This is rather last minute, but I hope it will be useful. The nursing campaign group, the 4:1 Campaign, has organised a protest outside the Department of Health (on Whitehall, almost opposite 10 Downing Street), tomorrow lunchtime (Tuesday November 26, 2013), from noon until 2pm, and I am going to go along as one of the speakers.
The “Rally for the NHS” is described on Facebook as a response to “disastrous news about the NHS” in recent weeks, “from the RCN [Royal College of Nursing] revealing the NHS has over 20,000 nursing vacancies, to the Department of Health’s decision to downgrade (effectively close) 100 A&E departments.”
The campaigners add, “We believe those who support the NHS, its staff and patients need to provide an alternative vision for the future of the NHS. That’s why we are going to be outside the Department of Health on the 26th with our own proposals for how to protect and improve the NHS. The rally will last from 12-2 outside the DoH in Whitehall, with speakers and stunts to highlight different aspects of the crisis afflicting the NHS, while giving an opportunity for health workers and patients to give their solutions to the crisis being created in the NHS.”
The figure of 20,000 nursing vacancies emerged on November 12, when the RCN released its latest report, “Running the Red Light.” The figure is an estimate, but one based on detailed investigation, in the absence of reliable figures from the government,. I was shocked to read that the government “stopped collecting data on NHS staff vacancies in 2011, with the last available data suggesting the vacancy rate for nursing posts was 2.5% in 2010.” The RCN added that “responses from 61 acute and mental health trusts suggest this figure is now running at an average of 6% — though in some places it is as high as 16%.”
This is a troubling situation, and one that chimes with the concerns of the 4:1 Campaign, which describes its aims as follows: “We are arguing for a mandatory minimum ratio of nurses, so there would be no more than 4 patients to 1 nurse, with variations according to your hospital ward’s or unit specialty. For example, on a typical acute medical or surgery ward there would be one nurse for every four patients on a typical day shift. We are calling only for a mandatory minimum, not a limit, so nursing numbers can and should be increased to meet higher patient need in areas with extremely unwell patients like High Dependency and Intensive Care.”
Although there are signs that aspects of the nursing crisis are being addressed, with Nursing Times reporting that 73 of 102 trusts that responded to requests for information stated that they “had allocated more money to employing nurses in 2012-13, compared with the previous financial year,” the other main point of tomorrow’s rally — the threat to downgrade 100 A&E departments — is even more troubling.
Last week, NHS England’s Urgent and Emergency Care Review Team issued a report, through its National Medical Director, Sir Bruce Keogh, entitled, “Transforming urgent and emergency care services in England,” in which, as the Guardian explained, plans for “a two-tier accident and emergency service, with specialist expertise in areas such as stroke and trauma concentrated in fewer hospitals,” were put forward. As the Guardian put it, Keogh “said it was absolutely necessary to rethink under-pressure A&E services because too many people turn up there who do not need emergency care.” The Guardian added, “While 40% leave without any treatment, frail and elderly people end up waiting for hours and sometimes could have been better cared for at home.”
This is evidently not the best use of services, but the problem with Keogh’s intentions is that they do not inhabit the real world, and, instead, live in a fictional world in which the 40% who do not require treatment magically do not turn up at A&E at all. In reality, of course, although NHS managers talk of increased community care to reduce pressure on A&E departments, it is only an aspiration, and not reality. Just a glance at the media over the last few months reveals that A&E departments are under greater pressure than ever before — see, for example, “Top doctors warn of ‘worst winter’ in hospitals as A&E crisis grows,” in the Observer on November 2.
In its article last week, the Guardian — rather cynically, I thought — noted that Keogh’s proposal “attempts to sidestep the fundamental political problem inherent in any NHS reorganisation: communities and their MPs take to the streets at any mention of a hospital closure.” The article added, “Under the two-tier plan, none of the current 140 A&E departments in England would close.”
Instead, a large number of A&E departments — between 70 and 100 — are to be downgraded, or, as the Guardian put it, “will be seen to be downgraded.”
This is simply disingenuous reporting, as the closure of emergency services inevitably leads to people having to travel much greater distances to hospitals that retain emergency services. As someone deeply involved, over the last year, in the campaign to save Lewisham Hospital from being downgraded — to pay off the debts of a neighbouring hospital trust, accrued in part because of ruinously expensive PFI deals — it is clear to me that Lewisham’s case is typical.
The planned closure of A&E (which means that all frontline acute services close) would have meant that tens of thousands of Lewisham residents (including thousands of pregnant women) would have had to leave the borough to be treated, or to give birth. If the senior NHS managers and the government had their way, this would have meant seriously ill people and pregnant women having to undertake a long journey to the Queen Elizabeth Hospital on a remote heath in Woolwich. This, alarmingly, can take nearly two hours by public transport (see video here), and would not be easy by car — or even by ambulance — at rush hour.
In the Guardian‘s misguidedly breezy reporting about the plans to downgrade A&E departments, it was noted that 40 to 70 of the existing 140 A&E departments “will become ‘major emergency centres,’ where the seriously sick and damaged are taken by ambulance for hi-tech treatment for heart attacks, stroke and trauma, bypassing other closer hospitals on the way.” There is nothing to complain about this part of the plans, of course, and it is to the credit of the NHS that, in recent years, the decision to focus on certain key health issues — heart attacks and strokes, for example — at specific hospitals has been very successful.
This was dealt with in detail in the Guardian‘s article, in which it was noted, correctly, “Advances in science have led to the concentration of stroke services, for instance, in just eight of the 32 London hospitals. An ambulance would take a stroke patient to University College London hospital, but not to the Royal Free.”
However, it does not follow that more and more services should be moved to “major emergency centres,” as the case of Lewisham again demonstrates. Whilst it is wonderful that some key services are dealt with at Guy’s and St. Thomas’s, and at King’s, the 270,000 people of Lewisham need and deserve — and can pay for, through taxation — a wide range of other services, including A&E (for children as well as adults), some acute services and maternity services. If the Keogh proposals go ahead, millions of people across the country will be travelling long distances for treatment — and the more people have to travel, the more there will be deaths in transit.
The Guardian‘s attempt to downplay what will happen to the other A&E departments — the 70 to 100 that will not become “major emergency centres” — is that they “will become ordinary emergency centres, which will cope with problems requiring less specialised care” — again, a way of avoiding the reality of hollowing out services to such an extent that many hospitals will be unable to operate as they need to, to remain as suitably functioning establishments. This is something we were very aware of in Lewisham, and there is no reason to presume — despite Sir Bruce Keogh’s hopes that helplines and GPs will keep people away from A&E departments — that downgrading half of England’s A&E departments will have anything other than a truly disastrous effect on the health needs of millions of people.
Note: For further information about “The Keogh Urgent and Emergency Care Review,” see here.
Andy Worthington is a freelance investigative journalist, activist, author, photographer and film-maker. He is the co-founder of the “Close Guantánamo” campaign, and the author of The Guantánamo Files: The Stories of the 774 Detainees in America’s Illegal Prison (published by Pluto Press, distributed by Macmillan in the US, and available from Amazon — click on the following for the US and the UK) and of two other books: Stonehenge: Celebration and Subversion and The Battle of the Beanfield. He is also the co-director (with Polly Nash) of the documentary film, “Outside the Law: Stories from Guantánamo” (available on DVD here — or here for the US).
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On Facebook, Dessie Harris wrote:
well stated…thank you.
Adrienne Murphy wrote:
Right behind you keep up the good work
J.d. Gordon wrote:
Sounds like a good cause, Andy.
Thanks, Dessie and Adrienne. The NHS needs millions of us to support it, and to take on the NHS senior managers – Keogh being the prime example – who have fooled themselves into thinking that huge cuts can improve clinical outcomes, when that’s clearly not possible.
And J.d., yes, it is indeed a good cause, but, you know, I specialise in those!
Pauline Kiernan wrote:
I posted on this the other day: ‘I ask one question: how will 3,700 nurses fill 20,000 nursing vacancies. Mr Hunt?
And that’s a hugely important question, Pauline, generally avoided in the coverage I have seen, which hasn’t made clear that the massive recruitment needed doesn’t fit with the remorseless pressure to cut NHS expenditure that is coming from NHS senior management and the government. BBC coverage here: http://www.bbc.co.uk/news/health-25005671
I suppose essentially we’re being told by Hunt that we should be grateful for 3,700, even though we need so many more. I also expect we’ll see a whole load of racist spinning about the recruitment of nurses from abroad. Daily Mail article here: http://www.dailymail.co.uk/news/article-2512985/Foreign-nurses-propping-NHS-At-40-trusts-actively-recruiting-abroad-plug-staffing-crisis.html
Joyce McCloy wrote:
its like the US. corporations control your government. It takes your taxes and your public services and auctions them off to privateers like Sir Richard Branson
Yes, the US model is the gift that keeps giving to UK politicians who want to privatise everything and maximise profits for private companies they end up being paid by, Joyce. Hence the sell-off of the NHS, part of the destruction of the British state that isn’t going to end up being value for money – just a decaying, divided country in which everything costs too much, but more and more people don’t have any money. All of the people involved in making the cynical decisions that lead to these outcomes are criminals.
Dejanka Bryant wrote:
Well said Andy. My thoughts are exactly the same.
Pauline Kiernan wrote:
Thanks Andy. Shared with your introduction pasted in. x
Dejanka Bryant wrote:
That was today, wasn’t it?
Thanks, Pauline and Dejanka. Yes, it was today. Not many people there, unfortunately, partly because of the very worthy UK Uncut demo against the Big 6 energy companies; partly, I suspect, because it needed wider publicity; but also because far too many people won’t get out on the streets to fight for the NHS. This is my friend Ruth’s photo of me today, speaking in public for the first time about the NHS. I loved it! Apparently I’ve had quite a lot of experience speaking about a prison in the Caribbean run by the US – oh yes, Guantanamo: https://www.facebook.com/photo.php?fbid=10151746920172190&set=a.10151746916527190.1073741861.656352189&type=1
Investigative journalist, author, campaigner, commentator and public speaker. Recognized as an authority on Guantánamo and the “war on terror.” Co-founder, Close Guantánamo, co-director, We Stand With Shaker. Also, singer and songwriter (The Four Fathers) and photographer.
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