Medical or Nursing Research

The President of the Centre for the New Europe, Europe’s leading Brussels based free market think tank, has just had this excellent article published in The Times

Headed ‘I bet I know why the BMA is banging on about that’, Stephen Pollard exposes the pseudo-science and professional self-interest behind this a new report from the BMA 

The BMA, no doubt mindful of new Gabling Act which allows people to make more decisions on how they spend their money, concludes that problem gambling should be treated on the NHS like any other illness and, wait for it:

“The BMA is concerned that there are insufficient treatment facilities available.”

As Pollard points out, the BMA recommends that an extra £10 million should be spent through the NHS, and another £10 million on campaigns against gambling. He concludes:

“To translate: hand over your money to us now.”

Interesting organisation the Council of Deans and Heads of UK University Faculties for Nursing and Health Professionals

Professor Paul Turner, chair of the Council and its Executive Officer, according to the website, reported to the Health Select Committee enquiry into NHS deficits that the number of training places for nurses had been cut after strategic health authorities had been asked to make savings across the Board.

‘This will only have an impact in years to come when there will be fewer places available for training and, as a result, fewer qualified nurses coming into the profession.’ Professor Turner.

Ok, that’s great, I can sleep easy at night safe in the knowledge that in my dotage I’ll be looked after by robotic android nurses straight out of ‘Bladerunner’ fully pre-programmed to cater to my every need, except when they blow a circuit and accidentally decapitate me. Much more efficient way of providing nurses I’m sure.

Apparently the Council’s own figures showed that only 56% of newly qualified nurses had been able to find jobs this year and only 58% of newly qualified midwives had found substantive posts.

‘We don’t know what is happening to these nurses who can’t find jobs, but many of them may be lost to the NHS, which is very worrying.’ Professor Turner.

Yes, very worrying. Why don’t you ask them you ninny?

I’ve requested this survey from the Council (you won’t find it on their website, in fact you won’t find very much at all on their website, it’s an exercise in minimalism, they clearly tell all they know to the Health Select Committee but prefer to leave the rest of us mere mortals in complete ignorance) and I’ll publish it here next week if they send it to me so watch this space. Where have all those wonderful new nurses gone? I hope they have found jobs in the independent or charitable sectors and are being well looked after. Perhaps Nurses for Reform should run a survey on: ‘Where have all the new nurses gone?’.

This report, Mind the Gap: Sustaining Improvements in the NHS Beyond 2006 , makes for a good read.

Aficionados of healthcare will recall that back in 2002 the British government announced plans for health spending to rise annually by 7.2 percent (in real terms) up to 2007-08. This means that by the next financial year the government will be spending some £110 billion pounds of taxpayers money on state health and social care.

Now, in detailing key NHS reforms between 1997 and 2006, the report not only goes on to analyze the likely progress and impact of further reforms between 2007 and 2015 but, crucially, it evaluates the need for significant financing reform after 2008.

In pointing out that people’s expectations of healthcare are continuing to outpace what the state can afford the overall conclusions makes for powerful reading. For it suggests that the NHS is heading towards a 10% funding shortfall by 2015 and that capital expenditure will be the first causality. It points to continuing cuts in number of staff, constraints on wage and salary levels, and even a return to the waiting list levels prior to the proactive involvement of the independent sector four or five years ago.

The good news is that it suggests that co-payments and a range of new private funding schemes might well be a way forward.

Interesting to note that the very excellent Professor Anne Marie Rafferty et al., Professor of Nursing at Kings College London has just published research which proves that wards with a lower nurse-to-patient ratio had a 26 per cent higher patient mortality rate. Following her survey of nearly 4,000 nurses in 30 hospital Trusts in England she concludes that had there been more nurses on the wards then 246 more lives could have been saved. This research has just been launched by the Royal College of Nursing. Results:

‘Patients and nurses in the quartile of hospitals with the most favourable staffing levels (the lowest patient to nurse ratios) had consistently better outcomes than those in hospitals with less favourable staffing. Patients in hospitals with the highest patient to nurse ratios had 26% higher mortality.’

When I trained at South Lothian College of Nursing & Midwifery from 1982-1986, long before the dreaded Project 2000, this knowledge that it was intensity of bedside care that determined the quality and safety of healthcare on any given ward be it acute, psychiatric or, as we had in those days, a ward for the learning disabled, was self-evident and was just one of the reasons why student nurses spent much of their training learning on wards at the bedside with trained nursing staff. Now we need highly trained and gifted academic nurses like Anne Marie to research and prove the case. Doubly so when we have a Government encouraging Trusts to ‘shed staff’ at the moment in the interests of balancing the books of an under pressure NHS their policies have overheated with too many productivity targets.

Those of us who have spent long careers in health and UK public healthcare understand that it really is time for politicians to ‘butt out’ of healthcare as our American cousins would say. Politicians cannot and should not be allowed to manage health services and health service delivery. This important matter should be left to the professional community of health service managers, doctors, nurses, therapists and paramedics. Self-governing Foundation Trusts are a good thing, a self-managing independent NHS, responsive to the consumer-patient, would be even better. Let’s get there as quickly as we can.

Ask a patient going into hospital for a hip operation what they expect of their care and they will probably come up with the following list:

  • A bright clean surgical ward with some privacy – a single room or at least a four bedded bay would be a great bonus
  • A well staffed ward with friendly competent nurses in clean uniforms and perhaps a lead nurse in the team responsible for their personal care plan, who discusses it with them
  • Decent food and some choice of menu
  • Polite, attentive and caring medical staff and a consultant that comes to see them on his ward rounds to explain and discuss the treatment options, their operation and the recovery timeline
  • Opportunity to discuss their operation
  • Opportunites to for structured convalescence before discharge
  • The right to see their nearest and dearest when they want to see them

The problem we still have in the UK is that although we have come a very long way from the great variability of NHS care of the 1980’s, this list is still not a guarantee in every NHS hospital in the UK, but it is in the independent sector. Now why is that?