be). I personally hate auditing, it is a tedious task, but necessary in the NHS of today when everything must be benchmarked.
Nurse training is not going to change, no matter how many old-school nurses of the past, may wish it to. There is nothing fundamentally wrong with educating our nurses to a high standard as long as we recruit the right type of caring, compassionate, hard working and dedicated people into our profession. It would certainly help to have the right skill mix, more registered nurses and less health care assistants. HCAs are not trained but often have the most contact with the patients and are given roles that should really be the remit of the RN.
I agree with this. I trained under the old system in the 1970's, we learned our trade on the wards and the practical education was excellent. However, the theoretical education was woeful. Nursing has moved on since the 70's and quite rightly so. Nurses today need to know not only how to do something but why they do it and how they could do it better to improve overall patient care.
Project 2000 training initially went too far the other way. Nurses spent more time in university and not enough time on the wards. However, for several years now nurse training has been 50% university based and 50% clinical placement based which I believe is the correct balance.
Like Marella, I too realised my initial nurse training was ineffective and limited. Although I possessed good practical nursing skills I needed to learn more about why we do things as we do and just how to do them. I needed to question and challenge existing practices and felt I could only do this by improving my nursing education. I obtained my first degree 22 years ago and continued to improve my education and therefore my practice until the day I took flexi retirement earlier this year. Better education makes better nurses...I would have thought that was obvious.
The core of nursing is of course caring - having a better educated nursing workforce does not diminish this in any way whatsoever. It enhances it. As a nurse mentor I am very impressed with the caring and compassionate nature of many of our student nurses...
I feel to blame nurse education is too simplistic. I believe it is fit for purpose and any attempt to dismantle it would be a very backward step.
To be honest, I can't abide J Hunt and am looking forward to a time when the Tories are out of office. J Hunt just makes me cross when he is interviewed, he is so clueless. Whenever he gets asked why the review body's 1% pay increase for nurses is not being honoured, he comes up with the same response that it's either a pay-rise or nursing redundancies.
I can't see the benefit of paying out redundancy packages to nurses only then to use agency staff to fill the shortfall There are minimum safe staffing levels - is he saying if we take just a 1% pay-rise (after a 4 year pay freeze) then we will have to do the same job with less staff? I don't think the CQC (or anyone sane) would accept that when we are already so short-staffed!
However, at this present time, myself and many of my colleagues wouldn't mind too much accepting a redundancy package, which at this stage in my career, would not be too shabby. Many of us ITU nurses are so well qualified, we can earn a lot more doing agency work anyway. So I would say to J Hunt, go ahead and honour the 1% rise, many nurses like myself don't mind being made redundant - we'll only be coming back to the same unit in an agency capacity - and costing you more ;-)
I understand what you are saying, and it seems self defeating (the 1% pay rise business) but do you believe too much of the money ends up in administration instead of the front line or have I got the wrong end of the stick.
I understand what you are saying, and it seems self defeating (the 1% pay rise business) but do you believe too much of the money ends up in administration instead of the front line or have I got the wrong end of the stick.
I can't see the benefit of paying out redundancy packages to nurses only then to use agency staff to fill the shortfall There are minimum safe staffing levels - is he saying if we take just a 1% pay-rise (after a 4 year pay freeze) then we will have to do the same job with less staff? I don't think the CQC (or anyone sane) would accept that when we are already so short-staffed!
Welcome to the wonderful world of the public sector and bureaucracy , its the way they do their accounting and depending on which pot of money they are using
I understand what you are saying, and it seems self defeating (the 1% pay rise business) but do you believe too much of the money ends up in administration instead of the front line or have I got the wrong end of the stick.
From my experience, you have the wrong end of the stick. In my trust, we need our admin staff and they are on much lower wages than the frontline staff. Most of the ''managers'' are nurses - matrons and heads of nursing - who do a very important job in managing budgets, overseeing wards, ensuring high standards are maintained, recruiting staff, disciplining etc. Everybody has an important role and, without those managers, or indeed the admin staff, the work they do is just passed down to the ward managers who are frontline staff.
Of course, the real management in a trust consists of an executive board. This is the Chief Executive, The Director of Nursing, the Finance Director, the Medical Director etc.
They have their assistants and deputies but, again, I can't see how we could afford to lose any of them.
I can't speak for all trusts, that's just my own perspective, and I work in one of the largest trusts in London.
Welcome to the wonderful world of the public sector and bureaucracy , its the way they do their accounting and depending on which pot of money they are using
I know a nurse who received a £30 000 lump sum as a redundancy package and returned to work in the same hospital just a few weeks later in a different job but on the same salary. It's complete madness.
Go ahead, J Hunt, make us all redundant! There will be lots of vacancies for us to fill once the appropriate time has elapsed (I believe it is about 6 weeks before you can reapply to join the NHS). As I said, there will also be lots of agency work available and the agency bill in the NHS is already astronomical.
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I know a nurse who received a £30 000 lump sum as a redundancy package and returned to work in the same hospital just a few weeks later in a different job but on the same salary. It's complete madness.
Go ahead, J Hunt, make us all redundant! There will be lots of vacancies for us to fill once the appropriate time has elapsed (I believe it is about 6 weeks before you can reapply to join the NHS). As I said, there will also be lots of agency work available and the agency bill in the NHS is already astronomical.
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But it comes out of a different budget so it saves money in one budget and uses unspent money in another , it ridiculous but thats the way the public sector works , we waste billions every year with these practices and not just in the NHS
I know a nurse who received a £30 000 lump sum as a redundancy package and returned to work in the same hospital just a few weeks later in a different job but on the same salary. It's complete madness.
Go ahead, J Hunt, make us all redundant! There will be lots of vacancies for us to fill once the appropriate time has elapsed (I believe it is about 6 weeks before you can reapply to join the NHS). As I said, there will also be lots of agency work available and the agency bill in the NHS is already astronomical.
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My GP practice has some excellent nurses, some joined having been made redundant, others left the hospital they were working at and got jobs with local GPs.
But it comes out of a different budget so it saves money in one budget and uses unspent money in another , it ridiculous but thats the way the public sector works , we waste billions every year with these practices and not just in the NHS
When I was a ward manager, I had a budget for stock and a staffing budget. My staffing budget covered both substantive and agency costs. The agency bill is huge and there is no ''unspent money'' in any budget specifically to cover those costs. It all comes out of the staff budget!
To be honest, J Hunt is just scare-mongering with his implicit threats of staffing redundancies. He thinks we are all as thick as he is.
From my experience, you have the wrong end of the stick. In my trust, we need our admin staff and they are on much lower wages than the frontline staff. Most of the ''managers'' are nurses - matrons and heads of nursing - who do a very important job in managing budgets, overseeing wards, ensuring high standards are maintained, recruiting staff, disciplining etc. Everybody has an important role and, without those managers, or indeed the admin staff, the work they do is just passed down to the ward mangers who are frontline staff.
I can't speak for all trusts, that's just my own perspective, and I work in one of the largest trusts in London.
My perspective is slightly different probably because I work in a middle sized trust well away from London and in primary care.
Of course admin staff are needed and as you rightly say Marella, get rid of too many admin staff and this work is simply passed down to us - the frontline staff. My argument is focused more upon the complexity and opaque nature of the Trust's management structure. We may know the names of these individuals, but we have no idea what they do and more importantly who and what they have responsibility for.
There appears no clear line of authority and responsibility to the top. The NHS is highly hierarchical but it's complexity is mind boggling. Nobody appears to be able to make any decisions. And when decisions are finally made (by whom - we do not know) we the frontline staff have not even been consulted. The decisions are always top down and imposed upon us whether we believe it is appropriate for patient care or not.
I want more openness in the managerial system rather than this hush hush nobody knows anything culture which appears to pervade in our Trust which only serves to reinforce gossip and rumour.
It would also be nice for us to see where the Trust money is actually being spent. Yes the trust does publish their accounts and spending priorities on their website but I never seem to understand it. It is written in a pseudo legal, financial terminology fashion which I find totally unfathomable.
On how earth patients manage to understand this I have no idea....I suppose they're as confused as we are.
Comments
You I dismissed political hands on the NHS but I think he at least is trying, it is such a monumental task and I think he does have a point of the route to hospital needs to be clean and also the route home needs to be cleared up too.
God help him, he will be in for flack no matter what he tries.
We share our office with clerical staff and I know all their work is audited too. Each department has it's own budget which is audited. For example we share a fax machine with a treatment room service (we are the district nursing service) separate budgets. Recently, we needed to buy a few toners - of course they were in stock up at the hospital but it was the departments budget which paid for them. There was a bit of an argument (which I kept totally out of - my business is patients) between staff as whose budget was going to pay for these. I thought it totally laughable and sad. Not only did we all work for the NHS we all worked for the same trust.
However, each item had to be audited down to the last toner for the fax machine.
The evidence will be somewhere because the audits are done.......clinical audits by frontline staff. We sometimes see evidence of these - which usually tell us what we already know, but are very useful for occasionally they don't. The rest seem to disappear into the ether...
Its actual political suicide going on here. Llanelli is supposed to be a labour stronghold so what have they gone and done. Even Nia Griffith is being ignored the local hospital's A&E was first being closed now its being "modified" to be run by nurses and GP's. with other cases being sent to Carmarthen and Swansea.
Trouble is Carmarthen is already at breaking point and Swansea being out of the Hywel Dda trust area means it costs just as much sending a patient there as it would to Glasgow or London etc. The entire plan is a shambles the locals are in uproar but the welsh assembly see it an amazing idea and carrying on regardless.
mark drakeford is an idiot he was brought in to try and sort the mess out and there's no sign of it. Ed Miliband can face the reality the assembly here in Wales couldn't have made more of a mess if they tried. And instead of passing the entire thing off as some political stunt he needs to send a team down and see the proof on the ground they have got it so badly wrong.
In the assembly elections next time I can see Labour taking a hammering simply over the NHS issue they seem totally clueless there is really deep local anger and I suspect that's why Nia Griffith has been so vocal she knows this isn't going to play out well.
I am beginning to think what these audits are is smoke and mirrors. The layers of paperwork is ridiculous, what I think they are calling audit is nothing of the sort. In the real world Audit puts together all the accounts and then sorts out all the information regarding each area where the money has been spent etc.
What appears to be happening is just getting people to run around with bits of paper like headless chickens.
Those trusts have a lot to answer for, they are producing these ridiculous "audits" aka diversionary tactics to hide goodness alone knows what. I hope Jeremy Hunt before he leaves does a root and branch proper audit so the nation can see where the money goes, because we know for sure it is not going where it should.
I think there is a lot of skullduggery and I wonder if it is from the ones who do the least, know they have non-jobs and produce any tactics to divert attention from themselves, whilst spouting, not enough money, knowing they are the thieves taking money under false pretences, it makes me mad because it is everyone other than them that suffer.
On a previous NH thread I wrote that a 10% reduction in paperwork would result in a 25% increase in time given to care and treatment. Some disagreed, others thought it was a reasonable analysis. It would also make a lot of NHS nursing staff a lot happier and lead to a better job satisfaction.
I am all for that, and listening to J.Hunt on QT last week i think he said they have cut a lot of the paperwork, but the NHS trusts know how to sneak more in when they want, I hope he can sort some of that out, it would be the biggest gift to nursing staff.
I think 10% is not enough, a lot of the pen pushers who pass their work over to frontline staff need to go. I wonder what % that would make in difference to the wages we could use for frontline staff rather than admin who hide in offices dreaming up new ways to justify the useless jobs they do.
I also blame the Registrars for taking and not producing world class systems which would help their staff on the ground.
One of the key issues with Wales.
It goes from GP/Dentist/Ambulance right through the NHS services.
Routine follow up's the doctor says come back in 6 weeks when you reach the appointment desk the best they can do is 13/14 weeks.
My hospitals are based in London because the local health board finally admitted owing to the rare nature of it they simply don't have a doctor down here. so the funding issue after being taken to court 3 times and winning they finally accepted.
one of the understandings was if anything like MRI's etc could be done local they would which is fair enough. I needed one to keep a track on the pelvis area. down here 18 months. the doctors in London said that's was completely unacceptable and got it up there within 14 days.
you name a service and unless you pay private the waiting times are just horrendous.
they had a walk in and out blood place it was brilliant 5 minutes waiting all done. it was allowed to go bust a few months ago now blood tests you can wait upto 4 hours with people waiting there at 6am so they know when they open at 9am.
http://www.southwales-eveningpost.co.uk/Prince-Philip-Hospital-patient-collapsed-lab/story-14044926-detail/story.html
this was from 2011 and since then its gone a LOT worse. Basically all the "changes" and reforms just made everything worse.
I left the profession a few years ago, but give me a week back on the wards and I would sort it out quite easily. Reminding nurses to wash their hands?
Please - the training is basically wrong
I trained in the early to mid eighties and I certainly do not believe things were better back then.
There has always been bad nursing care and uncaring nurses but it wasn't so visible to the general public back then, probably because most of the actual hands-on nursing care was carried out by pre-reg students (nowadays mainly by HCAs, some of whose background is non healthcare related). There was also, commonly, poor infection control. There were a lot less HAIs (hospital acquired infections) back then, admittedly, but many of today's infections are related to indwelling devices such as catheters, cannulae, invasive lines etc which were not so common back then, plus C Diff is associated with over-use of antibiotics which kill normal gut flora. Intravenous antibiotics were a rarity, not the norm of today, so drug resistance was not such an issue. We students were used as cheap labour and received a very basic academic training. Luckily for me, I had received a very rounded school education in Ireland and was ambitious and motivated enough to continue my professional development post qualification, undertaking critical care courses, a BSC and a management course which has enabled me to progress in my career.
The new nurses of today have a much better attitude, overall, than many of the nurses of the past. Times have moved on, the workload has risen enormously and the paperwork increases on a daily basis.
As Winterlily has said, absolutely everything a nurse or a doctor does is audited - and then the audits are audited! I don't know who's going to put a stop on those audits because they are the evidence that the work is being carried out following correct procedures and protocols. Every single procedure that is carried out, whether it be inserting a naso-gastric tube, performing a catheterisation, inserting a cannula etc generates a whole care bundle and care-plan. These are then audited periodically and are used to provide evidence to inspecting bodies such as the CQC that we are performing to national standards (or not, as the case may be). I personally hate auditing, it is a tedious task, but necessary in the NHS of today when everything must be benchmarked.
Nurse training is not going to change, no matter how many old-school nurses of the past, may wish it to. There is nothing fundamentally wrong with educating our nurses to a high standard as long as we recruit the right type of caring, compassionate, hard working and dedicated people into our profession. It would certainly help to have the right skill mix, more registered nurses and less health care assistants. HCAs are not trained but often have the most contact with the patients and are given roles that should really be the remit of the RN.
Two of my sisters were trained and started nursing in the late 60's, the ethos was fantastic back then and they both concur with you. I think the NHS is now paper based and has forgotten there are patients out there because most of the managers are behind desks or hiding in stock rooms making up reasons for their existence. The nurses and porters are almost wasting away wanting help and all the managers can do is produce more paperwork.
When did physical hands on care for a patient become dependent on which piece of paper was lodged.
I remember in 1997 when my niece was pregnant and during a visit to see her I took her for a routine ante natal appointment. The midwives were fantastic but looked really flustered after some young lady in clacky court shoes came strolling into the room and said you two have to move on now and wrote something down. The appointment was not finished as my niece had some concerns about the birth and the midwives answered her. Two minutes later said Clacky heels came back and asked them to hurry up. So I asked her if there was a problem, the answer was a swift turn and out the door she went.
The midwives told me that was the new format for attending appointments in a 6 minute slot.
Have to tell you it sent shudders down my spine, if I told my staff to spend X time on a client I would have gone belly up in no time.
So I do wonder, what exactly do these graduates do all day other than hamper the care of patients?
It is a scandal and no one will address it.
You are right what you learned as a student nurse is with you for life, it isn't like a rota but it learned by rote almost and those ethics remain with you for life. Nowadays it is all action plans and stupid things which have absolutely no bearing on the common sense of a good nurse. Maybe before these graduate managers enter a workplace they should be trained by frontline staff for six months before they are allowed anywhere near their action plans.
What would you do if you were J Hunt? Maybe what we should do is get every nurse, porter or any frontline staff to write to him and fill him in about life in the NHS, that would be the best information any government could possibly be given to make a real decision on where the improvements could be made. Imagine if that gives you more time with your patient and less time auditing? I refuse to use that word, it is CYA for those frauds who live in la la land above you and add nothing of any worth.
I assure you the paperwork, for nurses at least, has not been cut. In fact it is increasing more than ever. For example, for pressure area care alone (prevention of pressure ulcers) there are pages and pages of forms one needs to complete. We are required to do these for if a patient develops a pressure ulcer and the required documentation is not completed we are hauled before a meeting and have to justify what went wrong and why. If we cannot produce a documented paper trail we are in the wrong. When someone does develop a pressure ulcer there is then a whole load of other paperwork to complete.
Of course there needs to be good record keeping as several different nurses will care for any given patient and need to be updated about a patient's progress. Nurses need to formulate care plans from their assessments and continually evaluate these care plans. However, it is the amount we have to do which we find so demoralising. What also makes us angry is it's presented as a means to improve the quality of care - when in reality it takes us away from patient contact and does nothing to improve care - the phrase is of course 'if it has not been documented it hasn't been done'. It's about fear of litigation and covering backs not about improving patient care...:(
Our district nursing service is creaking at the seams. No money appears to come to the front line, we have had no extra nurses - although I know they have recently taken on 40 or so foreign nurses at the local hospital.
I can only comment regards clinical audit. However, there are restrictions as to what clinical stock we can order, for example. It is all itemised and ordered electronically. Staff are only allowed to order from a restricted itemised stock. Once ordered, it has to be authorised by our manager before being sent on to the hospital to be sorted. Our stock room is never well stocked and we usually carry stock around in our cars to ensure we do not run out.
I can only speak of my experiences. However, I know a lot of nurses not only within my trust but others in neighbouring trusts and around the country. They all say the same. If the money is there it is not getting to the frontline. Yes there have been improvements but they have been patchy and piecemeal. For example, our trust recently got rid of a whole tier of management. However, about half of these managers were then redeployed undertaking similar roles as previously. At the same time the district nursing teams are working under great stress.
Everyone is demoralised. We feel undervalued and blamed for all the ills within the NHS...for me personally the worst insult is that nobody appears to be listening to what we have to say. Morale is rock bottom. I have never seen so many nurses so demoralised in all my years in the NHS.
I can only imagine what you go through as I have never been in the profession, It is the (see bold) that winds me up, how thick do they think everyone is?
Why is this not picked up, the fact that that particular tier of management was got rid of was because it was useless, so they then deploy some of the same elsewhere, all the time holding back money from the frontline where it belongs.
It appears to me that they deliberately keep the frontline starved so they can bleat about not enough frontline staff during their election campaigns and in previous years that has been believed, but now people can see the blatant politicising of the NHS hopefully some bright spark out there can get it to the media. It seems the media once onto a story will prompt the politicians to do something, this is something big and yet no one wants to know.
The solutions are probably staring us in the face but none can see and no one has the nuts to go public with it.
It will come down to whistleblowers in the end because those managers have everything sewn up, it should be the NHS club.
And all the while the real workers, and patients are left to suffer so they can sit in their offices thinking up new ways to hang on to their ill gotten pensions.
I can't see the benefit of paying out redundancy packages to nurses only then to use agency staff to fill the shortfall
However, at this present time, myself and many of my colleagues wouldn't mind too much accepting a redundancy package, which at this stage in my career, would not be too shabby. Many of us ITU nurses are so well qualified, we can earn a lot more doing agency work anyway. So I would say to J Hunt, go ahead and honour the 1% rise, many nurses like myself don't mind being made redundant - we'll only be coming back to the same unit in an agency capacity - and costing you more ;-)
I agree with this. I trained under the old system in the 1970's, we learned our trade on the wards and the practical education was excellent. However, the theoretical education was woeful. Nursing has moved on since the 70's and quite rightly so. Nurses today need to know not only how to do something but why they do it and how they could do it better to improve overall patient care.
Project 2000 training initially went too far the other way. Nurses spent more time in university and not enough time on the wards. However, for several years now nurse training has been 50% university based and 50% clinical placement based which I believe is the correct balance.
Like Marella, I too realised my initial nurse training was ineffective and limited. Although I possessed good practical nursing skills I needed to learn more about why we do things as we do and just how to do them. I needed to question and challenge existing practices and felt I could only do this by improving my nursing education. I obtained my first degree 22 years ago and continued to improve my education and therefore my practice until the day I took flexi retirement earlier this year. Better education makes better nurses...I would have thought that was obvious.
The core of nursing is of course caring - having a better educated nursing workforce does not diminish this in any way whatsoever. It enhances it. As a nurse mentor I am very impressed with the caring and compassionate nature of many of our student nurses...
I feel to blame nurse education is too simplistic. I believe it is fit for purpose and any attempt to dismantle it would be a very backward step.
I understand what you are saying, and it seems self defeating (the 1% pay rise business) but do you believe too much of the money ends up in administration instead of the front line or have I got the wrong end of the stick.
The short answer to that is YES!
Welcome to the wonderful world of the public sector and bureaucracy , its the way they do their accounting and depending on which pot of money they are using
From my experience, you have the wrong end of the stick. In my trust, we need our admin staff and they are on much lower wages than the frontline staff. Most of the ''managers'' are nurses - matrons and heads of nursing - who do a very important job in managing budgets, overseeing wards, ensuring high standards are maintained, recruiting staff, disciplining etc. Everybody has an important role and, without those managers, or indeed the admin staff, the work they do is just passed down to the ward managers who are frontline staff.
Of course, the real management in a trust consists of an executive board. This is the Chief Executive, The Director of Nursing, the Finance Director, the Medical Director etc.
They have their assistants and deputies but, again, I can't see how we could afford to lose any of them.
I can't speak for all trusts, that's just my own perspective, and I work in one of the largest trusts in London.
I know a nurse who received a £30 000 lump sum as a redundancy package and returned to work in the same hospital just a few weeks later in a different job but on the same salary. It's complete madness.
Go ahead, J Hunt, make us all redundant! There will be lots of vacancies for us to fill once the appropriate time has elapsed (I believe it is about 6 weeks before you can reapply to join the NHS). As I said, there will also be lots of agency work available and the agency bill in the NHS is already astronomical.
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But it comes out of a different budget so it saves money in one budget and uses unspent money in another , it ridiculous but thats the way the public sector works , we waste billions every year with these practices and not just in the NHS
My GP practice has some excellent nurses, some joined having been made redundant, others left the hospital they were working at and got jobs with local GPs.
When I was a ward manager, I had a budget for stock and a staffing budget. My staffing budget covered both substantive and agency costs. The agency bill is huge and there is no ''unspent money'' in any budget specifically to cover those costs. It all comes out of the staff budget!
To be honest, J Hunt is just scare-mongering with his implicit threats of staffing redundancies. He thinks we are all as thick as he is.
My perspective is slightly different probably because I work in a middle sized trust well away from London and in primary care.
Of course admin staff are needed and as you rightly say Marella, get rid of too many admin staff and this work is simply passed down to us - the frontline staff. My argument is focused more upon the complexity and opaque nature of the Trust's management structure. We may know the names of these individuals, but we have no idea what they do and more importantly who and what they have responsibility for.
There appears no clear line of authority and responsibility to the top. The NHS is highly hierarchical but it's complexity is mind boggling. Nobody appears to be able to make any decisions. And when decisions are finally made (by whom - we do not know) we the frontline staff have not even been consulted. The decisions are always top down and imposed upon us whether we believe it is appropriate for patient care or not.
I want more openness in the managerial system rather than this hush hush nobody knows anything culture which appears to pervade in our Trust which only serves to reinforce gossip and rumour.
It would also be nice for us to see where the Trust money is actually being spent. Yes the trust does publish their accounts and spending priorities on their website but I never seem to understand it. It is written in a pseudo legal, financial terminology fashion which I find totally unfathomable.
On how earth patients manage to understand this I have no idea....I suppose they're as confused as we are.