As with NHS funding, the government’s claims on staffing require close scrutiny
“The NHS is facing this winter with more doctors, more nurses and more money than it has ever had in its history”, said David Cameron at Prime Minister’s Questions last month.
Of course, all politicians like big headline figures like this. But what does this actually mean in practice? And why, if true, is the NHS so manifestly struggling to meet demand from GP appointments to A&E, cancer care and elsewhere?
The first thing and most obvious point to make is that increased supply of doctors, nurses and funding is meaningless unless mapped against demand.
On funding, despite negative growth in 2010/11, the government has in fact delivered an average of 0.9 per cent real terms increases per year.
However, with health care cost inflation running at around four per cent, this has led to an unprecedented funding squeeze creating a growing financial crisis across the NHS and a potential funding gap of £30bn by 2020, according to NHS England. Throw in a 12 per cent cut in adult social care and you’re beginning to get a more accurate picture of the government’s record on health funding.
There’s a similar story with staffing levels. Records do indicate growth in the numbers of nurses and doctors. There has been a net increase of 3,300 additional nurses since May 2010, an increase in the region of 1.25 per cent.
Growth has been concentrated in the acute sector, with an increase of over 4.5 per cent in the number of nurses in hospitals, largely spurred by concerns about safe staffing levels in the wake of the Francis Report. And we’ve seen an even more significant growth in doctors in hospitals at just short of 10 per cent.
But this has to be understood within the context of increasing demand. Visits to A&E have increased by over 30 per cent in the last decade, with a particularly strong spike in recent times, around 14,500 extra visits a week this year compared to 2013/14. Not only that but the number of hospital admissions from A&E has also leapt, with 4,000 more admissions per week than this time last year.
Clearly numbers are failing to keep up with demand, which is one of the reasons why the RCN can still point to 20,000 nursing vacancies and why trusts are turning to expensive agency workers to plug gaps. Research published this week by the RCN shows that spend on agency nurses will approach £1bn this year, a 150 per cent increase since 2012/13. And while numbers of doctors may be on the increase, hospitals are reporting shortages for essential A&E consultants.
If we look beyond hospital nurses we see a different picture, with huge losses in our community and mental health services. Under this government there has been a 27 per cent reduction in district nurses, a 22 per cent reduction in learning disabilities and around a 10 per cent reduction in psychiatric nurses.
This failure of provision in our communities is without doubt a key contributory factor to the growing demand place on hospitals and A&E and runs contrary to the Department of Health’s stated aim of investing in preventative care.
And a similar picture emerges for doctors in primary care. The number of GPs has remained largely static since 2010, yet the GP consultation rate has almost doubled in the last 10 years, from around three times to nearly six times per year or up to 14 times a year for the elderly.
The proportion of family doctors serving every 100,000 people has also dropped, from 70 in 2009/10 to 66.5 now. No wonder then that the BMA report that 74 per cent of GPs think their workload is unsustainable and 50 per cent say that morale is low.
A big part of the problem is the squeeze on training. Health Education England reported a decline in GP training figures in 2013/14 and while training places are beginning to increase for nursing staff, following cuts in the early years of this government, unions point out far more needs to be done, particularly in district and community nursing.
Beyond the government’s rhetoric, NHS leaders recognise the growing problems with retention and recruitment. The Five Year Forward View calls on Health Education England to do more to improve retention, particularly in nursing, General Practice and Emergency Medicine and to deal with workforce shortages in those areas with care quality or financial risks.
As with NHS funding, the government’s claims on staffing require close scrutiny. More does not always mean enough, especially in the face of steep rising demand. Getting the balance right is equally important.
Cuts to staffing providing care in our communities, combined with swinging cuts in social care and other preventative measures, is helping cause the increasing demand that the acute sector is finding so challenging.
The NHS has been locked into a vicious circle borne of an unprecedented funding squeeze that’s leading to a perfect storm of growing financial crisis, a failure to cope with demand and plummeting staff morale.
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