The health secretary must focus on retention as well as their recruitment, the Royal College of Nursing said in response to Jeremy Hunt’s announcement on training more home-grown staff.
Mr Hunt yesterday revealed workforce reforms designed to ensure the NHS was able to meet future demand for patient care by dramatically expanding the UK’s supply of home-grown doctors.
“More must be done to ensure the NHS can keep the staff it already has”
In a speech at the Conservative Party conference, he committed to fund an extra 1,500 medical student places, with applications open in 2017-18 and the places available from the start of the 2018-19 academic year.
The policy, revealed in a statement to the media before his speech, was designed to reduce reliance on staff from overseas and expensive agency staff, said Mr Hunt – though the timing of the announcement should be noted as it closely followed the calling off of planned strike action by junior doctors.
In response, the RCN said it welcomed the health secretary’s “acknowledgement” of the workforce crisis facing the NHS and the government’s “ambition” to reduce the reliance on agency staff.
But the college said the plans “must go further” to address the strain on existing healthcare staff and enable them to deliver high quality care.
Lara Carmona, RCN associate director of policy, international and parliamentary, said: “A big contributing factor to this crisis has been retention as well as recruitment.
“Many nurses are working for agencies because they can no longer afford to work for the NHS after a 14% real-terms pay cut in recent years. More must be done to ensure the NHS can keep the staff it already has,” she said.
“[This] announcement needs to be followed through with plans to make sure staff feel valued for the work they are doing, along with the development of a long-term workforce strategy which meets the needs of the health and care system both now and in the future,” she added.
However, with the exception of the medical student place policy, Mr Hunt made no other new announcements.
“No doctor or nurse ever wants to make a mistake – they chose their profession because they want to help people”
He also steered clear of key topics specifically affecting nurses, such as the ongoing nursing shortage, the future status of European Union staff working for the NHS, the controversial introduction of the new nursing associate role, and the removal of the student bursary next year.
The profession was mentioned six times by Mr Hunt during his speech at the International Convention Centre in Birmingham, mostly in regards to nurses being thanked for their work along with other healthcare staff.
In a section of the speech on caner, he noted improvements in diagnosis and survival rates since 2010, but said the government’s new cancer plan would introduce a maximum four-week wait from GP referral to diagnosis and bring in Ofsted-style cancer ratings for clinical commissioning groups.
“Let’s thank the thousands of brilliant cancer doctors, cancer nurses, scientists, carers, charities, volunteers, families and survivors for their work fighting this horrible disease,” he added.
Meanwhile, he described mental health as a “personal priority” for prime minister Theresa May.
Hunt must also focus on nurse retention, says RCN
He said a new plan would “see a transformation” in children’s services, more help for women with postnatal depression and a million more people treated for mental health conditions every year by the end of the parliament.
“Working in mental health can be really challenging,” he said. “So let’s thank the remarkable mental health nurses, counsellors, psychiatrists, charities like the Samaritans and Mind, volunteers and patients who fight stigma by speaking out. They are changing things for the better.”
Turning to accident and emergency departments, Mr Hunt acknowledged that A&E pressures were “rarely far from the headlines”.
“On behalf of the whole country, let’s thank all the hospital doctors, GPs, nurses, paramedics, counsellors, managers, porters, cleaners, caterers and volunteers for their work on the NHS frontline,” he said. “Their jobs are tougher than ever and they do a brilliant job.”
The health secretary also highlighted work being done on patient safety, noting that the NHS needed to be “better at learning from mistakes”.
“Too often in today’s NHS when something goes wrong, people worry about litigation, professional consequences or the reputation of their hospital,” he said. “The shutters come down.
“No doctor or nurse ever wants to make a mistake – they chose their profession because they want to help people,” he said. “So we need to help them too – by dismantling a culture that prevents improvement and replacing it with one that supports it.”
“Let’s thank all the hospital doctors, GPs, nurses, paramedics, managers… and volunteers for their work on the NHS frontline”
Mr Hunt noted that the government had established an independent healthcare safety investigation branch, was consulting on legislation to give doctors a ‘safe space’ to speak freely about errors, and that hospitals would be publishing their own estimates for avoidable deaths.
He also referred to the government’s controversial seven-day NHS policy – which sparked the junior doctors’ dispute – telling delegates that “part of raising standards” meant “improving the care we offer at weekends”.
In addition, the health secretary argued that leadership quality rather than funding levels was the most important factor with regards to improving patient safety.
“Serious errors cost us £1.5bn in litigation fees every year. That’s £1.5bn spent not on medicines, doctors or nurses – but on picking up the pieces when things go wrong,” he said.
“When you look at our safest hospitals, our best schools and our top police forces and you see, it’s not about the level of funding, but the quality of leadership,” he said.
“Leadership that supports doctors and nurses to learn from mistakes. Leadership that makes a complex system seamless for patients, by joining up the health and social care systems,” he added.
Jeremy Hunt’s speech at 2016 Conservative Party conference in full
“Good afternoon. Conference, I believe totally and utterly in our NHS. I want it to offer the safest, highest quality care of any country in the world for you and your family.
When I took on this role four years ago I said it was the biggest privilege of my life. Some say it’s the hardest job in government. Others say it’s the safest – because there’s not a long line of other ministers who want it. But for me it’s the chance to serve our country by guiding our most precious public service through difficult times.
And that’s why I’m proud to be back in front of you wearing my NHS badge. And why today I want to talk to you frankly about the state of our National Health Service: its successes, its challenges and our plans for the future. And I want to explain why, despite the headlines, we can all be proud of our NHS and confident in its future.
Now, take cancer, our no 1 killer. There isn’t a family in this country, including my own, that hasn’t lost a loved one to cancer. But the truth is that for many years we have had the lowest cancer survival rates in Western Europe.
But we haven’t been doing nothing. We know with cancer the key is to catch it early. So every day, compared to 2010, we are doing 16,000 more diagnostic tests. As a result we’re starting cancer treatment for 130 more people every day and now have our highest ever cancer survival rates.
Good progress, but still not good enough. So our new cancer plan will introduce a maximum 4 week wait from GP referral to diagnosis; bring in Ofsted-style cancer ratings for CCGs; do more molecular diagnostics and immunotherapy and save an estimated 30,000 lives a year.
I’m publishing those Ofsted ratings today and although they don’t make comfortable reading everyone will now see our commitment to build a safer NHS doing more than ever to fight cancer for you and your family.
So let’s thank the thousands of brilliant cancer doctors, cancer nurses, scientists, carers, charities, volunteers, families and survivors for their work fighting this horrible disease…
Or take mental health, a personal priority for our new Prime Minister. For decades, frankly, it has been a second class citizen in the NHS. But if your daughter has an eating disorder or if your father’s losing his memory it’s not your second priority to get it sorted, it’s your first.
So since 2010 we have increased by five times the number of people getting treatment for conditions like depression and anxiety; raised our dementia diagnosis rates to one of the highest in the world; legislated for parity of esteem with physical health; introduced waiting times targets; and now treat 1400 more people for mental health conditions every single day.
But again - still – we need to do better. So our new plan will see a transformation of children’s services, more help for mums with post-natal depression, more help for those looking for work and a million more people being treated for mental health conditions every year by the end of the parliament.
A safer NHS delivering better mental health treatment than ever for you and your family. Working in mental health can be really challenging. So let’s thank the remarkable mental health nurses, counsellors, psychiatrists, charities like the Samaritans and MIND, volunteers and patients who fight stigma by speaking out. They are changing things for the better…
More on mental health later, but look now at A & E departments, where pressures are rarely far from the headlines. Everyone needs to know they can get care quickly in an emergency and although we are seeing record numbers it’s not good enough that we are currently missing our 4 hour target.
But what have we done? Since 2010 we’ve set up 26 regional trauma units to give better care to the most complex cases. We’ve increased A & E doctors by 25% - that’s over 1200 more. And every day within the four hour target we treat 2,500 more people compared to six years ago.
A safer NHS doing more emergency care than ever for you and your family. Put this together and you see an NHS doing every single day 4,400 more operations than when we came to power – at the same time as halving MRSA, nearly halving CDiff, and cutting hospital bed sores by a third.
In short, despite the pressures of an ageing population, giving better care to more people than ever. So on behalf of the whole country let’s thank all the hospital doctors, GPs, nurses, paramedics, counsellors, managers, porters, cleaners, caterers and volunteers for their work on the NHS frontline. Their jobs are tougher than ever and they do a brilliant job…
And while we’re on the thank yous can I add a personal thank you to my ministerial team: Alistair Burt, Ben Gummer, George Freeman and Jane Ellison did outstanding work before moving on in the summer; and I am really lucky to have a talented new team with Philip Dunne, Nicola Blackwood and David Mowat, alongside our voice of experience David Prior. I am particularly thrilled that Nicola took a very brief break from the red boxes in September to get married. Congratulations Nicola.
AN NHS THAT WORKS FOR EVERYONE
There’s much to be proud of in the NHS, but we don’t get everything right. We just heard James Titcombe’s heartbreaking story about the death of his baby son Joshua. Do you know how many emails and letters James had to write over 6 years to get the bottom of what happened? 300 letters and 3000 emails.
He shouldn’t have had to write one, let alone that many. But faced with a grieving father, instead of supporting him the system pulled up the drawbridge. Any one of us could be the same Dad or same parent – so let’s be clear closing ranks against families who want to know the truth about their loved ones has no place in our NHS.
And Melissa Mead’s battle to save her son William from sepsis – wasn’t she powerful? William lost his life but Melissa’s work will save the lives of thousands of other babies. How committed to come here the week after having a baby. Congratulations Melissa and yes we will launch the campaign you want to raise awareness of sepsis…
I always offer these brave families apologies on behalf of the government and the NHS. But even as the words leave my lips, I know they aren’t enough. They want actions not words. They want to know that in our democracy no citizen will ever be rendered voiceless or powerless by a mighty state or a mighty bureaucracy, even one as loved as the NHS.
Which is why we’ve changed the law to require a duty of candour on all hospitals to be honest with patients when things go wrong; we’ve introduced Ofsted-style ratings for hospitals, GP surgeries and care homes so the public know how good their care is; and all NHS organisations now publish data showing how many of their patients would recommend the care they got to friends and families.
Lots more to do but we are building a safer, more responsive, more caring NHS for you and your family.
If you believe in the NHS, you want it to be the best. So many will be shocked to know that, according to independent research, every week in our hospitals we have around 150 avoidable deaths.
That’s the equivalent of a plane crashing out of the sky every week. And then there’s the harm that leaves people literally scarred for life. Twice a week a child is born with severe neurological injuries that could have been avoided and disable them for life.
Twice a week we operate on the wrong part of someone’s body, so called ‘never events.’ Last June a major teaching hospital removed someone’s fallopian tube instead of their appendix. Last December one patient had the wrong toe amputated.
Other countries have the same issues, often worse than us actually, but why anywhere in the world do we accept these kind of statistics as somehow inevitable in healthcare when we would never do so in the airline industry or the nuclear industry?
These aren’t about illnesses we are waiting for science to cure. They are things we can sort out right now. And that’s what we are going to do.
LEARNING FROM MISTAKES
Firstly by being better at learning from mistakes. We have brilliant doctors like Tim Draycott at Southmead and Tim Briggs in the Royal National Orthopaedic Hospital, turning heads all over the world by the way they learn from hard data to reduce harm and save lives.
But too often in today’s NHS when something goes wrong, people worry about litigation, professional consequences or the reputation of their hospital. The shutters come down and we don’t do the one thing that should happen, namely having an honest and open discussion and spreading the lessons learned across the whole NHS.
A blame culture and not a learning culture. It could be so different. No doctor or nurse ever wants to make a mistake – they chose their profession because they want to help people. So we need to help them too – by dismantling a culture that prevents improvement and replacing it with one that supports it.
So this year we’ve set up an independent healthcare safety investigation branch to make sure we learn from mistakes; we’re consulting on legislation to give doctors a safe space to speak freely about medical error; and we’ll publish hospitals’ own estimates of their avoidable deaths, the first country in the world to do so.
Changing culture takes time. But it’s the only way to build a safer, more transparent NHS that learns from mistakes so we raise the standard of care for you and your family
As I mentioned before, we also need to do better on mental health. Most days I try to reply personally to letters from members of the public about their care. One letter I’ll never forget. It was from a father in Cumbria, whose daughter was referred for a CAMHS appointment after writing suicide notes. Unfortunately the urgency of her situation was not picked up.
The next day that young girl with a promising future had killed herself. In fact – tragically – there are 13 suicides every single day. Even worse, nearly three quarters of them had no contact with NHS mental health services in the previous year.
We legislated for parity of esteem between physical and mental health. So now it’s time to deliver it with an improved suicide prevention strategy in a safer NHS that gives mental health the same priority as physical health for you and your family.
7 DAY NHS
And part of raising standards means, yes, improving the care we offer at weekends. Anyone who falls sick unexpectedly should be confident they’ll get the same high quality care every day of the week. It’s simply not acceptable that according to 8 recent studies we have a ‘weekend effect’ which means mortality rates up to 15% higher for those admitted on or around weekends.
Our 7 day hospital plans are simple. The Academy of Medical Royal Colleges recommends four key standards.
One says that whatever day of the week it is, highly vulnerable patients should be checked by a consultant twice a day. That’s because it’s vital to spot quickly if someone deteriorates. Pretty important. But when we last checked that happens in just one in twenty hospitals.
Another standard says that whatever day of the week, patients should be checked by a senior doctor within 14 hours of being admitted. Again pretty vital for patients. But again when we checked, happening in just one in ten hospitals.
These standards are primarily about consultants, but junior doctors, especially the more experienced ones, must play their part too. So whilst we’re all pleased this week’s strike has been called off, I say to the BMA and all junior doctors let’s not argue about statistics or whether we can do more to raise standards for patients.
The NHS that you believe in is the NHS we are building. So call off the strikes for good and start working with us to deliver safer care, 7 days a week, for patients and their families.
NOT JUST MONEY
Now of course for the NHS money matters. And some worry there isn’t enough for the demands we face. That’s why, despite our manifesto commitment to reduce the deficit, we gave the NHS the most generous increase of any government department last year - more than double, incidentally, what Labour promised at the election.
But just writing a cheque doesn’t raise standards. Labour tried it and gave us Mid Staffs. America spends three times more per head than us with more avoidable harm according to some studies.
In fact safer care doesn’t cost more, it costs less. Every time a patient has a fall, or picks up a bedsore or catches an infection they stay in hospital for longer, costing the NHS more.
Serious errors cost us £1.5 bn in litigation fees every year. That’s £1.5 bn spent not on medicines, doctors or nurses – but on picking up the pieces when things go wrong.
When you look at our safest hospitals, our best schools and our top police forces and you see it’s not about the level of funding, but the quality of leadership.
Leadership that supports doctors and nurses to learn from mistakes. Leadership that makes a complex system seamless for patients, by joining up the health and social care systems.
Leadership that says simply the care I’d want for my mum or dad is the care I’m going to give to my patients with a more efficient, safer, higher quality NHS for you and your family.
BUILDING FOR THE FUTURE
My job is to prepare the NHS for the future. And that means doing something today we have never done properly before: training enough doctors.
Currently a quarter of our doctors come from overseas. They do a fantastic job and the NHS would fall over without them. When it comes to those that are EU nationals, we’ve been clear we want them to be able to stay post-Brexit.
But looking forward, is it right to carry on importing doctors from poorer countries that need them, whilst we turn away bright home graduates desperate to study medicine?
Even if we wanted to carry on importing doctors, the supply is drying up. The World Health Organisation says there’s a global shortage of over 2 million doctors - we’re not the only country with an ageing population.
But we are the fifth largest economy in the world - so we should be training all the doctors we need. And today I can tell you that’s exactly what we’re going to do.
From September 2018, we will train up to 1500 more doctors every year, increasing the number of medical school places by up to a quarter. That’s the biggest annual increase in medical student training in the history of the NHS.
Of course it will take a number of years before those students qualify, but by the end of the next parliament we will make the NHS self-sufficient in doctors.
Training a doctor costs over £200,000. So in return we will ask all new doctors to work for the NHS for four years, just as army recruits are asked to after their training.
The result will be more home grown doctors and fewer rota gaps in a safer NHS looking after you and your family for years to come.
Conference, a country that works for everyone takes special care of the public service closest to everyone’s heart. And that’s the NHS.
Today I want the British people to know that nothing matters more to this government than protecting our NHS and preparing it for the future.
Yes we’re the country that discovered DNA, gave the world MRI scans and thanks to our brilliant universities may soon discover a cure for dementia and HIV.
Yes we were the first in the world to say it doesn’t matter if you are rich or poor, young or old, your family’s care should never depend on your family’s money.
But for the grandfather with a stroke, the mum giving birth, or the child with sepsis those values are about quality as well as equity. Standards as well as speed. Dignity as well as delivery.
That’s a big ask for those already working so hard on the frontline. But a big ask based on one simple truth: the NHS they want is the NHS we all want.
A safer, more responsive, more open 7 day NHS offering the highest standards of care for you, your family and every family in the country. That’s our vision; that’s our mission; and nothing will stand in our way. Thank you.”