Purplegerberas's Blog

A rambling collection of my thoughts about life, my children and crafty things

Nursing cuts: honesty is the best policy

on April 14, 2012

Our chief executive came to our team meeting yesterday.

I had a number of things I wanted to speak to him about and top of my list was staffing. I heard a couple of weeks ago that someone had left my team after a long period of long term sickness. I was told that their hours had been removed from my budget as part of our cost improvement programme and that I would not be allowed to replace her.

My main gripe is that there was no negotiation in the matter. No-one asked me what the consequences of that loss would be and the impact that it would have on patient care. It’s not the first time that this has happened. I realised that over the last 6 years our overall staffing has just consistently been cut every time someone has left, retired or requested a reduction in working hours. I worked out the spend on nursing time six years ago and compared it to today – both in financial terms and whole time equivalent. I was shocked by how much it has reduced when you consider that our county’s population has increased by 5% in this time.

Frequently the message given by the government is that spending cuts will not affect patient care and that front line services will be unaffected. This is absolute rubbish. By doing it slowly through natural wastage nurse posts are being cut without any consultation on what impact that will have on patients. Comparing our workload with 6 years ago we are still  seeing similar numbers of patients. We have made many changes that have made our working processes more efficient, saving time and money and the huge difference is our waiting times. Currently people may wait up to 17 weeks for an appointment to see us.  I do not think this is acceptable and compares to 8-12 weeks when our staffing levels were higher.

Looking specifically at continence, a clear link has been shown between cuts in specialist nursing numbers and increases in spending on disposable products. It saddens me that pressure on our workload means people are not receiving high standard of care and I feel more people are simply being given disposable products because we do not have the capacity and time to offer a good treatment programme. A recent publication made the recommendation that there is one continence advisor per 100,000 of the population. My service operates at less than half of this suggested figure.

So, warts and all, as a team we explained this situation to our chief executive. He said that as a trust we have a waiting time limit of 12 weeks – he would prefer it was lower. Our waiting list has never been highlighted as an issue to the board and he felt that our current waiting time is a concern. I feel we were able to demonstrate that whilst we are ‘coping’ on lower staff numbers, the implication is that people will wait longer for an appointment.  He was also unaware of the practice of staffing hours being cut without consultation. He felt it should not be happening without some sort of conversation about impact on care. I explained that I would not necessarily be looking for like for like replacement but I could offer suggestions that would still deliver cost savings without compromising patient care.

It shows that cost savings need to be considered with input from clinicians in order to keep the interests of patients at the heart of it. I feel I am in a good position to offer this – I have the interests of the people our service treats at the forefront of my mind but I am also capable of making a sensible business judgement on the financial implications for the wider NHS. My recent experience is that this conversation is not happening and it also seems that the board are unaware of this practice.

In the past I think there might have been a temptation to hide perceived flaws in services such as waiting times for fear of being seen as doing a bad job. I feel why hide the truth? Unless the full picture is given then nothing will change. I was keen to point out that we are doing a great job despite working under huge pressure and that potentially we are capable of so much more.

I’m crossing my fingers for a positive outcome from the meeting.


2 responses to “Nursing cuts: honesty is the best policy

  1. great post, I’m so interested in how they will save money using front line staff as opposed to middle management and not affect patient care. Impossible if you ask me.

  2. There are two sides to this. In my trust there have been massive cuts to middle management. Initially this did concern me as it is likely to add more onto my workload. This example shows though that middle management does a great job of hiding the realities from the board. So often we have attempted to communicate worries or concerns upwards in the organisation only for the message to be lost somewhere in the middle. Thinning that layer out may be more productive improving communication and making our work more transparent.

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