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Chris Hart: 'Cuts and falling living standards are storing up problems for the health service'


Chris Hart argues that nurses’ stories of serious woe signal that a real storm is brewing …

I’ve recently spent time with nurses from a wide range of hospitals. Almost every one had a tale of serious woe, describing how they were unable to provide the levels of care that their patients needed, how the demands being made of colleagues were outstripping their ability to respond.

Some may think this a common, timeless refrain. But there was something different about the common themes emerging. These were all experienced practitioners reflecting on significant changes and, moreover, in the context of worsening relationships with their managers. And all the time, the rain was falling.

The floods that have devastated the homes and, in some cases, lives of thousands are the result of some of the most extreme weather on record.

But the inability to protect our citizens in the first place and then respond to the needs of their communities are entirely man made. And those men and women are politicians.

Opened in 1982, the Thames Barrier was used 27 times in its first 18 years, but that number rose to over 100 since the year 2000 so current events should not have been a surprise.

Strip away the political shenanigans about the funding of the Environment Agency and water defences and, once inflation is taken into account, funding under the coalition is between £30-40 million less than under Labour over a similar period.

Not much in the context of a £2 billion budget? Ask those whose homes are under water.

Specifically, there’s been a 6% cut in central government funding for flood and coastal defence during the 2011-15 spending review period. The revelation that 294 flood defence schemes across England hadn’t received their promised funding prompted the announcement of an additional £120 million in late 2012. But this still didn’t bring spending back up to 2010 levels.

Another element to this tragedy is that the government’s historic cost benefit analysis meant it wanted every £1 spent to generate £5 of benefit.

The coalition changed this so now every £1 spent would have to generate £8 in benefit. In other words, less had to go further.

The government’s mantra about constantly seeking value for money, efficiency, and ‘taking tough decisions’ in the wider public interest is completely undermined

Another way of looking at it is that the government had calculated it could further ratchet up the misery experienced by its citizens. Just as it has in health.

And it’s not just about the Environment Agency. Over 630,000 jobs have been lost in local government since the coalition came to power, as a result of a 43% cut in funding. By the next election over a million jobs will be gone.

It’s not just about saving money.

The financial crisis – and lest we forget, one caused by privately run banks that had to bailed out by the previous government using our money – has been used by the coalition to fatally undermine public services. Lack of investment has translated to the lack of infrastructure required to prevent a crisis or respond to it.

The government’s mantra about constantly seeking value for money, efficiency, and ‘taking tough decisions’ in the wider public interest is completely undermined.

Its neglect and the relentless damage it has inflicted on our public services means the flood damage and consequential fallout might cost the country as much as £15 billion.

Meanwhile, cuts in other areas of public services, housing and benefits, as well as the falling standard of living for millions are storing up problems for the health service at a time when trust budgets are facing the most dramatic reductions seen since 1948. Already struggling services are facing greater challenges year on year.

The re-organisation (sic) initiated in Andrew Lansley’s 2012 Health and Social Care Bill, at a time of £20 billion ‘efficiency savings’ is the equivalent of removing the flood defences in the organisation of the nation’s health care provision.

What we can see, with the floods, is that once a critical mass is stripped out of vital services, they might be able to muddle through for a while but the point comes, whether by natural disaster or otherwise, so that when the levees break there is no holding back the water.

It’s the direction in which the NHS is travelling. It has thus far been lashed by winds and rain. But, as those nurses’ stories are telling us, there’s a real storm brewing. Unless we do something now, we too will be, literally, overwhelmed by the flood of demand.

There is one final, bitter irony.

Flood stories in mythology and religion usually have one common denominator: the forces of nature wreaking havoc on the wicked and sinful.

Perhaps we are to blame for electing governments who have consistently punished the weak, the vulnerable, those least able to defend themselves. Yet the politicians who have left innocent communities underwater are themselves protected, in the Palace of Westminster, by one of the great public spending projects of the latter 20th century, that Thames Barrier that has been closed so many times in recent weeks.

Chris Hart is consultant nurse in forensic and intensive care nursing, South West London & St George’s Mental Health NHS Trust and principal lecturer, Kingston & St George’s University of London.


Readers' comments (5)

  • And perhaps the profession is guilty of not "punishing" those "nurse leaders and academics" who have failed both patients and their clinical ward/department based colleagues.

    Tell me Chris HART who has been responsible for placing patients at risk ? Who has deliberately reduced nurse staffing levels and diluted skill mix ?

    I will tell you!

    It was not politicians but "nurse leaders" who believe that a clinical nurse can care for 8,10, 14 acutely ill, highly dependent patients on their own with the assistance of one (or if very fortunate) two HCA's

    I could care less about the floods they will recede but the bad, incompetent "nurse leaders" remain in place causing continung and ongoing harm to patients and the real nurses

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  • I'll be interested in others' views. Yes, senior clinicians and managers definitely have to accept their responsibility for expecting nurses to carry unacceptable risks and not be able to deliver the care people require - and question their own conscience. However, all of us in healthcare have to do the same if we 'let it go' without saying anything. In many respects, it is easy to adopt an 'us and them' analysis but I think the truth is that we have to find a way to develop a dialogue that looks to address the problem in a different way. And we have to remember, many of the problems we're facing are about funding, policy and systems that are beyond the control of managers or senior clinicians.

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  • it's everybody's problem! everybody in the land who has any connection with the NHS as users, potential users and workers and all who contribute financially to the system or are entitled to free services from it.

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  • If a service cannot be run safely as a result of "financial" constraint the honest and honorable action to take is to reduce or close down that service.

    Just as matter if interest Mr Hart are you able to detail the "cuts" made at governmental level to the NHS budget !

    I suspect there have indeed been no such cuts !

    Take a long hard look at your own Trust Mr Hart, then come back here and tell us about how wonderful the "management " is and how no money is wasted!

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  • How anyone can deny that there has been cuts to the NHS budget is beyond me. Even if the funding stays the same two years running that is effectively a cut in real terms. How can Trusts all the over the Country be told they have to make millions of pounds worth of savings if there are no cuts?

    And yes there are definitely health implications for patients who can no longer afford heating, hot water and food - the number of people needing to use food banks in my area has been a real eye opener.

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