NHS Reform

Diana Ronaldson in her letter (EADT 15/8/09) highlighted a problem that working nurses often fear to mention. Their contract makes it a disciplinary offence to speak out, but it is from the frontline, not senior management that we need to hear from to understand the depth of the problem. The government has not pumped money into front line services. It has pumped money into managing and controlling the service.

The senior staff nurse is the senior working nurse in a hospital ward, and yet one such nurse told me that a nurse is far more likely to be disciplined for failing to complete her paperwork, than for neglecting the patients, who are increasingly seen as 'target units' rather than patients needing care. If a nurse is worried about a patient she has to call in a clinical practitioner, who might have only 6 months training, who can then call a doctor. That can be a critical delay when a patient faces a relapse. In the old days a Junior Doctor was directly on call to nurses.

A private nursing home has to have 3 staff at night for 24 residents. A hospital ward with 24 seriously ill patients has only 2 staff on call at night.While the same ward might have 10 managers/sisters.

It's nurses who deliver and carry the risk of care, while business managers usually with no medical training who are paid the higher salary. The NHS is paid for by you and me to serve the community. They have their priorities wrong! For example, patients are kicked out of acute wards after 3 days to meet targets, but pulmonary embolism rarely shows within 3 days! Returning patients just start the statistics off again, and not seen as a failure of care.

But it is still one of the best health services in the world thanks to the commitment of our nurses and doctors. We need more of them and less management.