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The NHS - what a mess

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The NHS needs fixing NHS finances are just one of the problems facing the health system

So much seems to be going on at the moment in the NHS that it is hard to focus on just one issue.

Many hospitals are on 'black alert' with sick patients being treated on trollies in corridors.1 This has been reported anecdotally, in the national press and all over social media. How can the government not take note of this and not respond? It is a sad day when our hard work is not acknowledged, even in the most difficult times, and that politicians feel it is unnecessary to comment or try to make a difference. Although the Red Cross have a long standing commitment to helping out with social care, they have reported the strain on social care as unprecedented.1

All of these problems will be exacerbated by falling numbers of student nurses. With the removal of bursaries, there is already evidence that recruitment is down around the UK.2 The government thinks that the student numbers will increase, but placement capacity will not.3 It would seem that some disciplines are more likely to be affected than others eg learning disability and mental health nursing.4

It is not just about hospitals, as GPs are in the firing line too. They have been advised that if they do not provide a 7-day service, funding will be withdrawn.5 It is common knowledge that general practice is struggling with increased numbers of older patients, more complex patients and earlier discharges. Added to this is the decreasing number of supportive staff such as practice nurses, many of whom are reaching retirement age. Many GPs are forming confederations to help cover the hours – but let us not forget that primary/first contact care is available 24/7 with the provision of urgent care centres, the 111 triage service, GP out-of-hours visits and in A&E. So why the jibe at GPs? The BMA reports that they are scapegoats as the NHS is in desperate need of funding in all areas.5

According to the nursing press, unpublished Sustainability and Transformation Plans (STPs) suggest axing thousands of nurse jobs. How those of us who are left will manage, I do not know. Their nickname ‘Slash, Trash and Pillage’ seems to be sticking – and in the light of the suggested changes I suspect it will stick.6

Rather a gloomy start to 2017, and unless you have a crystal ball handy, it is difficult to see where this will all end. Look after your own health and do not shrink from standing up for nurses and our precious NHS.

Kirsty Armstrong, senior lecturer in primary care at Kingston and St George's and advanced nurse practitioner in urgent and OOH care

1. The Independent. 2017. More than 20 NHS hospitals on 'black alert' amid reports patients were left in ambulances.

2. Nursing in Practice. 2016. RCN: Scrapping NHS bursary leading to nursing application drop.

3.Nursing Times. 2017. Placement limits may put brakes on course expansion.

4.RCN Bulletin. 2017.

5. The Independent. 2017. Theresa May vows to push ahead with 7-day GP services to take pressure off A&E services.

6. Health Service Journal. 2017.Daily insight: Nearly all hospitals missing nurse staffing plans.

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NHS England have replaced the bad old 'Black' alert with fresh new varying shades of 'Opel' to better demonstrate the overwhelming and unprecedented stress across the entire system of health and social care.

Despite relaxing the original 98% 4 hour target to 95% the standard has now consistently been the worse since its introduction 13 years ago. The Secretary of State for Health is considering relaxing the target further so that it only applies to those patients with 'time critical' clinical conditions. This begs the question, what happens to those patients who have legitimate clinical need but are considered not 'time critical'? The four hour target matters, principally because it affects patient safety.

Nurses are being forced to ration care due to the relentless and overwhelming demand. Winter pressures are no longer seasonal, they last all year in most UK emergency departments and minor injury units. Constant negative coverage of the NHS does nothing to encourage students to want to consider nursing as a career. The vacancy factor for RNs in many emergency departments remains at a constant 15-20%.

Was the Chief Executive of the British Red Cross correct when he described the NHS as being gripped by a 'humanitarian crisis'; its not comparable to Aleppo or Sudan but many hard working emergency nurses would be in agreement with the sentiment. NHS nurses and others working in emergency and urgent care are doing a remarkable job, but how long can this be sustained?

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