Nurses for Reform Blog

I recently read a superb article on early intervention in psychosis in ‘The Health Service Journal’ dated 23^rd November, 2006 (1). It is about the service at Birmingham and Solihull Mental Health Trust and how it helped a young Asian man of 25, diagnosed as suffering from Manic Depressive Psychosis.

Such services are of proven effectiveness in reducing in-patient admissions into mental health beds and in reducing re-admission rates in psychiatric units. Why are they not the norm now in the UK?

A report by Rethink examined the development of early intervention psychosis teams between 1997 and 2005. It showed that there were 117 early intervention teams in name but only 87 of them had staff. In the south east only 20 per cent of the planned teams were operational, compared with 73 per cent in the Midlands. So had the young Asian Midlander been living in London, he might well be roaming the streets of the capital homeless by now.

Yet, from my last blog you will have read about the staggering wastage of newly qualified nurses to God only knows where, a proportion of whom must be RMN – qualified, and now, conceivably, unemployed.

As an RMN-qualified nurse myself, I would love to have the opportunity, by agreement with my employer, to spend some time in ‘return to practice’ duties helping out my local early intervention psychosis team on my local patch, and yet there is no such mechanism for community involvement offered by my local PCT. However, perhaps I am exhibiting ‘knight’s move thinking’ here? Why can’t PCT’s take a more holistic view of health needs and methods of delivery in their communities? Well, I know they’ve all been worrying about whether they are going to be in a job next week or not for a while now – but that’s how politicians think people working in health need to be motivated. How wrong they are.

We certainly need to rethink these vital community outreach services in psychiatry, particularly in London. Perhaps Nurses for Reform should lobby to meet Professor Louis Appleby, the DoH’s ‘Mental Health Tsar’ on this subject?

What do you re-think?

(1) The Health Services Journal, November 23^rd, 2006 pp 22-24 Article by Lynn Eaton.

Dr. Robert LeFever is a good man and without doubts one of London’s best General Practitioners.

He wrote this fascinating paper a while back and now runs this regularly updated and highly commendable blog.

For all those many Londoners who find it difficult to get to see an NHS GP in a timely and appropriate manner why not sign up with Robert? Take it from nurse – you won’t be disappointed.

As regular readers of this blog will know, I was recently awarded my PhD in health economics. As such, I thought I would share with you one of the books that most influenced my thinking not least because it gives great insights in to the real history and political economy of British healthcare.

Working Class Patients and the Medical Establishment: Self-help in Britain from the mid-nineteenth century to 1948 was written by Dr David Green, Director of the think tank Civitas . The book chronicles the history of healthcare provision via the Friendly Societies and other mutual aid organisations. Crucially, it recognises that:

“The working classes of nineteenth century Britain organised for themselves an extraordinarily effective scheme of medical care. Through the local friendly societies and medical institutes, they engaged doctors to care for them, and did so with a degree of success which this pioneering study reveals for the first time. A surprisingly high proportion of working men were covered.”

This is a truly great book which opens up a much neglected area.  It also has great implications for the controversy over the de-institutionalisation of welfare which is going on throughout the Western world today.

Sadly, while it is no longer in print I recently bought another copy from here . If you are minded and able to obtain one you will not be disappointed.

I am delighted that a recent letter of mine was published in the Nursing Times. This is what it said:

I was delighted to read Karen Lamb’s comments, ‘Starting Out’ (31 October – 6 November 2006), that “in the real world” of private hospitals, evidence based practice is not just encouraged but it is actively embraced, good hygiene practice is “carried out regimentally” – and where “a new treatment is introduced nurses are encouraged to research the treatment and condition”. Pointing out that the nurse-patient ratio is 1:3 in a private hospital compared with 1:8 in the NHS, Karen is right to conclude that working in the private hospitals sector has “restored [her] faith in the nursing profession”.

Today, nurses are increasingly recognising that nationalised healthcare is not only disasterous for their professional standards but it is catastrophic for patients. This is why Nurses for Reform believe (NFR) it is no longer acceptable for nurses to sign up to careers in public sector healthcare only to find they are unable to access the resources and autonomy they need to do their work. NFR rejects bland egalitarianism in favour of contestability. Above all else we believe that greater partnership with the private sector is to be actively welcomed and that this sector’s contributions are good news for patients and healthcare professionals alike.

NFR believes in fundamental change. It believes that only by putting patients and consumers interests’ first will healthcare improve. It is only when healthcare is opened up to real consumers and trusted brands that nurses will find themselves working in a sustainable environment and with the incentives, resources and encouragement to deliver a responsive, popular and truly high quality service.

Interesting organisation the Council of Deans and Heads of UK University Faculties for Nursing and Health Professionals

Professor Paul Turner, chair of the Council and its Executive Officer, according to the website, reported to the Health Select Committee enquiry into NHS deficits that the number of training places for nurses had been cut after strategic health authorities had been asked to make savings across the Board.

‘This will only have an impact in years to come when there will be fewer places available for training and, as a result, fewer qualified nurses coming into the profession.’ Professor Turner.

Ok, that’s great, I can sleep easy at night safe in the knowledge that in my dotage I’ll be looked after by robotic android nurses straight out of ‘Bladerunner’ fully pre-programmed to cater to my every need, except when they blow a circuit and accidentally decapitate me. Much more efficient way of providing nurses I’m sure.

Apparently the Council’s own figures showed that only 56% of newly qualified nurses had been able to find jobs this year and only 58% of newly qualified midwives had found substantive posts.

‘We don’t know what is happening to these nurses who can’t find jobs, but many of them may be lost to the NHS, which is very worrying.’ Professor Turner.

Yes, very worrying. Why don’t you ask them you ninny?

I’ve requested this survey from the Council (you won’t find it on their website, in fact you won’t find very much at all on their website, it’s an exercise in minimalism, they clearly tell all they know to the Health Select Committee but prefer to leave the rest of us mere mortals in complete ignorance) and I’ll publish it here next week if they send it to me so watch this space. Where have all those wonderful new nurses gone? I hope they have found jobs in the independent or charitable sectors and are being well looked after. Perhaps Nurses for Reform should run a survey on: ‘Where have all the new nurses gone?’.

As a national charity that supports those with Alzheimer’s and their carers the Alzheimer’s Society http://www.alzheimers.org.uk/ does wonderful work.

Indeed, NFR fully supports their recent campaign to make sure that those with the early stages of this dreadful condition get the latest and best medicines available. It is in the realms of bestial cruelty that patients should have to wait for their condition to get worse before they are entitled to have their medication – and thereby loose its full benefit and in time cost us all more.

As nurses, there is a professional onus on all of us to support the best available treatment and to attack any state body which actively seeks to deny access. This is precisely why elements of this recent campaign are to be welcomed.

Nevertheless, delighted that patients in the independent sector will surely continue to receive the best, NFR demands three things:

1. Social Engineering. NICE should immediately make open for all to see the formula by which it makes its decisions.
2. Transparency. NICE should no longer sit in private. Its meetings should be held in open with nothing less than the full glare of the media.
3. Responsibility. The government should actively encourage those patients and their loved ones who have the money to immediately make provision for these medicines.

I don’t often blow my own trumpet but on Tuesday I was awarded my PhD from Brunel University in West London. 

After five years work, the thesis – entitled Power, Politics and Coercion: Notions of Economic Failure in Healthcare Systems – was accepted has being a sound piece of work.

I hope to have it published soon and will keep you posted. At present, there are two publishers interested – one in the US and one in the UK – so I hope it will eventually see the light of day sometime in the spring of 2007.

Now, having read masses about health economics over the last five years, I strongly recommend this excellent and challenging paper by Brian Micklethwait – How and How Not to Demonopolise Medicine.  It is a thought provoking piece that makes for a great read.

Although I might have my PhD don’t worry, I am forever, truly and always a nurse first!

I seem to be getting more and more interested in the RCN website these days. On October 19^th a press release was posted lamenting the recruitment freeze and its negative impact on the recruitment of newly qualified nurses.

What a good and solid influence Beverley Malone is on British healthcare. However, I then read in the Health Services Journal of 9^th November that the RCN Head of Policy is expressing concern that senior nurses are being asked to return to ward duty in the interests of reducing Trust deficits. If I was still working in management in the NHS I would have been delighted to have been asked to return to the ‘engine room’ of healthcare, if for no other reason than to maintain my registration by performing some ‘return to practice’. I would have worried about making a fool of myself in front of all those brilliant youngsters however. But what a treat! Well done Pauline Tagg at University Hospitals of Leicester NHS Trust for deciding to temporarily demote yourself from Director of Nursing to Nursing Auxiliary to help her Trust’s finances out and to simultaneously provide some much-needed hands on care to patients – so making your Trust’s wards safer by increasing the nurse to patient ratio. Perhaps all Trusts will adopt this policy from now on and rotational ward duties for Directors of Nursing on their wards will become the norm. Out of the Boardroom onto the wards! Yet Mr Howard Caton howls:

‘This is the first time we have heard a nurse at Director level going back to hands on nursing but we have had a number of examples of senior nurses and specialists being asked to do the work of a band-five or band-six nurse.’

Has anyone heard of the word customer here? The NHS exists for its customers the patients, and if the ruddy Chief Executive is a trained nurse and can backfill on a ward he or she should do so in cases of extreme need. Get real Howard and join the classless society mate.

A lesson in economics might not be a bad thing for you either. Try starting with the supply and demand curve.

What about putting a freeze on a few administrative nursing posts in the interests of bringing a few newly qualified nurses in at staff nurse level, oops, sorry, I mean band six level. Now that would be revolution wouldn’t it? Or perhaps it would just be good management of the NHS.

Back in the 1950s, 60s and 70s many politicians and opinion formers around the world promised that state healthcare systems would provide a safety net to aid the poor and needy – and that they would do this in a high quality manner. In
Britain, politicians promised that the NHS would provide all medical, dental and nursing care and that its provision would be of the highest quality. Similarly, in 1977 the Italian government introduced a National Health Service that in its aspirations was similar to the British system.

Today however instead of delivering the best, these systems are firmly straying into the mediocre. As politicians seek to get themselves off the hooks of past promises so they are invariably invoking a wide range of cost containment measures with ever greater restrictions on the use of quality medicines topping their list of priorities.

It is in this context that a recent opinion editorial in the Washington Post is of profound interest. Written by
Alberto Mingardi of the Italian think tank, Istituto Bruno Leoni , and the Centre for the New Europe  in Brussels, he argues that the Italian experience with price controls on medicines should make the new Democratic leadership in the US hesitate when it comes to the repeal the non-interference clause of Medicare Part D. He concludes:

“By attempting to hold down drug prices, the Italian government has deprived its citizens of the best care without reducing health-care spending. And it has deprived the country of what could be a vibrant sector of the economy. In their rush to revamp
Medicare, U.S. policy leaders should be careful not to make the same mistake.”

No doubt, this op-ed is based on a presentation that Alberto gave at a Capitol Hill briefing organized by the Galen Institute, the Institute for Policy Innovation and the International Policy Network last September. You can watch the archived webcast of the conference at this link:

The published proceedings of the conference are available here: 

This report, Mind the Gap: Sustaining Improvements in the NHS Beyond 2006 , makes for a good read.

Aficionados of healthcare will recall that back in 2002 the British government announced plans for health spending to rise annually by 7.2 percent (in real terms) up to 2007-08. This means that by the next financial year the government will be spending some £110 billion pounds of taxpayers money on state health and social care.

Now, in detailing key NHS reforms between 1997 and 2006, the report not only goes on to analyze the likely progress and impact of further reforms between 2007 and 2015 but, crucially, it evaluates the need for significant financing reform after 2008.

In pointing out that people’s expectations of healthcare are continuing to outpace what the state can afford the overall conclusions makes for powerful reading. For it suggests that the NHS is heading towards a 10% funding shortfall by 2015 and that capital expenditure will be the first causality. It points to continuing cuts in number of staff, constraints on wage and salary levels, and even a return to the waiting list levels prior to the proactive involvement of the independent sector four or five years ago.

The good news is that it suggests that co-payments and a range of new private funding schemes might well be a way forward.