What effect will the emergency budget have on nurses?

30 June, 2010 | By Martin Jones

Nursing Times blogger Martin Jones on the emergency budget and what George Osborne’s proposals mean for nurses.

A world weary nurse tutor said to us during our basic training, “nobody enters nursing to get rich. If you want to get rich, you’re in the wrong job”. In the week of the coalition government’s emergency budget, as a nurse, how do I feel about George Osborne’s proposals?

Firstly, I’m not sure that I buy into the assumption that our national finances required ‘emergency’ treatment, let alone that the treatment must be so severe. I trusted that the economy was in safe and experienced hands under ex-Chancellor Darling and ex-Prime Minister Brown.

Secondly, as a socialist voter who voted tactically – and successfully - to help defeat a sitting Tory MP, am I satisfied that the Liberal Democrats are applying an effective brake on the most excessive tendencies of Conservative politicians? If Cameron had won an outright majority on 6^th May would public services have suffered even greater cuts in an emergency budget? It’s hard to know.

And is it fair that public sector workers should be paying for debt caused in the banking sector? While bankers continue to reap the rewards of their bonus culture, nurses earning more than £21,000 are subject to a pay freeze, with a review of NHS pensions due later in the year. The latter is expected to mean paying more or receiving less.

Compared with other departments in the public sector the NHS appears, at first glance, to have escaped lightly with no change in overall spending. However 20% VAT will affect NHS purchasing, effectively lowering budgets. And more people are likely to require our services. The population continues to age and the consequences of social exclusion on health have been largely ignored. For the same money we’ll be expected to meet greater demands on our services as old age and poverty propels more people into worse health.

But its worst effect will be to increase the gap between rich and poor. Millionaires like the Prime Minister, nurses, teenagers spending pocket money, the unemployed… All will have to pay the same 20% VAT making this a socially divisive tax. As Richard Wilkinson and Kate Pickett demonstrated in their study, ‘The Spirit Level: Why More Equal Societies Almost Always Do Better’, inequality in industrialised countries is at the root of higher morbidity and mortality amongst their poorest citizens.

Failure to increase tobacco and alcohol duty will leave nurses dealing with the well-documented consequences of both. In the sexual health clinic we will expect to treat more patients who had risky sex after drinking alcohol. This in the week that our clinical meeting discussed introducing the Fast Alcohol Screening Test (FAST) during consultations. To use one of New Labour’s better pieces of jargon is this the end of ‘joined-up thinking’?

Going back to our cynical nurse tutor, I didn’t come into nursing in order to become rich and don’t expect to. However I am concerned that helping some of my most vulnerable patients with their social needs may have become even more difficult. And that the poorest in our society may end up with the greatest health needs.

About the author

Martin Jones, Clinical Nurse Specialist HIV, East Sussex Downs & Weald.

Martin Jones has worked in sexual health and HIV since 1986.

Readers' comments (14)

Anonymous | 30-Jun-2010 10:49 pm
"I trusted that the economy was in safe and experienced hands under ex-Chancellor Darling and ex-Prime Minister Brown."

You lost me there fella. Why is NT allowing you to whine about the fact that there is no longer a labour government? Social division and exclusion went up during the last 13 years - I assume not as a result of labour policy? Do you ever get tired of the mantra 'Higher Taxes for Rich People?'. It's just wallet envy mate.
Unsuitable or offensive?
Anonymous | 30-Jun-2010 11:11 pm
"And that the poorest in our society may end up with the greatest health needs."

The poorest have always had the greatest health needs. The problem with socialism fella, and I know it's counter intuitive so bear with me, is that it increases the amount of poor and socially excluded and asks for bigger and bigger taxes to pay for them. Look at any inner city London labour controlled council and tell me that the lot of the people has increased despite decades of spending and support.
Unsuitable or offensive?
Michael Barber | 1-Jul-2010 4:58 pm
It is a shame that the first to comments are both anonymous and patronising with their faux freindly use of "mate" and "fella". There is some millage in the criticism that the New labour government failed to deliver a fairer and juster economy but to accuse Martin of wallet envy is a statement so wide of the mark that I felt it important to put this straight. He is an honourable and decent man working in the difficult area of Sexual Health - oh and yes he is my mate.
Unsuitable or offensive?
Anonymous | 1-Jul-2010 5:47 pm
"Wallet envy"? that's very sad if that's you're argument for taxing the less fortunate. Believe it or not most people don't actually choose to be poor or live in squallor. Hope you're not a nurse.
Unsuitable or offensive?
Anonymous | 1-Jul-2010 5:52 pm
Moan, moan,moan! What's done is done. As each government changes so do the policies.
It's about time a government made such drastic moves and is moving away from a nanny state!
Stand on your own 2 feet instead of scrounging off the state, look after your own health. You don't have to be rich or poor to prevent ill health.
Getting rid of the middle management and the Quangos will do us all a favour.
And yes...I am also working in the public sector on a poor pay but that's my choice like everyone else who has chosen to work in the public sector as a nurse!
Unsuitable or offensive?
Anonymous | 1-Jul-2010 5:55 pm
The Capatilists save the money, apply cuts to "curb spending, thus restricts the health care profession, at all levels, to do their job properly. In the 80's there were issues on pay, standards of cleanliness due to contracts being put to tender, and the NHS has little control over the domestics. Traditionally the Left wing are high tax appliers, but spent the money on the services, which has been done. The last Government was the "Third Way", a mixture of both. However, the last Government used the money rather foolishly. The number of high earning managers were increased, instead of the ground work force. The domestic side are still tendered, although a few trusts have taken over the tender. That said, the staff from the previous contractors remain, and standards have not risen immensley.

It is a pity that the politicians, on all sides, have not consulted us, the experts on health care, rather than taking advice from fat cats who liase with Chief Execs, whom, lets face it, are completly clueless.

As for the comment about alowing the blogger to whine that there is no longer a Labour Government, I would say that the obvious Con Dem supporter has not taken the point. The blogger has merely stated that he trusted the Labour Government to give the NHS the best possible chance of us delivering the health care that we ought to, and not cut services, essentially give us a pay cut, yet raise VAT to make items that would be used to do our jobs properly
Unsuitable or offensive?
Anonymous | 1-Jul-2010 7:08 pm
Sorry if I burst anyones bubble but the last government relied on uncontrolled free market capitalism to pay for and borrow for it's grand scheme. That policy failed because the free market failed (as it always does). It's not the fault of the banks but the lack of foresite of the politicians. If you believe that Darling and Brown were not going to cut public services after the election then your daft. If you don't tax the less fortunate they do little to get themselves out of their predicament, as nothing is expected of them - they have nothing invested in society.
Unsuitable or offensive?
Anonymous | 1-Jul-2010 9:27 pm
Oh and I have just notice the comment before last. Education is a fundamental issue. Remember the issue of Social Class and ill health? Finance is required to educate, and the cuts will not accomodate for this. Yes get rid of middle management, but those that need to be educated wont untill trusts impliment strategies that are cost effective to do such an exercise. Anyone with sensible suggestions??
Unsuitable or offensive?
Anonymous | 1-Jul-2010 9:31 pm
Re: 1-Jul-2010 7:08 pm.
The cuts would not have been so savage. The global recession has not helped. It is partly the fault of the banks, but the government should take some of the blame also. Politics is such a mind field yet it is so important to every day lives. The comment about the tax on the poor. Are they less entitled to a decent standard of living??
Unsuitable or offensive?
jay white | 2-Jul-2010 3:01 am
The budget is trying to sort out the last governments spending spree...... unfortunately. The last government gave away a substantial amount to people who did not need it..... maternity healthy eating grants of just under £200, to name but one and it was meant to benefit those who could not afford decent food however like fools they paid it to every one. IT IS A JOKE !! I am afraid, just like family benefits, paid to those who do not need it.

Meanwhile we have the new agenda for change, increase the lower levels of nursing at the expense of the higher levels .... managers being exempt of course.
Equalling a drop in pay and status, while increasing stress and responsibility.

Some things never change, more chiefs in the NHS now than at any other time since its conception. Lets have more indians and less chiefs instead of pay freezes.

Unsuitable or offensive?
Anonymous | 2-Jul-2010 8:00 am
No one got it right, labour or coalition gvt. Politics is like that. Unfortunately the NHS employs the highest number of immigrants who are not wanted by the tories. Most of these immigrants are on short term contracts. Therefore I was not expecting a special favor for NHS workers. We can mourn about money but I feel the NHS is the worst managed organisation worldwide. How many managers are doing the same job under different titles eg patient safety manager and clinical risk manager. These jobs are all paid from 8a upwards. There is need for a major review of all NHS managers on what they do if the govt is serious about saving money.
Unsuitable or offensive?
judy mewburn | 2-Jul-2010 8:16 am
What a diverse set of comments......... fantastic. I am all in favour of everyone doing a little belt tightening , myself included. We have been governed by a profligate and blind government for the last 15 years , we are now paying for their method of boosting their popularity. Do not disparage the rich, they usually got there through hard work and now employ and pay many people. They also pay taxes. Its time for nurses to look at their situation and try and find economies. We are used to coping and are best placed to help and advise this current government.... and they have taken the step of asking for suggestions on ways of saving , so go on, make some !
Unsuitable or offensive?
jjjez@hotmail.com | 2-Jul-2010 5:56 pm
The only areas that need to be trimmed and middle management and jobs that have no direct effect on patients.

At my hospital i will be asked by 5 different people how many beds and discharges i have.
Of course these are all dependent on peoples health rather than numbers but at least in the past it might have only been 2 people.

The Discharge co-ordinators no longer organizes complex discharges. Instead she nags us about HNA's and merely collects them sends them away and keeps a list of who has had one done.

The capacity management team do not try to address capacity instead they force me to move nearly better patients to the day surgery unit overnight so they can send me an acute patient 90% of the tie is an old person admitted with shortness of breath who no longer had that symptom 5 minutes after having a nebuliser in A&E. a clever hospital would send these people home on the same day then have community staff monitor them - oh well

The matrons have also waded into this an askthe same questions - He or she has no input into ward care other than to rubber stamp requests for resources etc

The CSNP (site) nurses also repeat these question endlessly.

This is the same kind of inefficiency we have in management except fo those people are often faceless and never heard of. these harridans are in my face daily sqwaking on about discharges.

I tend to just plant my feet if i'm in charge and make sure that none of my patients go anywhere. It's my accountability too, so if i don't want to transfer a patient i exaggerate their condition.

Sooner or later my hospital will stop trying to manipulate things and demand a larger hospital - which is the only solution in reality.

As for the pay freeze - well for all of your who vote conservative i say:

'grow up and stop trying to associate yourselves with them. you will never be like the ruling elite'

they are one of the most anti-ordinary peolpe groups ever to walk the face of this country and your support only deepends the problems in this country.
If only John Smith of the Labour party wasn't murdered, we never would have had to have Blair and his faux conservative mindset.
Unsuitable or offensive?
Martin Jones | 3-Jul-2010 8:52 am
‘Poor in UK dying 10 years earlier than rich’ Guardian (1st July 2010). This takes us straight into ‘The Spirit Level: Why More Equal Societies Almost Always Do Better’ by Richard Wilkinson and Kate Pickett (Allen Lane), cited in the blog. I’ll have to get it back from my daughter for rereading and a future blog. However looking at the book review that caught my attention: -
“The authors point out that the life-diminishing results of valuing growth above equality in rich societies can be seen all around us. Inequality causes shorter, unhealthier and unhappier lives; it increases the rate of teenage pregnancy, violence, obesity, imprisonment and addiction; it destroys relationships between individuals born in the same society but into different classes; and its function as a driver of consumption depletes the planet's resources” http://www.guardian.co.uk/books/2009/mar/13/the-spirit-level
Let’s not even get into a debate about socialism versus New Labour except for me to let you all know that I left the Labour Party in 1995, as Blair ‘modernised’ in order to appeal to the electorate.

Nonetheless I won’t hide my disappointment at the state we’d reached despite thirteen years of Labour government. However the coalition’s budget contains nothing that will reduce inequality, most commentators instead predicting a widening gap between poor and rich. And I have set out my concerns about the consequences for health.

I agree with several bloggers about the proliferation of ‘chiefs’ when more ‘Indians’ might have had greater impact on morbidity and mortality.
Unsuitable or offensive?