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Sanctioned for not being able to sign on on bank holiday Monday. Tears, frustration and rain.


The poor side of life

Today’s demo started rather hurriedly and to be honest I didn’t know if I was coming or going. This feeling was amplified because it was cold, rainy and my daughter was a bit fed up. understandable of course. But she soon settled down into our usual routine and all was well.

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We are seeing a lot of new faces due to Stalybridge Jobcentre shutting. They don’t know us and what we are doing, and we don’t know them or their situations either. So we have to start from scratch, which at times isn’t easy.  But it’s a whole lot harder for them.

I started a conversation with a man who had been previously attending Stalybridge Jobcentre for his appointments. The first thing that he said to me was that he couldn’t believe how rude the front desk staff are at  Ashton Jobcentre, and how rude some of the advisors are also…

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NHS waiting times: all change?


Original post from The King’s Fund

‘……………By James Thompson  Senior Research Analyst, Health Policy

With health policy announcements coming out almost daily both before and after the election, it’s time to take stock of where we are with NHS waiting times.

First: the good news. Since the turn of the year there have been improvements in performance across all targets, apart from diagnostics.

Percentage still waiting/having waited more than 18 weeks (more than six weeks for diagnostics)

Data source: Referral-to-treatment waiting times statistics www.england.nhs.uk

Diagnostic waiting times statistics www.england.nhs.uk

But, although performance has improved almost across the board, most if not all of this improvement reflects the usual upward swing at this time of year. We will need a month or two more to see if this is sustained.

The Secretary of State’s short-term policy fix of a ‘managed breach’ on waiting times – whereby performance targets were suspended so that hospitals could focus on treating the patients who had waited the longest without being penalised – ran from June 2014 to March 2015 (excluding December 2014).

So was the policy successful? On the one hand, more patients are now waiting longer to receive elective treatment in NHS hospitals than they have done for over a decade. On the other, this policy was not meant to benefit the majority; it was primarily aimed at those patients who had been waiting the longest. There is evidence that the policy has benefited patients who had already had long waits: an additional 25 per cent of admitted patients and 50 per cent of non-admitted patients (those who receive treatment as outpatients) who had waited more than 26 weeks for treatment (the proxy for a long wait) were treated between June 2014 and May 2015 compared to the same period the year before.

So, what are the latest developments?

First, in June, NHS Medical Director Sir Bruce Keogh advised that the referral-to-treatment targets were ‘confusing’ and had created perverse incentives by penalising hospitals for treating patients who had waited more than 18 weeks to begin treatment. He recommended abolishing two of the targets (the percentage of patients treated within 18 weeks as inpatients (the ‘admitted standard’) and as outpatients (the ‘non-admitted standard’)). This would make the percentage of patients still waiting for treatment the sole measure of referral-to-treatment performance.

NHS England accepted his recommendation, and a further one – that financial sanctions for breaching the still-waiting target should be increased. The aim is for the NHS to concentrate on treating all patients (including those who have already been waiting a long time) as quickly as possible.

Although now abolished from the official targets, hospitals are still required to continue gathering data on the admitted and non-admitted figures, so it will be interesting to see how these change over time. Though I agree that focusing on the total waiting time of the whole list is fairer than the previous somewhat contradictory three targets, my concern is that performance against the now defunct admitted and non-admitted targets will deteriorate. We will continue to monitor and publish these figures in our quarterly monitoring reports.

We do need to remember that a well-resourced NHS with a well-managed waiting list and effective planning of hospital services, should be able to manage the waiting list and achieve all three referral-to-treatment targets. The NHS managed to do this between April 2012 and January 2014, but has only done so in two individual months since then.

The other unknown is how long the total waiting list will get to this year. At 3.17 million in May 2015, a figure that rises to 3.4 million when factoring in hospitals that have not reported their numbers, the waiting list looks to be at its longest since February 2008. Ultimately any waiting time target will struggle if the number of people waiting rises relative to our ability to treat them.

In addition, an announcement in June 2015 from NHS England, the NHS Trust Development Authority and Monitor said that non-reporting should only happen in ‘the most exceptional circumstances’ and they are developing an open and honest process to re-start reporting as quickly as possible. If this happens, the size of the recorded waiting list is sure to increase further still.

So it’s a new age for elective waiting times, with a change in how we measure them and how providers are held to account. But there is also lots of uncertainty: how long will the waiting list grow this year? What will happen to performance against the measures that have been dropped? Will all providers who are failing to report waiting times data start reporting? It will be interesting to see what’s next for NHS waiting times – we’ll be following developments and letting you know what we find.

Too much too soon? What should we be teaching four-year-olds


Original post from The Conversation 

‘……………..By Courtenay NorburyProfessor, Department of Psychology at Royal Holloway and Debbie GoochPostdoctoral Research Assistant at Royal Holloway

Maybe not so smiley on the second day of school. First day of school by gorillaimages/www.shutterstock.com
Maybe not so smiley on the second day of school. First day of school by gorillaimages/www.shutterstock.com

The first day of school is a momentous event in the life of a child. For many it is a day filled with pride and excitement. For others it is more stressful; they may cling to their parents, unused to being parted for so long.

In England, these extremes of experience are particularly marked because of the very young age at which children start formal schooling. Children begin school in the year in which they turn five, meaning that many children start school shortly after their fourth birthdays. England is unusual in this regard; in 31 out of 37 European countries children do not start formal education until they are at least six.

The age at which children start school may not matter as much as what happens to them once they get to the classroom. Given our backgrounds in developmental psychology and speech-language therapy, we think the current targets set for children in their first year at school are not developmentally appropriate. Our research published in the Journal of Child Psychology and Psychiatry demonstrates that the youngest children in the class find these targets particularly challenging.

England has a curriculum for Early Years Foundation Stage, which outlines developmental goals from birth to five years old. This includes three prime areas of learning such as personal, social and emotional development; physical development; communication and language; as well as specific areas of learning such as maths and literacy.

In 2012, the New Early Years Foundation Stage Profile was introduced, to document attainment at the end of the early years curriculum. The profile is completed by the teacher at the end of the first year in school, and children are assessed on the extent to which they meet or exceed expected progress on 12 key targets across these areas of learning. Those making expected progress are deemed to have achieved a “good level of development”. Here are a few of the key targets:

  1. Understanding: children follow instructions involving several ideas or actions. They answer “how” and “why” questions about their experiences and in response to stories or events.
  2. Health and self-care: children know the importance for good health of physical exercise, and a healthy diet, and talk about ways to keep healthy and safe.
  3. Writing: They write simple sentences which can be read by themselves and others. Some words are spelt correctly and others are phonetically plausible.
  4. Numbers: children count reliably with numbers from one to 20, place them in order and say which number is one more or one less than a given number. They solve problems, including doubling, halving and sharing.
Up to 20 by five years old. Child counting via PhotoUG/www.shutterstock.com
Up to 20 by five years old. Child counting via PhotoUG/www.shutterstock.com

Government statistics confirm a 22% attainment gap between the oldest and the youngest children in the reception year. It is therefore not surprising that there have been calls to adjust the assessments at the end of the reception year for age, so that at least on paper, younger children are not disadvantaged.

Half of all children don’t meet the targets

But our study highlights a much bigger issue. We sampled more than 7,000 children in mainstream reception classrooms in Surrey, a relatively affluent county in south-east England. Across this population, only 57% of children achieved a “good level of development”, comparable to national estimates of 52%. If half the children in the country can’t meet the targets, we argue that perhaps the targets are wrong.

Yet age is not the only, or even the most important, factor in predicting academic success in the reception year. In our study, there were other things that contributed to poorer academic progress: being a boy, living in more impoverished neighbourhoods, speaking more than one language, and displaying more behavioural difficulties.

However, oral language – such as vocabulary, grammar and story-telling skills – was the most important predictor of progress on curriculum targets. This is because the curriculum requires children to listen, comprehend, explain themselves and use words to solve problems. In our study, twice as many younger children were reported to have poor language skills at school entry, relative to their oldest peers. And fewer than 5% children with low language proficiency achieved a good level of development on the Early Years Foundation Stage Profile.

Years of research has also told us that language is the foundation for literacy. Children arriving at school with lower levels of oral language proficiency, for whatever reason, are therefore at a distinct disadvantage for learning.

Don’t set children up for failure

We suggest that focusing the first reception year on developing children’s oral language abilities may help to attenuate the attainment gaps experienced by younger children. It is also possible that a focus on oral language will narrow the gap for children from impoverished communities and those who are learning English as an additional language. We predict that ensuring a good foundation in oral language will also improve reading and writing in later school years, even for the oldest children in the class.

Literacy targets, particularly writing, have been introduced at ever younger ages in an effort to improve standards, but we fear this may do more harm than good. Asking children to engage in tasks that are developmentally out of their reach increases frustration and experience of failure. Many of the children that we have followed up over time tell us at the tender age of six, that they “aren’t good at reading” or they “can’t do writing.” This is a tragedy.

We need to develop children’s oral language skills early and leave formal classroom instruction until children have the foundation skills they need to achieve. This should raise the attainments, and esteem, of all children.  …………’

 

What’s behind the A&E ‘crisis’?


Press release from Nuffield Trust                                              The Report  What’s behind the A&E ‘crisis’?

‘…‘Disproportionate’ emphasis on A&E target not in patients’ interest, say Nuffield Trust

06 March 2015

A briefing examining the real reasons behind England’s A&E ‘crisis’ has warned that the emphasis on the totemic target of deciding on whether to admit patients within four hours has become disproportionate. It argues that new approaches to performance management, with other measures given equal status to the four-hour target, should be adopted.

England’s A&E system is near crisis. With the financial squeeze set to continue, there is no relief in sight if we keep up the current approach. We need to rethink our assumptions as many of the ‘magic bullet’ solutions suggested miss the point. It’s not about more people turning up, but about a system with a squeeze on hospital space and staff, which needs to get better at discharging people safely and on time.

Nigel Edwards, Nuffield Trust Chief Executive and report author

In the briefing aimed at political leaders as the General Election approaches, the Nuffield Trust think tank says that measuring the performance of A&E departments is essential. But how we react to changes against the four-hour target can distort behaviours inside hospitals in ways that are not in the interests of patients or staff. This, the think tank says, can mean that significant amount of staff time is spent reporting upwards to commissioners and regulators, with potentially detrimental impacts on the quality of care.

The briefing argues that policymakers should instead take a longer-term and broader view of performance in A&E, which may involve relegating the four-hour target to sit alongside a richer set of indicators. These could include the number of people leaving A&E without being seen or how long people wait on trolleys after the decision to admit them to hospital. Such an approach was announced by the then urgent care tsar Matthew Cooke in 2010 but has not been realised.

‘What’s behind the A&E “crisis”?’ describes how emergency departments are near “breaking point”. It presents data showing that major A&Es have not met the four-hour target (that 95 percent of patients should be admitted to hospital or sent home within four hours of arrival) since 2013; the number of patients waiting on trolleys for over four hours has almost trebled since 2010/11; and the numbers of delayed ambulance handovers have risen by 70 per cent over the same period. Yet other measures, such as waiting times to treatment and re-attendances within seven days have changed little.

The authors argue that the cause of the pressures has been misunderstood, with too much focus on the 2004 GP contract, NHS 111 and the gradual increase in numbers of people attending emergency departments. They show that long-term trends and immediate causes are often confused, suggesting that the recent problems are driven by an inability to discharge hospital in-patients quickly and safely enough to keep A&E patients flowing through hospitals.

Nigel Edwards, Chief Executive at the Nuffield Trust, said:

“England’s A&E system is near crisis. With the financial squeeze set to continue, there is no relief in sight if we keep up the current approach. We need to rethink our assumptions as many of the ‘magic bullet’ solutions suggested miss the point. It’s not about more people turning up, but about a system with a squeeze on hospital space and staff, which needs to get better at discharging people safely and on time. That doesn’t negate the need to for bold strategic re-design to ensure the urgent care system is fit for the long-term.

“The four hour target has come to loom over every other measure of how well patients with urgent needs are being cared for. Nobody denies that it really matters to people. But there are a lot of other things that matter in emergency healthcare. Politicians and regulators need to stop micro-managing this target and should instead examine how to put the four-hour target on an equal footing with other critical indicators like trolley waits or time to treatment. This could be achieved by introducing clustered randomised controlled trials of such indicators in some areas.” 

Commenting on the briefing, Professor Matthew Cooke, former urgent care tsar said:
“I wholeheartedly agree with the Nuffield Trust that overfocus on the four-hour target does not improve emergency care and may lead to perverse actions to hit the target whilst missing the point. The wider set of indicators I introduced when I was National Clinical Director were aimed to prevent this over focus and create a balanced set of quality measures. But the intense performance management of the four hour target has negated the impact of the balanced set of measures. Concentrating on the whole system and measuring quality across that whole system is, in my opinion, the way forward.” ….’

Love ’em or loathe ’em, NHS targets are here to stay


Original post from The Health Foundation

An extract

‘………..Discussion of the forthcoming UK general election is dominated by military language: battle lines have been drawn, salvoes have been fired, skirmishes are underway. So it seems appropriate to suggest that the political arms race over the NHS has now well and truly begun.

The campaign promises on the NHS we’ve heard so far – and doubtless also the promises we’ll hear between now and 7 May – essentially split into two categories. First are commitments about resources, ie pledges to either provide additional funding or make existing budgets go further by cutting perceived waste (NHS managers will be wearily familiar with this terrain). Second are commitments about setting priorities for how the NHS will use those resources, such as extending GP opening hours, speeding up cancer diagnostics, improving access to mental health services, and so on.

The basic purpose of that second set of commitments is essentially to convince the public that the political party making them has the right plan for the NHS. But recent polling suggests only 16% of the public generally trust the political class to tell the truth, whereas 90% of people trust doctors to do likewise. So why do politicians continue to compete over who has the right priorities for the NHS, if the public doesn’t really trust any of them? ………….’

We shouldn’t just blame sheer weight of traffic for NHS queues this winter


Glen Burley

by Glen Burley      This post is from the blog of The Health Foundation        The Original Post

‘I was in Manchester last weekend and drove back on the M6. As we approached the Cheshire/Staffordshire border the traffic slowed down and stopped. We then crawled slowly for what seemed like ages and then, near to the Stafford, exit there it was: an insignificant little car being loaded onto the back of a recovery vehicle. ‘Was that all it was?’ was the cry from my 10 year old. And of course, that’s all it was.

Whilst it is tempting to just blame sheer weight of traffic, often it is something simple downstream which holds everything up, increases the risk of more accidents and makes everyone stressed.

We know all about queues in the NHS. Our trust has suffered more than most in the past and as a consequence we volunteered for the Flow, Cost, Quality programme. I won’t go over all of the learning, you can find that in the programme learning report, but I was asked to provide an update and a reflection, now 18 months on from when we implemented some of the most significant changes.

Remarkably things are all still going very well in our system, but part of the reason for that is that we haven’t rested on our laurels. One of the key learning points from the programme was that you have to know your systems – all of the solutions in the world won’t help you if you don’t have the right capacity. So we keep changing as the environment does.

In terms of KPIs we have moved from one of the worst performers on the four hour target to one of the best. We have met the target in all but two months since the summer of 2013 and are still managing to hold above 95% this year, despite the system-wide pressure. Our mortality has moved from above average to below average. The newly published A&E patient survey has moved us from average to being in the top 10 ‘most liked’ and our clinicians are doing what they trained to do, and liking it. We have just looked back on our capacity plans from three years ago and realised that we have more activity but with the equivalent of 40 less beds. As a consequence we are still delivering a small surplus, even though we have seen no rebasing of our emergency tariff and hence get paid less than most trusts for the work.

So it is all quite remarkable really. Whenever I am asked to talk about what we did I try to emphasise a few key messages.

Firstly, this kind of whole system change takes time. You need to understand your system and solve the blockages in it with the right solutions, in the right volume and they take time to bed in. Like the motorway, the solution can be quite simple, but it is often not where it first appears to be.

Secondly, you need to co-produce solutions with clinicians who bring ideas and enthusiasm to implement.

Thirdly it is a continuous challenge; you need to make sure that every part of the system understands their demand and their capacity and that they routinely monitor it – they will always find that the demand is much less variable than the capacity.

We of course have bad days, like all systems do, and we can safely say that we are under significant ‘winter pressures’ at the moment in our trust. Bad days in the NHS cause queues, not quite stretching from one county to another like the M6. However sometimes it feels like it!

The problem is not so much with periods like this, where we are seeing significant peaks in demand, but with many of the other weeks in the year when activity was lower but nonetheless many systems were not flowing as effectively as they should.

But the headroom from the good days means that you don’t panic. When the system gets blocked we now look internally for an explanation – a problem with medical cover on a ward, a slow-down in a diagnostic department – rather than either blaming someone else or using the ‘sheer weight of traffic’ argument.

However, most importantly, we have learned that the whole system needs to flow. We run hospital and community services and it was the hard work of our community staff, the way they became more responsive, which was the final piece of a rather complicated jigsaw.

The other message from me I know some people won’t like. Some people feel that the A&E target is divisive. But I really do think that it matters. We know that it is more of a measure of flow in the whole system than simply a measure of how well A&E is performing. We have also proven that patient experience and, more crucially patient safety, are compromised when the four hour target isn’t being met. So I would urge this not to be dismissed.

Of course the reason why some people don’t like the target is that it has become a stick to beat people with and has created a focus on explaining yesterday’s performance rather than spending time getting things right for the future. So I do have tremendous sympathy for those under intense scrutiny on this as it can be debilitating. Conference calls and escalation meetings don’t solve flow problems. Someone has to have the time to look ahead, solve the problem and drive that recovery vehicle down the hard shoulder!

This blog is an updated version of an article published in the Health Service Journal, 8 January 2015.

Glen is Chief Executive of South Warwickshire NHS Foundation Trust.

Find out more

Read more thoughts, tips and resources about improving patient flow on our Winter Pressures spotlight page

NHS; Is it fit for Purpose?


NHS Scandal

Why has the caring stopped?

Over the last few months many problems with the NHS have become known, so therefore, are we now saying the NHS is not fit for purpose?  I believe there are some of us are saying YES, while others are saying NO and even others who are not sure. So lets try to find some answers. The NHS was created in 1948 and since that time has undergone many changes, some because the NHS wished to, some due to advances in technology and medical science and some inflicted upon it by successive governments.  But during all this time the fundamental principles of the NHS have not been changed. When created it was to be ‘free at point of delivery for all citizens of the UK’. This in most cases is still correct. So why are all these problems occurring? Lets start at its beginning.

  1. Every UK citizen was entitled to signup with a local general doctor, known as a General Practitioner (GP), it may have been the same doctor to whom they went to when ill in the past, but then they would have had to pay the doctor directly for this service.
  2. The NHS was born out of a long-held ideal that good healthcare should be available to all, regardless of wealth. At its launch by the then minister of health, Aneurin Bevan, on 5 July 1948, it had at its heart three core principles:
    • That it meet the needs of everyone
    • That it be free at the point of delivery
    • That it be based on clinical need, not ability to pay
  3. These three principles have guided the development of the NHS over more than half a century and remain. However, in July 2000, a full-scale modernisation programme was launched and new principles added.

    The main aims of the additional principles are that the NHS will:

    • Provide a comprehensive range of services
    • Shape its services around the needs and preferences of individual patients, their families and their carers
    • Respond to the different needs of different populations
    • Work continuously to improve the quality of services and to minimize errors
    • Support and value its staff
    • Use public funds for healthcare devoted solely to NHS patients
    • Work with others to ensure a seamless service for patients
    • Help to keep people healthy and work to reduce health inequalities
    • Respect the confidentiality of individual patients and provide open access to information about services, treatment and performance

Since then there have been the setting of targets by successive governments.

I do believe in having targets, but wish to call them standards. We have always had standards to maintain in the NHS, but these days in trying to run the hospitals as a business, finance as become the main factor instead of care. Before all else, care has to be the first priority.When the NHS was created in 1948, it was not envisaged that the population would increase in great numbers and that medical science would advance so quickly in both technology and treatments. To cater for this, our hospitals have had to increase in size to cope and this as left management abilities to flounder. We need to maintain standards, but not by tick boxes, use the technology in administration practices that have been created. All records are computerised, so all relevant information should be to hand from the computers, no additional staff in put required. Proper supervision of all staff needs to be reintroduced and all work as one team and that is to the betterment of care to the patient.

When the NHS is working well it can not be bettered and unfortunately, this is not deemed news worthy by the media. But many aspects of hospital care are wanting and an investigation should not just look at the present, but look to the past to see when this change for the worse occurred. Was it Government targets being introduced, withdrawal of Matrons, Sisters or charge nurses becoming more hands on, instead of managing the ward, the replacement of cottage hospitals with the large hospitals of today, aging population, emphasis on academic  nursing qualifications instead of the ability to care, influx of staff where English is not first language and understanding it is limited, changing from larger open wards to smaller units within the ward, increasing in technology and medical conditions, hospitals run as a business instead of a caring facility. The list is endless, just what is the answer, this has to be known before steps can be taken to improve them.

Alarm bells should be ringing, the NHS is provided with money from Government, from money raised from UK taxpayers, to be used to provided care for patients. Why is some of this money being used to gag people from letting the UK public know the truth.For one thing no one should be gagged for telling the truth, if the NHS is not fit for purpose then the public need to know.

What all employees in the NHS should realise is that by the source of the money for their salaries in coming from the public, it is the public who are effectively their employers, it is just that it has been sub-contracted to the Government and the NHS.

Image or Care, What is of most concern to the NHS?

It should be care, but who knows when you follow the current articles in the UK press.

How many More?

It makes you wonder how many other gagging orders are in operation and what is still left to be uncovered.

So it is not only Sir David Nicholson who is a fraud, but also his right hand , Dame Barbara Hakin. You will see both these persons have received Royal Honours, but for what, in these two it would appear to be for incompetence and lack of professionalism. If the people at the top of the NHS are not fit for purpose, what hope is there for the NHS. A clean sweep needs to be undertaken and this should start at the top and go as far down as possible until we find those who are fit for purpose. Hopefully there will be some.

It is time that every aspect of the NHS is given a full audit and every detail investigated. If staff are not up to the job, then they must go, but the facilities have to remain open. If the staff are not up to the job, then get staff who are, there would appear to be plenty qualified staff ready and waiting to be employed.

As I have said when the NHS is working well, it is excellent, as I have seen myself, by the care afforded to my own family from all aspects of the health service in Sheffield.

The creation of the National Health Service 1948 was a magnificent achievement, unfortunately, without the aid of a crystal ball, the founders could not have envisaged so much would be happening in the UK in so short a time. As stated successive previous governments have created target to be achieved and certainly at Stafford Hospital this is one reason for its failings. As it was concentrating to much on attaining these targets than maintaining its primary function of providing good quality care for its patients. Unfortunately, I believe more hospitals will have been found to fail for similar reasons as time goes on. Then as to gagging orders and payments made to gag NHS officials to stop then advising what is happening, how can this have been allowed to happen.  Not only is this diverting money needed for providing the care function, it is also being dishonest with the public, who are all contributing to the cost provided by them by paying their taxes.

Anyone responsible for misleading in this way should not be employed, certainly not within the NHS, more likely should be doing time in prison for, hopefully, what should be a criminal act.

The NHS should be fit for purpose and where this is not currently so, every effort needs to be made to make sure that it is. The NHS can not be left to fail, as it is an integral part of the UK and one that we should be proud of. All within the NHS need to work as a team, as no one individual can work without the support of the others.

Hopefully, in the very near future, we can all say that it is.

Nicholson still holding on to office

Nicholson should go and go now and so should any others of the same ilk. His right hand woman, Dame Barbara Hakin for a start.

To remove Sir David Nicholson sign the E-petition

The Blame Game

The NHS is safe in whose hands, all parties are to blame for the current situation, maybe some parties more than others.
But, surely, now is the time for unity to ensure all can be done to save the NHS where it is failing.

The NHS is an intergral part of the UK and can not be allowed to fail in any shape or form. Many of the problems have been successive government interference in creating bureaucracy to administer systems to keep to, what may have been welcome targets. But if an organisation is only concentrating in maintaining its operation into achieving certain targets, this could and most likely as, caused other non-targeted area to suffer. When you have an organisation based on care, no one area can be concentrated on, with the exclusion of some others. The management have to oversee the whole operation not selected parts.

It is for the reason to save the NHS, that all parties, be they in Government, opposition, NHS or any other areas, should work together for the common good for all in the UK

What the NHS needs?


A dose of kindness

While the NHS will always need money, that is not the primary requirement, but is an important requirement.

The NHS is fundamental in the delivery of CARE. So CARE is the primary requirement and when the NHS was created everyone employed, especially the nurses, main wish was to provide care to their patients. It was viewed as a vocation, not just a job.

During the economic expansion in the UK during the 50’s and 60’s, immigration was encouraged to ensure job vacancies were filled. In fact if it was not for the immigration many areas including the NHS would not have been able to continue.  The people recruited to the NHS had what was required, the compassion for the job, not necessarily educational qualifications. The training could be provided on the job. This ensured the excellence of the NHS was maintained.

But with extensive Government intervention over the last 30 years, the NHS has concentrated too much on chasing targets and not sufficient in maintaining patient care.

Also when the NHS was created the degree of care was, while very good, was limited to the available knowledge of that period in relation to the health conditions of the patients, the health practices available and there were hardly any expensive drugs. The level of immigration was minimal and foreign travel to exotic locations was hardly heard of outside the ruling classes and the intrepid explorers. Today the range of medical conditions which patients may be suffering from have increased considerably. With the advancement of medical science, not only are people living longer, but people who would have died at birth or soon after are surviving into relative older age, with many having varying disabilities. Our hospitals are no longer small cottage hospitals, but are extremely large, with many specialising in certain conditions. There is now extensive foreign travel by a large section of the population to exotic places.

Due to the extensive increase in size of our hospitals, the management structure as had to be changed. Whereas previously the cottage hospital was run by a Matron, now no one person can undertake sole direct charge.  Matron could look at all aspects of the running of the hospital and maintain day-to-day control. She would immediately notice if all was not progressing to her satisfaction.  Also there would not have been any noticeable financial constraints. Hardly any of the health measures, treatments and operations would have been very costly.

Today there are masses of managers each undertaking responsibility for their own area of operation and do not always take into account  other related areas when making decisions.

Due to the targets culture, while these managers are consumed in endeavouring to reach and maintain these targets, other areas of operation, where there are no targets, are left to progress, or not, on their own to some extent.

Many say, bring back Matrons, which they have in some instances, but these Matrons are not the Matrons of old, their areas of control are limited and there will be a few Matrons in the hospital, where previously there would have been only one.

It is said there is a shortage of nurses in the UK and moves are being undertook to recruit from abroad. But how can this be when some UK nurses are likely to be made redundant due to cash restraints in the NHS.

So what is the answer?

Ensuring all staff give ‘a dose of kindness’ would be a start, but it is not the total solution. Effective management would be another and an end to continued Government intervention would be another.

What would also help would be a major change to the working culture of the UK. Today how many take pride in their job, ensuring they perform to their best ability and adhere to getting it right the first time.

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