When something is going wrong in a system of work,fingers naturally will often point to the management structure. Senior staff can be questioned, managers decisions criticized.in this case with the NHS, the biggest manager and where the buck totally stops, is with the Government of the day. They have the overall say in how our NHS is run.
I am no expert here on figures and am not a statistician . What I can say can only be based on what I have seen for myself and read in the media. So let’s take the Mid Staffordshire case. The horrific situation of systematic failings in care was largely created by a catalyst of cost cutting and the relentless drive towards becoming a Foundation Hospital. In order to become that,(foundation status means more self-governing) the hospital had to slash debt, have improved performance targets and be seen to be keeping on track, not only in budget but what it could show on paper to be improvements, efficiency and throughput.
In-fact, this objective is part of every hospital up and down this country. Along with this, the Private Finance Initative called PFI’s was introduced by the last labour government and its impact have made the present situation even worse. PFI’s are loans to hospitals to rebuild, improve and to makeover old hospitals into shiny, spanking new ones. However, many of us will know the outcomes of hospitals struggling to pay off these loans. They have been left with huge debts and deficits.
Then, on top of that, we have fines if certain targets are not met. If a patient goes over a four hour waiting time to be discharged from the Accident Emergency Department to a ward, transferred to another unit or sent home, the hospital is fined. If an ambulance does not deliver and dispatch a patient in a certain time span, it is fined. This is all supposed to be about improvements in performance, get the stick of financial punishment out, and somehow magically results will be produced forthwith. But what has happened? As wards shrink in size, as hospitals slash inpatients beds and staff to save money, there results in a chaotic rush of bed juggling, and the frantic efforts to free up beds against fewer manpower resources. If a patient is discharged and then that patient is what we would term a “bouncer”, that is to say they are re-admitted within a certain time frame,the hospital gets… you guessed it, a fine!
How are hospitals suppose to stay on track budget wise if all they are threatened with is fines? This is government policy now and it is doing nothing to help patients with their care.Infact, this only creates more pressure to treat a patient as a price tag, a unit, a juggling ball on a bed; and leads to what we have heard about bed moving in the middle of the night, against the tide of complaints of sleep deprived patients on wards. It’s like musical beds. Patients become little more than another stat to be got through the system as quick as possible. Now we have jobs purely for bed managers and early discharge assessors and the term, the “bed- blocker” comes to my mind. This is when someone is stuck in the system with no outlying community bed to go to ( because they have been either cut or closed) but they can’t go home either.
Never has the pressure for beds and timed targets been so great as it is now; with increased population, sicker older people, increased expectations of the population to be seen and treated and the changes in GP’s out of hours care. Literally hospitals are fit to bust…..
I leave you with a question. How can these government-led poliices be conducive to quality total patient care? And the nurses, as well as other NHS staff, are caught right in the middle of it. I tell you something: it makes for a hell of a lot of stress. It does nothing to help health-care professionals, with their own mental health, who are suppose to be angels or compassion, care and tranquillity, when really they are tearing their hair out, to give this essence of care that is talked about….
Tomorrow: An example of the crazy burden of data collection and why ultimately I left NHS Nursing.