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NHS cuts: 'there are difficult decisions ahead'

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Nursing Times blogger Martin Jones ponders the position and attitudes of politicians as cuts are enforced and decisions need to be made as to where.

As an unexpected consequence of blogging for Nursing Times, I have been interviewed twice on BBC Radio 5 Live and twice on BBC Radio Sussex, after researchers picked up on my blogs about the new government’s budget and NHS pensions.

Last Friday morning, as I cycled to work along Eastbourne seafront, my mobile phone rang. It was BBC Sussex: could I comment on the RCN’s press release predicting that 27,000 frontline jobs will be lost in coming NHS cuts? I thought about this, agreed and at the appointed hour the researcher rang back and put me through to the studio.

The thrust of the presenters’ questions to me was to challenge the RCN’s assertion, since ministers have given assurances that frontline jobs will not be lost. Coming in the same week as the student tuition fees protest, when deputy prime minister Nick Clegg was confronted with his pre-election pledge to oppose higher education fees, I went for a cheap shot, stating that in this context, I found it hard to believe anything that our political leaders promise.

A close friend of mine, a former chief executive of several hospitals, listened to the interview and the following day made two critical observations - one of which I will discuss here. He challenged me about my cheap shot: did I really believe that all politicians were not to be trusted? Well, he knows that I know and admire the local MP, a newly elected Lib Dem who works as hard as any nurse works for the public good. In the build-up to last May’s general election I delivered leaflets on his behalf and had supportive letters published in the local press. I have another good friend who is a Lib Dem councillor.

My friend likened it to his experiences as chief executive, when he might be charged with identifying millions of pounds to save from the hospital budget. There he was trying to run an effective, efficient hospital on behalf of the taxpayer and instead he had the responsibility for making cuts. He became fed up with the distrust of staff and unions that came with his job - as a chief executive he wanted the same as any nurse: an excellent health service. Did I really believe that most politicians are not similarly hard-working public servants?

Well, that got me thinking. For a start, I know that my friend is a well-thought-of chief executive, although I have never personally worked in one of his hospitals. On reflection, I acknowledged that of course I believe that many politicians are motivated by the desire to serve the public and are essentially good people. I admire diligent constituency MPs and ward councillors. Of course, there are plenty of other driving forces for politicians including power, influence, privilege, etc., but I am not so cynical as to distrust all MPs.

It is temptingly easy to blame chief executives and politicians, when in fact they are obliged to perform invidious tasks – some of which I might not like to tackle. I had a go on our council’s budget simulator, creating a county council budget that will take account of a 30% reduction over the next four years. Would I cut services for older people? Adults with physical disability? Adults with learning disabilities? Adults with mental health issues? Over 15 areas of council service to choose from. Have a go: it’s really hard. I didn’t want to make cuts at all. In fact, I wanted to increase the budget in some areas; but the simulator insists on a 30% cut.

My lesson from this is that before taking easy swipes at politicians or chief executives, it is worth remembering that many of them are as motivated by public services as many nurses are. I am grateful that they take on some of the difficult decision-making that I may prefer to shy away from if in the same boat.

Finally - and to exculpate myself - cutting the NHS budget without reducing frontline staffing will probably be difficult. After all, our salaries constitute a large slice of the budget. And, as I did say on BBC Radio Sussex, even if the cuts are from other staffing groups, there is a danger that nurses will end up carrying out the administrative tasks currently performed by non-clinical colleagues.

There are difficult decisions ahead.

About Martin

Martin Jones, Clinical Nurse Specialist HIV, East Sussex Downs & Weald. He has worked in sexual health and HIV since 1986.

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Readers' comments (1)

  • Chief Executives are doing a job, and like all other roles, some do it much better than others, some are awful, you can see where hospitals have failed in basic care and others are functioning at an amazingly high level.

    Local councillors work hard, but are not influencing policy.

    I can't see how politicians aren't responsible though, and history has proved how fickle they are with promises.

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