Playing politics?
Is medicine a career worth pursuing?
Not according to a poll conducted by Hospital doctor & Medix with 14,000 doctors responding. Two thirds say they wouldn’t recommend it.
More than half of the 14,000 doctors who responded said they felt morale at work was “poor” and in the case of junior doctors “terrible”.
Government reforms, targets and the central NHS computer system were all given as reasons for low morale. The catastrophic introduction of a new job applications system for junior doctors - the Medical Training Application Service - was also a cause.
The survey asked doctors if they agreed with Patricia Hewitt, the Health Secretary, when she said 2006 had been the best year for the NHS. Nearly 90 per cent disagreed.
One doctor told the survey: “As more hospitals try to balance books by sacking staff, the remaining staff are having to pick up the slack, resulting in more mistakes being made. Morale is at an all-time low and getting worse.”
Don’t look to hard for steps being taken to remedy the situation. After all, everything is hunky-dory according to the DoH.
A spokesman for the Department of Health said the Healthcare Commission’s latest NHS staff survey indicated that staff remained “generally satisfied”.
Is anything guaranteed to be more nauseating than the mindless drivel that passes for PR?
The problems with out-of-hours care continues to exercise minds at Pulse with the BBC reporting on a survey that shows 40% of PCT’s replacing doctors with nurses.
Pulse magazine found 19 out of 50 primary care organisations it surveyed had replaced doctors with cheaper alternatives in some areas.
The survey found another 10 organisations were considering cuts to the number of doctors they employed out-of-hours.
It found some organisations had cut doctor numbers by as much as 50%. Instead, they were increasingly relying on nurses, and emergency care practitioners, who are trained in paramedic skills, to provide the service.
Both the Times & the Telegraph report on the distribution of NHS funds with the claim that 85% of new NHS cash has gone to Labour voting areas.
Of every pound spent by the Government on building hospitals since 1997, 85p has been spent in Labour constituencies.
New figures show that constituencies held by Conservative and Liberal Democrat MPs have missed out on Labour’s hospital-building programme. Of 46 hospitals built by Labour since it came to power, 33 are in seats that are held by Labour MPs, Andrew Lansley, the Shadow Health Secretary, established through a question in Parliament.
Before the 2005 general election, when most of the decisions were made, 36 of the new hospitals were in seats held by Labour MPs, with only 8 being built in the constituencies of Conservative MPs.
The total capital value of the new hospitals is £4.1 billion, of which £3.5 billion (85p in every £1) has gone to Labour areas.
Yesterday the Government announced that it is to spend £50 million on community hospitals and super-surgeries. All but one of the ten schemes for new or refurbished community hospitals is in a Labour-held constituency. The exception is Hornsey, held by a Lib Dem.
Mr Lansley said: “Four in every five of Labour’s new hospitals have been built in the constituencies of their own MPs. Meanwhile, ministers are holding secret meetings with Labour Party officials to target up to 60 hospital cutbacks on the constituencies of Conservative and Lib Dem MPs.
“These figures confirm what we suspected when Patricia Hewitt went against the advice of health experts and ordered a hospital to be built in a Labour constituency in South London.
“Last year Patricia Hewitt launched a policy dictating that care should be provided at home and not in hospitals. Patients in Conservative and Lib Dem areas will be wondering why it is their hospitals that have to close, while patients in Labour areas benefit from virtually all the spending Labour is committing to new hospitals.â€
Labour holds 54 per cent of the constituencies in England, so the balance of spending is disproportionate.
There is however a rebuttal from the govt:
Andy Burnham, the health minister, angrily denied the claims and said that the needs of patients determined where hospitals were built.
“The Tories slashed capital spending in the early 1990s and left the fabric of the NHS in an appalling state, in many cases in the most deprived areas. Now they are having a go at us for putting things right.
“Over 100 major new hospital projects worth more than £10 billion have either already opened or have started construction since 1997 as we rectify years of under-investment.
“Patient need, not party politics, drives the building of new NHS hospitals. I would defend each and every single one of these schemes.”
Hospitals are falling down all over the country, so there is need for more than the 100 claimed. It is just a question of the geographical distribution of priorities & I don’t think anyone claimed that unnecessary hospitals were being built. So a masterly political reply?
The Department of Health denies any political interference. It says that bids for local hospitals come from local NHS, and are not dictated centrally by ministers. Patient need, not party politics, determines spending.
Labour also represents many disadvantaged areas, where the health needs are greater. Allocation of NHS resources is designed to reflect health needs, though it does so rather imprecisely. So spending heavily in Labour areas is evidence not of political interference but of need, ministers argue.
But while they may defend a preponderance of spending on acute hospitals in Labour areas simply on the ground that many big hospitals are located in cities — where Labour dominates — the same defence can hardly be used of community hospitals, which are more often found in rural areas.
In one sense though the areas that missed out can consider themselves lucky. £10 billion spent has become £50 billion to be paid out by the end of term under the PFI agreements that finance the bulk of the new schemes. Let us see how affordable the bills are in a few short years.
In an effort to repair the damage caused by the last week of stories repudiating her maternity policy, Patricia Hewitt writes in the Guardian today. Let’s see how her claims stack up.
Your article claims the NHS has “too few midwives to achieve even the basic levels of care for families” (Birth care promise is unattainable, April 7). This is untrue.
The UK remains one of the safest countries in the world in which to have a baby, and 80% of women are satisfied with the maternity care they receive. Of course, more needs to be done if we are going to deliver our manifesto commitment that, by the end of 2009, every woman will have choice over where she gives birth and what pain relief to use, supported by a named midwife throughout her pregnancy. That’s why last week we set out how, for the first time, women and their partners will be guaranteed this choice.
I am sorry but please specify which part of that statement you claim to be untrue. Can you provide the numbers to back it up? I would like to see the numbers of staff required to provide safe care as per RCOG / RCM norms & the actual numbers extant.
Your piece quoted selectively from research, suggesting that “more women want midwives they can trust than wish to be able to make choices about their care”. Of course mothers-to-be want doctors and midwives they trust. But we also know they want to be given a say over the care they receive. Women want a range of options - from consultant-led care in hospitals, to midwife-led units and home births - and their choice will depend on what’s best for them and their baby.
Not being disputed here. But do you disagree with the statement?
We know that more women would choose home births if the choice were available. Where the NHS locally employs enough midwives to support genuine choice, 10-12% of women choose a home birth compared with only 2-3% nationally. That’s a lot of women currently denied the option they would prefer.
See, the operative phrase is “where the NHS employs enough”. Diverting staff from inadequately resourced maternity units is of no benefit to anyone.
High-quality services that support genuine choice must not be the sole preserve of the articulate middle classes. That’s why tackling inequalities in maternity care is at the heart of our approach. We know that providing more ante- and post-natal services in the community, including through Sure Start and Children’s Centres, helps improve access to care - and outcomes such as low birth weight - among hard-to-reach communities.
Again, see above. Also please refer to the plans for reconfiguration of maternity services published by your department. Does the right to choose not apply to the larger number of women who prefer local safe hospital based obstetric care? We have just read of the proposed closure of local maternity units in Derbyshire & I am very familiar with the threat to obstetric services in my local area.
The article described a “chronic shortage of midwives” meaning that our “promise to offer all women a choice of … birth cannot be met”. We know we can’t deliver this vision unless we have the right type and number of staff. Huge progress has been made since Labour was elected - there have been almost 2,500 more midwives and 44% more students entering midwifery training since 1997, and an additional 1,000 midwives will be qualifying over the next few years. But in parts of the country more must, and will, be done, including creating more training places to encourage more midwives into the NHS, and supporting flexible working to keep them there. We also want to encourage those who have left the NHS to return. We know that many midwives prefer working in midwife-led units or supporting home births, so giving mothers-to-be to this choice will help make the NHS a more attractive place to work.
Refer to the comments from the midwife quoted in my previous comments on this subject.
Under Labour, the budget for maternity services has increased from £1bn to £1.7bn. As the chancellor announced in the budget, an additional £8bn is being invested in the NHS this year alone. Labour’s investment and reforms, and the hard work of NHS staff, will deliver the quality and choice of maternity care all mothers want, and deserve.
Even by your own reckoning, maternity services are not going to see much extra money. and most of the funding is going towards non-clinically prioritised “reforms”.
A large number of challenges to this letter on the Guardian’s comments section seem to disagree with you.
And from today’s HSJ:
Surveys by the HSJ and Nursing Times of more than 2,100 nurses, therapists and managers.
Seventy-three per cent of staff nurses and 76 per cent of therapists said they did not spend enough time caring directly for patients. A total of 89 per cent of nurses and 83 per cent of therapists said this was bad for patients.
Finally an IT solution that goes partway towards meeeting clinical needs.
Critical care consultant Dr Gary Smith explains: ‘VitalPAC is a system that uses handheld computers - PDAs and a local wireless network - for entering patient’s vital signs such as temperature, pulse, respiration and blood pressure. This information is charted and analysed along with blood tests and radiology results and can be viewed from any device that allows access to the hospital intranet.’
To complement the network, Portsmouth will need something like 200 PDAs - one for every four or five beds - plus a further 100 or so tablet PCs used at ward management level. On-call staff will carry personal devices, for example internet-connected mobile phones, while data to and from diagnostic services will be transmitted via workstations.
There are a few tricks they are missing & I was unable to get funding for a similar project way back in 2002 but maybe the time is now right.
And from the “department of stating the bleedin obvious” words that are good in theory but hardly ever implemented:
people closest to the frontline are often best placed to identify issues, work out the solutions and implement new ways of working.
Adaptive leadership distinguishes between leadership and authority. Adaptive leaders do without formal authority. Instead, they influence through engaging people and enlisting their support for powerful ideas. No-one gives them permission and they frequently go beyond the limits of their job description to do what is not authorised. There are potential risks for the person here - they might be perceived as rocking the boat.
I think I bear the scars to identify with the “rocking the boat” comment.