The Royal College of Nursing’s general secretary has warned the NHS faces its “toughest year”, with specialist nurses losing their jobs and vulnerable patients “in the firing line”.
In a Nursing Times interview to mark five years in his post, Peter Carter predicted most trusts would make “false economies” by cutting nursing costs and slashing their total expenditure by up to 9% in 2012-13.
“I believe next year is going to be the toughest year yet in the history of the NHS,” he said.
Mr Carter acknowledged the need to fulfil NHS chief executive Sir David Nicholson’s target for cutting expenditure by £20bn over four years but said money was being wasted by cutting the posts of specialist nurses involved in areas such as diabetes or breast care.
“Just cutting the post of the last nurse that retired isn’t very intelligent. A diabetic liaison nurse keeps people out of hospital, they prevent complications, they save their salary time and time again. That’s the sort of post we are seeing cut,” he said.
“A majority of trusts aren’t thinking this through properly. They are caught like rabbits in the headlights of the Nicholson challenge.”
Mr Carter predicted the most vulnerable patients would be hit hard: “Mental health, along with the elderly and learning difficulties, are three services which are right in the firing line as part of the cuts.”
He predicted that advances made since the introduction of the national service framework for mental health in 1999 would be “compromised” due to cuts in early intervention and outreach services. This could lead to a “fairly constant stream of inquiries reporting into homicides and suicides and care in the community was blamed”, as seen in the 1990s.
“I can see a re-emergence of problems like suicides,” Mr Carter said. “I’m worried that the short term thinking behind cutting these teams will set up problems.”
Mr Carter said a shift in resources away from the acute sector was justified as “40% of patients don’t need to be in hospital at any given time”. He backed innovation in areas of community infrastructure including telehealth.
“If you redesign services and have a lot more early intervention you will obviate the need for people to come into hospital,” he said.
“Particularly in large cities and metropolitan areas, you would have to question if we need the same number of hospitals. I don’t believe we do.”
He added: “With proper workforce planning and a proper project plan it doesn’t mean job losses.” He insisted that annual staff turnover in most hospitals meant a “proper redeployment process” could take place “in the best interests of patients”.
Although Mr Carter insisted “the vast majority of patients have really good care”, he conceded nursing faced a challenge protecting its image following a series of critical reports about care standards, especially relating to older people’s treatment.
Mr Carter said companies providing domiciliary care in many areas used a “predominantly unqualified workforce”, many of whose members were young, untrained people.
“It’s not a fault of the individual young person who is the care assistant. The fault is with these organisations that are doing this on the cheap. Unless it changes rapidly you will get more of these … scandals.”
Mr Carter said the poor treatment of people with learning disabilities at Winterbourne View it was an example of a “a predominantly private organisation charging huge fees, making massive profits but the workforce that they employed were predominantly untrained, low-paid health care assistants on £16,000 a year”.
He urged UK health departments to take “a much keener interest on who’s getting these contracts”, adding: “Is quality given the same importance as cost? The evidence suggests that in some areas cost is the predominant factor.”
Mr Carter also called on the UK’s four chief nursing officers to do more to “promote that this country has far more to be proud about in its nurses than it needs to be concerned about”.
Abolition of national pay
“It will become a major campaign for us to resist what the government is trying to do.”
The RCN’s financial health
“When I started at the RCN there were huge debts and a sense that the organisation had lost its way a bit. We’ve got the organisation internally stabilised, we’ve cleared all the debts – we are now trading in profit.”
“Membership had been dropping. We were down to 390,000. [Now] membership is rocketing… we’ve risen by 30,000 members.”
Rebecca Leighton, the RCN-represented nurse cleared of charges relating to poisoning of patients at Stepping Hill Hospital
“We are now considering what grounds if any there are for appeal [against her dismissal from her job]. We are certainly not deserting Rebecca and I would hope she would confirm that.”
Prime minister David Cameron and health secretary Andrew Lansley
“I’ve got no doubt that the prime minister, because of his personal experiences, holds the NHS in high regard. I’m sure Andrew Lansley does, but the issue with Andrew is that he thinks competition is going to be a remedy for many of the NHS’s ills and I simply don’t believe that.”
His positive report on care at Mid Staffordshire Foundation Trust before failings were exposed
“I visited some wards, spoke to patients and relatives, what I saw was good and I’m not going to row back from that.”