Q&A with the Green Party on its 2015 election manifesto
Q How will your party ensure nurses are adequately remunerated, so that their pay reflects changes in inflation and the unsocial hours involved?
A The Green Party supported the recent strike by health care workers and believes that the government should listen to the Pay Review Body.
We would immediately increase funding for the NHS and make sure that there were annual uplifts to reflect inflation and increasing demands on it. This would mean there was money available to pay decent wages.
“But the answer isn’t simply to pump more money into the system”
There has been talk of increasing access to the NHS with routine care available seven days a week. This will have to include additional pay for unsocial hours.
But the answer isn’t simply to pump more money into the system: staffing needs to be properly planned so that there are enough staff trained and available in the required specialities. This would be cheaper than bringing in agency staff to cover gaps.
We are also adamantly opposed to privatisation of the NHS, partly because private companies (particularly in nursing homes and residential homes but increasingly in hospital services) often have poor terms and conditions for their staff, but take money out for private profit of their share holders.
Q What will you do to retain nurses in practice and do you agree that extra numbers of nurses in training are needed?
A Nurses need decent pay for all grades and specialties and the possibility of career progression, with pay levels reflecting higher training and experience. But nurses also need decent conditions, i.e. safe staffing levels, ongoing professional development, job satisfaction and respect.
“We need to be training more nurses in the UK, not relying on nurses from abroad”
We need to be training more nurses in the UK, not relying on nurses from abroad. And we need a unified, publicly provided system, not a patchwork of private providers who do not fund the training of the workers they are pleased to use (and often exploit).
Many roles in the community and hospitals could and should be taken by nurses rather than doctors. Workforce planning should not be restrained by the existing barriers between the professions.
Q What would you say to a nurse who goes home every night knowing that she (or he) hasn’t given the best care for her patients?
A Ultimately good health care depends on the relationship between the health professional and patient.
The job of managers is to create an atmosphere in which that caring relationship, supported by evidence and professional ethics, can flourish. This is not just about adequate resources (staff and equipment) but about having freedom from targets, protocols, pathways and unnecessary bureaucracy which distract workers from their central task.
“Go back to your job description and contract – is it being respected?”
The marketisation and privatisation of the NHS have distorted the ethos of quality, patient-centred and led to frustration and wasted effort on the part of patients and staff.
Having said that, health professionals can often see ways to improve the system, allowing them to deliver a better service. This can be a “bottom up” process so it is important for nurses who feel like this to find the strength to speak up.
Go back to your job description and contract – is it being respected? Are you getting your mandatory training? Are you getting clinical supervision? Have you talked to your manager and other members of your team? How can you turn your dissatisfaction into a positive suggestion which might make a difference for you, your colleagues and your patients?
Q What will you do to prevent the boom and bust approach to workforce planning that we have had for the past decade?
A Bring the NHS back into public control with democratically accountable regional bodies answerable to a national body. Assess the needs of the population given current patterns of sickness and then plan accordingly.
As stated above, this should encompass all types of staff, nurses and doctors, but also therapists, technicians, health care assistants and (social) care workers.
“Bring the NHS back into public control”
Some divisions between specialities and grades are historical and arbitrary. It is likely that focussing on the range of tasks which could be carried out by nurses would lead to greater effectiveness and efficiency across the system as a whole.
Q What will you do to rectify the skills gap in the community nursing workforce – eg lack of district nurses – to enable people living with long term conditions to be better supported at home?
A People with chronic conditions, particularly the elderly, are the fastest growing group needing health care. We would put extra resources into community-based care including training for staff.
“We would put extra resources into community-based care including training for staff”
One approach would to offer separate training for community nurses, including district nurses and primary-care based nurse practitioners. This might be completely separate, or a speciality undertaken after the main nursing degree. Such nurses would be well placed to head up teams of health care assistants working alongside carers providing “social” care (i.e. home helps).
Ultimately “integration” of health and social care is about good relationships and delineation of roles in the front line. Community nurses should also be able to diagnose and prescribe, working in partnership with General Practitioners.
Q More complex treatment and an ageing population raise resource issues that no political party wants to tackle for fear of losing votes. Is cross-party working on the NHS the only way forward?
A There are growing pressures on the NHS but these are not simply due to the ageing population and more complex treatments available. The epidemic of diabetes, alcohol-related problems, mental illness and so on are symptoms of a sick society.
The Green Party has a manifesto which is designed to tackle the root causes of the problems, taxing the wealthy and investing in the infrastructure for a sustainable, healthier, society.
“We don’t see the NHS as an isolated “problem” service that can be “solved””
We also believe that resources need to be shifted away from ever more complex treatments (often promoted by the pharmaceutical industry) into basic, preventive care which would save money in the long term. And, as already stated, we want to halt and reverse the privatisation of the NHS and indeed other public services.
So we don’t see the NHS as an isolated “problem” service that can be “solved”. Having said that, we would be willing to work with other parties to set out core principles and future funding which would allow the long term planning it desperately!
Q What will you do to ensure the voice of nursing is heard when deciding health policy and do you think nurse leaders should have an advisory role on a par with senior doctors?
A Yes, nurses should be involved in national and regional decision making. They are under-represented on hospital boards and commissioning groups. They should contribute to the over-arching planning especially with regard to work force planning.
Q Is the Care Quality Commission a friend or foe of nurses? What would you do to ensure the CQC is effective in creating an open culture for staff to raise concerns?
A The CQC asks the questions: is this organisation safe, effective, responsive, caring and well-led? Doctors and nurses I know who have served on the CQC say it genuinely seeks the views of all workers and recognises that faults are usually due to poor leadership rather than the staff themselves.
“[Nurses] are under-represented on hospital boards and commissioning groups”
Despite the recommendations about protecting whistle-blowers, it would probably be easier to raise problems via the CQC rather than “go it alone” and as such nurses and all health care workers should welcome the CQC.
Q The safety of nurses at the workplace should be a priority. What policies, if any, do you have in mind to ensure the safety of nursing staff?
A There need to be safe levels of staffing, so nurses are not tackling in appropriate tasks on their own or working when they are tired, or beyond their training and competence. When resources are stretched and the whole system bogged down in unnecessary targets, patients as well as health workers become frustrated.
“When resources are stretched and the whole system bogged down in unnecessary targets”
This is when people may become aggressive, or make complaints. So reshaping the system to allow health care workers to really respond to the needs of their patients would improve safety for all.
Q What do you see as your number one policy priority for nursing?
A A genuine recognition of the value of person-centred care at the heart of the NHS.