GREATER MANCHESTER, ENGLAND
RETIRED ORTHOPAEDIC SURGEON
I worked in NHS for 40 years (1974 to October 2014)
I was Consultant Orthopaedic Surgeon for 24 years
[ 7 years at Rochdale Infirmary and 17 years at Tameside Hospital ]
I did my speciality training in London at St Mary’s Hospital and in Greater Manchester at Manchester Royal Infirmary, Salford Royal, the Children’s Hospital and Wrightington Hospital
I strongly believe that only legislation regarding mandatory nurse and midwife to patient staffing ratios in England will resulve the shameful chronic under-staffing in hospitals. [as in Canada, Australia and in many States in the USA]
I am strongly against further marketisation and privatization of the NHS and Social Care.
As a campaigner for legislation on mandatory nurse and midwife to patient staffing ratios in England for many years I fully support the Welch Bill. I deeply regret that in England the recommendations in the individual reports of Francis , Keogh , Cavendish and Berwick  have been ignored.
Yesterday, whilst travelling in Cumbria, I heard on a local radio about the appalling nursing staffing levels in a Carlyle NHS hospital, I am sure this is happening in many other Trusts all over England.
I agree that a significant number of patients' discharge is delayed for multiple valid reasons: waiting for essential equipment at home; waiting for a place in a nursing home; waiting in hospital for a final but essential investigation; etc. There is however a significant number of patients that are discharged before they have sufficiently recovered from their illnesses. Some of them are readmitted in a more critical condition and end up staying longer or in a few cases do not survive. Others die at home, but otherwise could have lived longer if allowed to recover fully.
The fact is that many hospitals in England closed too many wards and there are no sufficient beds.
Planners and modernisers are mistaken thinking that 'new' practices such a creation of so call 'community teams' lead by 'extensivists' can replace well run and adequately staffed hospital wards.
Nurses, midwives, doctors and other 'team' members have been undergoing combined training - to improve outcomes and patient safety - in the NHS for many years. This is good.
The professional regulatory bodies have been busy up-dating their regulations, for instance encouraging health workers to report unsafe working conditions.[for patients and staff].
The main cause of poor and occasionally catastrophic outcome is lack of resources: Human [nurses, doctors] and material [beds, essential equipment] etc. This is compounded by the - obviously - contradictory role in the functions of MONITOR and CQC. The former penalises Trusts that put the wellbeing of patients before finances.
Sadly unsafe discharge of patients from hospital wards will continue to occur. Closure of beds in wards; closure of entire wards; or worse still- closure of hospitals over the years has reduced capacity to the point that hospital 'capacity crisis' are a weekly or even daily occurrence. This is compounded by the shortage of nurses [ measured against planned staffing] during between 10 and 30 percent of shifts.
In parts Two and Three of my book: 'The Flight of the Black Necked Swans' I describe these issues. Nurses should ask their local libraries to stock it. [See article from Nursing Times regarding this book]
As a consultant orthopaedic surgeon with 40 years of experience in the NHS, I can say that the main reason for lack of nurse retention is the appalling working conditions in the wards, when all too often one qualified nurse is responsible for between 12 and 15 or more patients.[ many very dependent or acutely ill or postoperative]. I describe my experience in a book https://www.nursingtimes.net/news/workforce/whistleblowers-book-highlights-risks-of-short-staffing/7003583.fullarticle