Category Archives: Nursing

20/03/2020

 

OPEN LETTER TO THE PRIME MINISTER FROM THE SOCIALIST HEALTH ASSOCIATION

Dear Mr Johnson,

The pandemic has exposed the steady destruction of our public services and welfare state which has happened over the last 10 years.

This is the most unprecedented health challenge in 100 years which is complex and difficult – but as voiced by many experts in the field, we have significant concerns about the way the UK government has hitherto been approaching this national emergency. We hope from now on this will be better co-ordinated. We support frontline staff at this worrying time.

However the public is finally waking up to the fact that, as a result of government austerity and privatisation policies, we are ill-prepared – with too few ICU facilities, NHS beds, healthcare staff and equipment – to offer a safe and effective response to the virus. Those most at risk also have to use a threadbare social care system which is already bending under the strain.

The UK should be in a relatively strong position on public health with a comprehensive service, considered one of the best in the world. However, Tory reforms in England destroyed the health authority structure below national level and has slashed budgets but at least Public Health England has a regional organisation and Local Government have Directors of Public Health. We wish to make some key points:

  1. You are placing staff at risk

There is not enough personal protective equipment (PPE) for clinicians/frontline staff who are now personally at risk every time they go to into work.

There is insufficient testing of staff who, having been put off work with minor illness and then return to the front line, do not know whether they have had the virus or not.

  1. You are placing patients at risk

There are too few beds and too few trained intensive care staff and equipment such as respirators. The government appears to have acted too late. We should be requisitioning beds from the private sector, not paying them £2.4 million a day.

Covid-19 testing has been wholly inadequate. It appears that a combination of inadequate preparation and misguided policy is responsible.

  1. You are placing communities at risk

Undocumented people, for instance migrants and refugees, have long felt unable to use the NHS for fear of being referred to the police or the Home Office. This will increase risk. Legislate on charging and reporting undocumented migrants must at least be suspended.

Those precariously employed, particularly gig economy workers, are still not financially protected and may be compelled to continue working inadvertently spreading infection.

Thousands of excess deaths have occurred in the last few years as a result of the slowdown and reversal in life expectancy. Austerity policies have been a significant cause. It confirms international evidence that cutting the welfare state while at the same time introducing austerity, kills people.

This pandemic is likely to add to that grotesque toll.

  1. You are placing the NHS at risk

Government policy has split hospitals from general practices and from each other. It has created an industrial approach to care where staff and patients are increasingly seen as economic units. The newest redisorganisation has opened up the English NHS planning process to the private sector and to the US, especially if we have a trade deal. In addition, it has the potential to split the English NHS into 44 independent units – exactly what we do not want as we fight a global pandemic. If your government’s Long-Term Plan had already been fully implemented doing exactly that, we would not have been capable of a well-coordinated national response to the Covid-19 crisis.

  1. You are placing Social Care at risk

Too little funding for Local Authorities has put social care on life support. Those most at risk receiving personal or residential care appear to receive the least advice and the least support to combat the virus. Those with Direct Payments, organising their own care with Local Authority funding, appear to be entirely on their own if their carers get ill.

  1. You are placing democracy at risk

The most recent reorganisation of the NHS has made both formal and informal democracy more difficult. Just when we need all communities to collaborate and contribute to responding to this global challenge, NHS organisations have become more distant and poorly responsive.

It has been frustrating and confusing to have changing government advice without any formal presentation of the data and evidence behind it. It was patronising and did not inspire confidence.

 

WE EXPECT YOUR GOVERNMENT TO:

  • Treat us like adults – show us the evidence on which you base your decisions
  • Protect frontline staff right now with clinically appropriate protective gear and systematic testing. Bring testing in line with the WHO recommendations.
  • Protect the population of the UK by permanently increasing NHS staff in hospitals and primary care, increasing hospital beds, increasing respirators.
  • Roll back privatisation and austerity across public services.
  • Seize the opportunity of this pandemic to invest for the long-term in the welfare state, recognising that a thriving society requires a thriving state.
  • Suspend now legislation on the charging and reporting of undocumented migrants.
  • Invest permanently in social care, making it free at the point of use, fully funded through progressive taxation, promoting independence for all and delivered by a workforce with appropriate training, career structure, pay and conditions.
  • Protect those in precarious employment from financial meltdown from the pandemic. All those who should not be at work should have an living income.
  • Ensure that people across the UK have equitable access to the help they need, through their Devolved Administrations
  • Review the Long Term Plan

 

Faced with this international emergency, we need to combine medical expertise – including support from abroad, with technical investment with practical solutions and community engagement along with emergency economic measures to fight this together.

 

Chair SHA

Dr Brian Fisher, London

Vice-chairs SHA

Dr Tony Jewell

Tony Beddow, Swansea

Norma Dudley, London

Mark Ladbrooke, Oxford

Secretary

Jean Hardiman Smith, Ellesmere Port

Treasurer

Irene Leonard, Liverpool

Co-Chair KONP

Dr Tony O’Sullivan, London

 

Co-signatories

Dr John Carlisle, Sheffield.

Terry Day, London

Carol Ackroyd, London

Corrie Louise Lowry, Wirral

Caroline Bedale, Oldham

Hazel Brodie, Dumfries

David Taylor-Gooby, Newcastle

Peter Mayer, Birmingham

Dr Alex Scott-Samuel, Liverpool

Dr Jane Roberts, London

Dr Judith Varley, Birkenhead

Vivien Giladi, London

John Lipetz, London

Jane Jones, Abergavenny

Dr Kathrin Thomas, Llandudno

Dr Louise Irvine, London

Dr Jacky Davis, London

Dr Coral Jones, London

Dr Nick Mann, London

Dr John Puntis, Leeds

Brian Gibbons, Swansea

Anya Cook, Newcastle,

Alison E. Scouller, Cardiff

Punita Goodfellow, Newcastle upon Tyne

Parbinder Kaur, Smethwick

Gurinder Singh Josan CBE,  Sandwell

Jos Bell, London.

Steve Fairfax Chair SHA NE, Newcastle upon Tyne

 

The Socialist Health Association is a policy and campaigning campaigning membership organisation. We promote health and well-being and the eradication of inequalities through the application of socialist principles to society and government. We believe that these objectives can best be achieved through collective rather than individual action.

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Unite, which has 100,000 members in the health service, strongly supports the call for retired nurses, those who have left the register and students in the last stages of their undergraduate training to volunteer for the fight against the coronavirus.
The Nursing and Midwifery Council (NMC), chief nursing officers of the four UK countries, and the Council of Deans of Health as well as health trade unions issued the call today (Thursday 19 March).
The two key requests are for:
  • Nurses and midwives who had left the profession in the last three years to join the Nursing and Midwifery Council (NMC) Covid-19 temporary emergency register so they can return to practice
  • For students in the final six months of their undergraduate course to work under supervision in hospitals wards and other parts of the NHS.
Unite lead officer for regulation Jane Beach said: “We are facing the worst public health emergency in the UK since the ‘Spanish’ flu at the end of the First World War. This is the supreme public health battle of our generation.
“Unprecedented events demand flexible and rapid responses, that’s why we are strongly supporting this call by the chief nursing officers of the four UK countries, the NMC and the health trade unions.
“We know that making changes to the way student nurses are educated in the last few months is an extreme measure, but we believe it is commensurate with the challenge we, as a society, face and so is the right thing to do.
“We thank our student nurse members for their feedback, which has informed our response to the discussions.
“We will be communicating with our members who have recently retired or left nursing to encourage them to consider coming back to help out during this national emergency.
“It is important to stress that for all, this is a choice. The detail will be in the guidance and we will continue to be involved in the development of this and in monitoring the implementation.”
The NMC has published the attached final joint statements and they are linked to its website which can accessed here www.nmc.org.uk/covid19
For more information please contact Unite senior communications officer Shaun Noble on 020 3371 2060. Unite press office is on:  020 3371 2065
Twitter: @unitetheunion Facebook: unitetheunion1 Web: unitetheunion.org
Unite is Britain and Ireland’s largest union with members working across all sectors of the economy. The general secretary is Len McCluskey.

 

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Our response to Government guidance on COVID and self-isolation
Our Senior Legal Officer, Katie Wood, has compiled initial guidance on COVID and pregnant women’s rights at work in light of the Government guidance. It covers health and safety, working from home, sick pay, maternity leave and pay, dismissal and redundancy. Please read and share the blog.We have written to the Chancellor of the Exchequer, the Rt Hon Rishi Sunak MP, about the Government guidance on social distancing and vulnerable adults, including pregnant women. The guidance to self-isolate has clear implications for the income of pregnant women in the workforce during their pregnancy and maternity leave, and for retention of their job. We urge ministers to make a clear public statement that the dismissal of a pregnant woman simply for self-isolating, in line with the Government’s advice, would amount to unlawful pregnancy discrimination. See our letter here and help us share it and demand immediate response from the Government.We are preparing a list of FAQs on COVID, maternity and employment rights. We shall release it as soon as it is ready. Please check our website for regular updates.

 

Our advice lines are open
We provide free legal advice on maternity and employment rights to pregnant women and new parents and will carry on throughout this crisis. Please note that receive a huge number of calls under normal circumstances, we are experiencing a spike at the moment. Please check our information sheets first, they cover a comprehensive range of questions.Our National Maternity Rights Advice Line is 0808 802 0029. It is open all weekdays from 10 am to 1 pm for all callers who live outside London.For London residents, please call our London Maternity Rights Advice Line 0808 802 0057, open all weekdays except Wednesdays from 10 am to 1 pm.For those with questions about NHS charging for maternity care, our Maternity Care Access Advice Service is 0808 800 0041, open Tuesdays, Wednesdays and Fridays 10 am to 12 noon.

Please share this information with your networks and direct your contacts to the right advice line number. If you are unable to get through, please be patient. This is an unprecendented situation and we have limited capacity. We are doing our best and we shall deal with all the calls we can handle.

Posted by Jean Smith on behalf of Maternity Action.

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COVID-19 Pandemic

The SHA wants to contribute to the tremendous national and international debate about controlling and mitigating the worst effects of the COVID-19 pandemic. We will base these thoughts through the lens of a socialist society, which advocated politically in the 1930s to create the NHS in the UK and for other socialist policies, which see the social determinants of health being as important as the provision of health and social care services as we strive for a healthier and fairer society.

This blog will be the first of a series and will cover

 

  1. A global crisis
  2. The Public Health system
  3. The NHS, Local Government and Social Care
  4. Funding for staff and facilities
  5. Staff training, welfare and support
  6. Vulnerable populations
  7. Assuring Universal Basic Income

 

  1. A global crisis

This COVID-19 pandemic has already been cited as the greatest public health crisis for at least a generation. The HIV/AIDS pandemic starting in the 1980s had a much slower spread between countries and is estimated to have caused an estimated 25-30m excess deaths so far.  The potential scale of this type of respiratory viral infection pandemic with a faster spread means we should probably look back to the 1957 Asian flu pandemic and indeed the 1918 post war ‘Spanish flu’. The 1918 pandemic led to an estimated 40-50m global deaths and was when there was also no effective vaccine or treatment for the new variant of flu. So basic public health hygiene (hand washing), identifying cases and quarantining (self isolation) are still important. We recognise this as a global challenge, which requires global solidarity and the sharing of knowledge/expertise and advice.

The WHO, which is part of the United Nations, needs our support and is performing a very beneficial role.  This will be especially important for those Low Middle Income Countries (LMICs) who often have unstable political environments and weak public health and health systems. Remember the Democratic Republic of the Congo who have only just seen off their Ebola epidemic, war torn Syria and the Yemen.

The USA and other high-income countries should be unambiguous about recognising this as a fundamental global pandemic requiring collaboration between countries along the principles of mutual aid. The UN and WHO need our support and funding and we look to international financial organisations such as the IMF/World Bank to rally around in the way that the world banking system showed they could in their own self inflicted 2008 financial crash. The WHO has recently referred to Europe as the epicentre of the pandemic and we urge the Government to put aside their ideological objections and co-operate fully with the EU and our European partners.

 

  1. The public health system

The UK itself is in a relatively strong position with a national public health service, which has focus at a UK level (CMO/PHE), scientific advisory structures (SAGE), devolved governments, municipalities and local government. The NHS too still has national lines of control from NHSE to the NHS in England and the equivalents in devolved countries. The Tory ‘Lansley’ reforms in England destroyed the health authority structure below national levels (remember the former Strategic and District Health Authorities) but at least PHE has a regional organisation and Local Government have Directors of Public Health. We regret the fact that the 10 years of Tory austerity has depleted the resources in PHE and Local Government through not funding the PHE budget adequately and not honouring the public health grant for local authorities. We hope that the recent budget will mean that the public health service and local government does receive the financial and other resources required to help lead the pandemic response. Pandemics have always been high up in the UK risk register.

 

  1. The NHS, Local Government and Social Care

We are grateful that despite the privatisation of many parts of the NHS in England we still have a recognisable system and a culture of service rather than profit within our one million or so staff and their NHS organisations. We were pleased to hear the open ended funding commitment from the Chancellor at the last budget and urge that leaders within the NHS in England and the devolved countries use this opportunity to try to mitigate the underfunding over the last 10 years and implement the emergency plans that exist and calibrate them to deal most effectively with this particular viral threat. Any debates about further privatisation of the NHS needs to be taken off the agenda and let’s not use the budget money to prop up the private sector but requisition capacity if that is what is needed and compensate usage on an NHS cost basis. We want to protect the NHS from the risk that the NHS Long Term Plan proposals for 44 Integrated Care Schemes opens up the risk of US styled private insurance schemes.

 

  1. Funding for staff and facilities.

It will of course be difficult as a result of the staffing crisis that has been allowed to drift over the past 10 years with shortages of NHS workforce of 100,000 of which 40,000 are nurse vacancies but also includes doctors and other key staff. We and our Labour Party colleagues have been reminding Tory Ministers  that it takes 10 years to train a medical specialist so you cannot whistle them up or poach them from other poorer countries. The government needs to abolish their proposed points based immigration regime and indeed the compulsory NHS insurance of £650 per adult which is a huge disincentive to come here and work in the health and social care system.

Hospitals and other health facilities in the UK take time to plan, build and commission. We can of course learn from Wuhan in China where they built a 1000 bedded hospital in weeks! Our own war preparation in the late 1930s when industry shifted production rapidly from civilian to military supplies is another exemplar. Despite the negative impact of 10 years of Tory austerity we urge the NHS to embrace this opportunity to invest in staff, supplies and facilities needed to manage the effects of the pandemic. Creating strategic regional NHS bodies will ensure that capital and revenue resources committed from the centre are used optimally and equitable to meet population needs in collaboration with local authorities.

 

  1. Staff training, welfare and support

Front line NHS and social care staff will need our support over this time. We must ensure that working practices protect staff as much as possible from the risks in the workplace. Training and provision of Personal Protective Equipment (PPE) is vital and employment practices will need to adapt to the changing situation. Lets not forget social care workers, dentists, optometrists and district nurses who are part of our front line. Staff will need retraining if doctors and nurses are to be diverted to unfamiliar roles as we will need A&E, pandemic pods and intensive care unit capacity to be enhanced. Sadly, we now have a significant workforce who work for private contractors as part of the Tory privatisation of the NHS. We need to ensure that they have the same employment safeguards, minimum pay levels, sick pay and the health and safety entitlements as NHS staff. This is the time to renationalise such services back into the fold.

 Patients with existing long-term conditions remain in need of continuing care as will patients presenting with new life-threatening conditions such as cancers, diabetes and circulatory diseases. NHS managers will need support to organise these different services and decisions to postpone non-urgent elective surgery to free up resources. What also makes sense is testing novel ways of supporting people digitally and by teleconferencing to reduce attendance at NHS premises. This can be rolled out for Out Patient provision as well as GP surgeries. The NHS 111 service, and other online services  and the equivalents in the devolved nations can easily be overwhelmed so pushing out good health information and advice is being done and needs to continue. The public and patient engagement has always been at the heart of our policies and can be rolled out in this emergency utilising the third sector more imaginatively.

 

  1. Vulnerable populations.

In our assessment of what needs to be done we must not bypass the urgent needs of some of our most vulnerable populations. The homeless and rootless populations, many of whom have longstanding mental health conditions and/or substance dependency, are particularly at risk. They need urgent attention working closely with the extensive voluntary sector. Also those populations with long term conditions who will feel at risk if services are withdrawn due to staff redeployment or staff sickness need planning for. Primary care needs to be the service we support to flag up those in need and ensure that their medications and personal care needs continue to be met even if we need to involve volunteers and good neighbours to help out with daily needs such as shopping/providing meals and other tasks.

Undocumented workers such as migrants and refugees are often frightened to use health services for fear of police intrusion. The government needs to make it clear that there will be no barriers to care for this population during this crisis and beyond.

Social care is in need of particular attention. It was virtually ignored in the budget. This sector is at risk in terms of problems with recruiting and retaining staff as well as the needs of the recipients of care and support.. While business continuity plans may be in place there is no question that this sector needs investment and generous support at the time of such an emergency. They will be a vital cog in the wheel alongside home-based carers in supporting the NHS and wider social care system. Those most at risk seem to be the most neglected. Disabled people with care needs have received little advice and no support. Already carers are going off sick and can be replaced only with great difficulty. Those paying for their own care with Direct Payments seem to get no support at all.

With the COVID-19 virus we are seeing that the older population and those with so called ‘underlying conditions’ are at particular risk. We must ensure that this large population do not feel stigmatised and become isolated. Rapid assembly of local support groups should be encouraged which has been referred to as ‘local COBRA groups’. Local government can play a key role in establishing local neighbourhood centres for information and advice on accessing support as we move toward increasing quarantining and isolated households. Again wherever possible the use of IT and telephone connectivity to share information and provide remote support will make this more manageable.

 

  1. Assuring universal basic income.

Finally the SHA recognises that the economy will be damaged by the pandemic, organisations will go to the wall and staff will lose their jobs and income stream. We have always recognised that the fundamental inequalities arise from the lack of income, adequate housing and the means to provide for everyday life. This pandemic will last for months and we think that the Government needs to ensure that we have systems in place to ensure that every citizen has access to an adequate income through this crisis. We pay particular attention to the 2m part time workers and those on zero hours contracts as well as the 5m self-employed. There have been welcome changes in the timely access to the insufficient Statutory Sick Pay but this is not going to be the answer. People will be losing their jobs as different parts of the economy go under as we are already seeing with aviation, the retail sector and café/restaurants. The government needs to reassure those fearful of losing their jobs that they will stand by them during the pandemic. It may be the time to test the Universal Basic Income concept to give all citizens a guarantee that they will have enough income for healthy living. We already have unacceptable health inequalities so we must not allow this to get worse.

 

  1. Conclusion

The SHA stands ready to support the national and international efforts to tackle this pandemic. We assert our belief that a socialist approach sees universal health and social care as an essential part of society. That these systems should be funded by all according to a progressive taxation system and meet peoples needs being free at the point of use.  We believe that a thriving state owned and operated NHS and a complimentary not for profit care sector is essential to achieve a situation where rich and poor, young and old and citizens in towns, cities and in rural areas have equal access to the best care.

We recognise that the social determinants of health underpin our health. We agree with Marmot who reminds us that health and wellbeing is reflected by ‘the conditions that people are born, grow, live, work and age and by the inequities in power, money and resources that influence these conditions’.

The pandemic is global and is a major threat to people’s health and wellbeing. Universal health and public health services offer the best means of meeting this challenge nationally and globally. Populism and inward looking nationalism needs to be challenged as we work to reduce the human suffering that is unfolding and direct resources to meet the needs of the people at this time.

On behalf of officers and vice chairs

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“Like everyone else, we feel helplessness, anxiety, and fear.”

by Dan Robitzski / 8 hours ago

As they try to fight the COVID-19 outbreak, medical staff in China are suffering from the seemingly endless slog of work, new cases, and the coronavirus itself.

Nurses in Wuhan, the city where the outbreak began, are fainting on the job, developing painful rashes, sores, hypoglycemia, and psychological exhaustion — and that’s why two of them published an impassioned plea for help from the rest of the world in the journal The Lancet on Sunday.

“While we are professional nurses, we are also human. Like everyone else, we feel helplessness, anxiety, and fear,” the authors, Yingchun Zeng and Yan Zhen, both from hospitals in Guangzhou, wrote. “Experienced nurses occasionally find the time to comfort colleagues and try to relieve our anxiety. But even experienced nurses may also cry, possibly because we do not know how long we need to stay here and we are the highest-risk group for COVID-19 infection.”

Nearly 2,000 medical workers helping COVID-19 patients in China have been infected, and at least nine have died. Meanwhile, the nurses write that the safety measures they have to follow, like quadruple-layering gloves and constantly wearing and washing tight respirators that are giving them bedsores, are simultaneously making them sick and rendering them useless as caregivers.

For instance, unpackaging medical supplies and giving a patient a shot while wearing four layers of latex gloves is particularly difficult.

“Due to an extreme shortage of health-care professionals in Wuhan, 14,000 nurses from across China have voluntarily come to Wuhan to support local medical health-care professionals,” the nurses wrote. “But we need much more help. We are asking nurses and medical staff from countries around the world to come to China now, to help us in this battle.”

 

 

 

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Make the UK the safest place world to have a baby!

Why is the UK still not in the top ten countries for infant mortality and for maternal deaths? Why? We are a rich country. We have an established high-quality health service. Healthcare is supposed to be accessible to all. How come babies and mothers die or are badly hurt at birth? How come Black and Ethnic minority babies suffer most? Why do poor areas have worse outcomes than wealthy areas? Why is infant mortality rising? (The infant mortality rate is the number of children that die under one year of age in a given year, per 1,000 live births. The neonatal mortality rate is the number of children that die under 28 days of age in a given year, per 1,000 live births. These are both common measures of health care quality, but they are also influenced by social, economic and environmental factors). Are there fundamental problems with core policy documents like the maternity review “Better births”? These are painful questions.

Our campaign wants real improvements for mothers and babies. This posting is not intended as a clinical paper, it is a discussion amongst activists and concerned citizens about where the problems lie. A key set of participants in this discussion are mothers who have given birth, including those who have lost babies, grandmothers and other birth partners, and women who could not conceive.

Our campaign published our Maternity Manifesto during the election but though well shared on Facebook, it did not get into any parties’ manifesto.

We also called a national meeting on issues in maternity care.

What then are the factors that result in UK outcomes at birth worse than other advanced countries?

The answers include shortage of NHS funding, staffing shortages, poor management in some hospitals, staff in fear of speaking out, some policies and procedures, disrespect towards the women carrying the baby, and, as cited in the East Kent enquiry, a lack of practical understanding by staff and by mums of the need to “count the kicks” in the latter part of pregnancy. The introduction of charges for migrant women has also caused deaths. NHS material seems to centre the cause on mothers who smoke, or who are overweight. (Now smoking in pregnancy is plain stupid, it really is, and most mums would not do so if they were not addicted. Don’t do it!). However, other countries, Greece for example, who smoke more, have better outcomes in pregnancy than does the UK. Wider problems like obesity and diabetes, and even women giving birth older, are mentioned in the literature about this. Again, the age of the mother as a factor, but this is only partly true. Giving birth older is often safer than giving birth too young. Globally it is most often young girls who die in childbirth.

Answers may lie in the financially and emotionally vulnerable place that pregnant women occupy in our society, including poverty, violence and stress. Poverty and inequality are factors in infant mortality; “The sustained and unprecedented rise in infant mortality in England from 2014 to 2017 was not experienced evenly across the population. In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100 000 live births per year (95% CI 6 to 42), relative to the previous trend. There was no significant change from the pre-existing trend in the most affluent local authorities. As a result, inequalities in infant mortality increased, with the gap between the most and the least deprived local authority areas widening by 52 deaths per 100 000 births (95% CI 36 to 68). Overall from 2014 to 2017, there were a total of 572 excess infant deaths (95% CI 200 to 944) compared with what would have been expected based on historical trends. We estimated that each 1% increase in child poverty was significantly associated with an extra 5.8 infant deaths per 100 000 live births (95% CI 2.4 to 9.2). The findings suggest that about a third of the increases in infant mortality between 2014 and 2017 can be attributed to rising child poverty (172 deaths, 95% CI 74 to 266).” (Our bold for emphasis).

The UK is a rich advanced country, with a long history of universal healthcare but we have rising infant mortality. “Rising infant mortality is unusual in high-income countries, and international data show that infant mortality has continued to decline in most rich countries in recent years” and “In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100,000 live births per year, relative to the previous trend“.

Poverty is not the sole cause of high Infant Mortality though, Cuba has good outcomes equal to the UK for infant mortality. Cuba is very poor indeed and the UK is one of the wealthiest economies (sadly Cuba does less well on maternal deaths).  

Research shows out of 700,000 births a year in England and Wales, around 5,000 babies are stillborn or die before they are a month old”. 5,000 babies each year. There have been major news stories about baby deaths in many hospitals, notably in ShropshireEast Kent and Morecombe Bay.

Maternal deaths. The UK is not in the top ten countries with the lowest infant mortality rate, neither is it the safest place to give birth. In 2015-17“209 women died during or up to six weeks after pregnancy, from causes associated with their pregnancy, among 2,280,451 women giving birth in the UK. 9.2 women per 100,000 died during pregnancy or up to six weeks after childbirth or the end of pregnancy.” In 2016 The UK ranked 24th in the world in Save the Children’s Mothers’ Index and Country Ranking Norway, Finland, Iceland, Denmark, Sweden, Netherlands, Spain, Germany, Australia, Belgium, Austria, Italy, Switzerland, Singapore, Slovenia, Portugal, New Zealand, Israel, Greece, Canada, Luxembourg, Ireland, and France, all did better than the UK. The situation in some other countries is massively worse than here but that is no excuse. But these baby and mothers’ deaths must stop. We cannot sit back and let these deaths continue.

Let’s be clear, the situation for women in pregnancy and childbirth is massively better than before the NHS, and is head and shoulders better than in the USA today. But maternal mortality is an issue here in the UK, and a huge issue in poorer countries, especially where women give birth without a trained professional being in attendance. Quite rightly professionals and campaigners in the UK participate in international endeavours to improve this situation. The NHS should be training and sending midwives to those countries, instead, it is recruiting midwives from poorer countries. In Europe we have cuts in healthcare through Austerity; in the global south, the same concept of cutting public services to the bone is called Restructuring.

Why is the UK, a rich country with (almost) universal health care not doing better by its mothers and babies? Look at just this case and see the problems in the provision of maternity care;

Archie Batten

Archie Batten died on 1 September 2019, shortly after birth.

When his mother called the hospital to say she was in labour, she was told the QEQM maternity unit was closed and she should drive herself to the trust’s other hospital, the William Harvey in Ashford, about 38 miles away.

This was not feasible and midwives were sent to her home but struggled to deliver the baby and she was transferred by ambulance to QEQM where her son died. Archie’s inquest is scheduled for March. (BBC).

We know that temporarily “closing” maternity units because they are full is a common occurrence. Women then have to go to a different hospital. Induction of labour can be halted because the unit is full. It is not a pleasant situation for mothers. Some maternity units have closed permanently, meaning mothers have to travel further for treatment, at a time when the ambulance service is under great strain (though being in labour is not considered an emergency for the ambulance service!).

Shortage of Midwives and consequent overwork for the existing staff. The UK has a shortage of three thousand five hundred midwives. The midwife workforce is skewed towards older midwives who will retire soon.

Gill Walton, general secretary and chief executive of the Royal College of Midwives said “We know trusts are facing huge pressures to save money demanded by the government, but this cannot be at the expense of safety. We remain 3,500 midwives short in England and if some maternity units regularly have to close their doors it suggests there is an underlying problem around capacity staffing levels.

Training midwives is not just about recruiting new starters to university courses. There need to be sufficient training places in the Hospitals who are already working flat out, leaving little time for mentoring of students, as well as places in the Universities. Alison Edwards, senior lecturer in midwifery at Birmingham City University, who says: ‘It isn’t as simple as recruiting thousands more students as this requires the infrastructure to support it.

‘You need more tutors, more on-site resources and, perhaps more importantly, more mentors and capacity in placement areas – which is currently under immense strain.’ 

One student midwife wrote about her experiences in this letter, where she described very hard work without either pay or good quality mentoring.

The government and the NHS call for Continuity Care from Midwives. This means the same midwife or small team of midwives cares for the mother through her pregnancy, birth and postnatal period. We too believe this would be wonderful if it were possible. It is however impossible with the existing ratio of midwives to mothers. Providing continuity of care to the most vulnerable mothers is a good step. NICE have reduced this to the idea of each woman having a named midwife. One to One a private midwife company claimed to provide this but was unable to continue trading, and went bust leaving the NHS to pick up the pieces.

Nationally the NHS is underfunded and looks set to continue so. Much of the problem comes from a long period of underfunding. We spend less than 9.8 per cent of GDP on health. Switzerland, Germany, France, Sweden, Japan, Canada, Denmark. Belgium Austria Norway and the Netherlands all spend more. That places the UK 13th in the list of high spenders on health care. The US spends 16.9 %. (although a lot of that money is diverted from patient care to the big corporations and insurance companies). The NHS was the most cost-efficient health care service in the world.

Underfunding causes staff shortages. Some errors at birth come from staff being overworked and making mistakes.

Some, our campaign believes, flow from fundamental flaws in government policy such as in the Maternity Review, where the pressure is on staff not to intervene in labour.

 Listen to the Mother. Some of the deaths are from women not being heeded in pregnancy and childbirth. This is backed up in reports from mothers, including some quoted in the big reviews mentioned above. However, overworked and tired staff who know labour like the back of their hand can easily stop heeding an inexperienced mother.

Poverty kills mothers and babies. As we said above, some deaths, poor baby health, and injuries come from growing maternal poverty and ill-health. Low-income families find it hard to afford good food. Food poverty affects a staggering number of children. The charity UNICEF estimates that “2.5m British children, or 19%, now live in food-insecure households. This means that there are times when their family doesn’t have enough money to acquire enough food, or they cannot buy the full variety of foods needed for a healthy diet. In addition, 10% of these children are also classified as living in severe food insecurity (the European average is 4%) and as a result, are set to experience adverse health.”

Studies show that;

The Independent inquiry into inequalities in health (Acheson 1998) found that a child’s long term health was related to the nutrition and physique of his/her mother. Infants whose mothers were obese had a greater risk of subsequent coronary heart disease. Low birth weight (under 2500 g) was associated with increased risk of death in infancy and with increased risk of coronary heart disease, diabetes and hypertension in later life. Accordingly, the Inquiry recommended, ‘improving the health and nutrition of women of childbearing age and their children, with priority given to the elimination of food poverty and the reduction of obesity’. (NICE )

A significant number of deaths of new mothers come from mental health issues that spiral out of control. Some of these will be newly developed conditions and some existing conditions made worse by pregnancy and childbirth. Mothers family and professionals must all be on the alert and intervene early. There are good ways to treat mental health in pregnancy.

Reducing the social and economic stresses around pregnancy would also help reduce the deaths and suffering

When Birth goes wrong it can be a dreadful experience for everyone involved. In most cases, the panic button brings in a well-drilled team of experts who can solve nearly every problem and do it calmly. At other times, it is dreadful, as described in the coverage of the birth and death of baby Harry Richford. Harry Richford was born at the Queen Elizabeth the Queen Mother Hospital in Margate in 2017 but died a week later. https://www.bbc.co.uk/news/uk-england-kent-51097200

Sands, the baby death charity explains that there are many causes of babies dying before birth. Crucially important is that mothers are heeded when they are concerned and that everyone Counts the Kicks

 

Maternity is not the only area of the NHS that suffers. There have been serious mistakes in NHS planning including closing far too many beds. The NHS closed 17,000 beds and now is working beyond safe bed occupancy. There are 100,000 staff vacancies. Waiting times in A and E are dreadful, as are waiting times for cancer treatment. NHS managers and the Government have taken the NHS far from the Bevan model of healthcare (for history read this).

Press coverage. How does the press cover the NHS, and baby deaths? There are very real problems in the NHS and maternity care but the coverage in the press of these problems seems to switch on and off in strange ways, often to suit Conservative Party political requirements. The NHS and the Government are masters of propaganda and news manipulation. The public needs to learn to judge the news and to look both for actual problems and look out for bullshit and manipulation. Why was news of the arrest of the nurse from the Countess of Chester hospital headlines on the 70th Anniversary of the NHS? Why was the news of the understaffing there not given similar nationwide publicity? Why have we heard little or nothing since?

If the government can switch the blame to the professionals in the NHS (but not their mates the high admin of the NHS), then they seem to be happy to publicise the problems. In other cases, problems are swept under the carpet.

Professionals expect to (and do) take responsibility for their own actions. Mistakes will be made. It is impossible to go through life without some mistakes. When we are dealing with life and death mistakes can be catastrophic, even where there is no ill intent.

Malicious action is rare.   There are the terrible cases of serial murderer Harold Shipman, and the convicted surgeon Ian Paterson who falsely told women, they had breast cancer and operated on them unnecessarily. The hierarchical system in the NHS and the lack of regulation in private hospital, which was described as “dysfunctional at almost every level” allowed that harmWe have not found such a case in maternity.

Unintentional bad practice, however, has also harmed babies. No one went to work intending to harm in the events publicised in the Morecombe Bay Enquiry into the deaths of 11 babies and one mother. It was said that “The prime responsibility for ensuring the safety of clinical services rests with the clinicians who provide them, and those associated with the unit failed to discharge this duty over a prolonged period. The prime responsibility for ensuring that they provide safe services and that the warning signs of departure from standards are picked up and acted upon lies with the Trust, the body statutorily responsible for those services.”

The Enquiry described what happens like this “In the maternity services at Furness General Hospital, this ‘drift’ involved a particularly dangerous combination of declining clinical skills and knowledge, a drive to achieve normal childbirth ‘whatever the cost’ and a reckless approach to detecting and managing mothers and babies at higher risk.”

The Furness General Hospital was pushing for Foundation Trust status at the time and was not exercising the necessary supervision.

“Maternity care is almost unique amongst NHS services: the majority of those using it are not ill but going through a sequence of normal physiological changes that usually culminate in two healthy individuals. In consequence, the safety of maternity care depends crucially on maintaining vigilance for early warning of any departure from normality and on taking the right, timely action when it is detected. The corollary is that, if those standards are not met, it may be some time before one or more adverse events occur; given their relative scarcity in maternity care, it is vital that every such occurrence is examined to see why it happened.

So, many factors come into play in such incidents of harm to mother and baby. Professionals too can be emotionally wrecked by tragedy.

Huge personal and professional lessons can be learned from a detailed review of cases where mistakes are made. There is a whole literature about learning from mistakes. The worst such incidents are referred to as Never Events. This is just one article about such errors but there is a whole field of research devoted to it. Serious Mistake Reviews often happen at the end of shifts, and in the worst cases, may lead to long public enquiries.

NHS as a research organisation One of the great virtues of the NHS is the research base it offers professionals. What happens in the NHS which covers 62 million people is studied, evaluated, and researched. This is invaluable to staff and above all to patients. Sadly this research is also of interest to big business especially to those who sell health insurance and to the big corporations who have their ‘snouts’ in the NHS ‘trough’. Research for the common good is clearly different from research to make money. We see that regularly in big pharma. Cheap effective medicines do not make money for the companies. Yet the government is giving away our medical data to companies to make a profit.

There are also “errors” that happen when everyone is following accepted procedures and protocols; “untoward events, complications, and mishaps that resulted from acceptable diagnostic or therapeutic practice”. Procedures within the NHS can be robust and well researched, and problems still occur.

https://www.mamaacademy.org.uk/news/mbrrace-saving-lives-improving-mothers-care-2019/

Research matters. Only by studying outcomes can these errors be revealed. A classic example is the once customary practice of episiotomy, cutting a woman to prevent tears to the perineal skin in childbirth, which is now no longer used except in an emergency. Research both formal and informal changed that practice. As another example of such research, Liverpool Women’s hospital has been involved in research about the benefits of leaving the baby attached by the cord if they are born unwell. NHS staff and other health professionals, academics and pressure groups are working hard to improve outcomes for mothers and babies. Each mothers death is reviewed in the MBRRACE-UK report

https://mamadoc.co.uk/the-maternal-mortality-report-we-should-all-learn-from/

Never again. The tragedy of the death of a mother and or baby is felt by that whole extended family. Most families want to know it will never happen again. Cover-ups and lies mean it will happen again, so brutal honesty is needed.

 

The aftermath of medical treatment or neglect which causes real harm is complex. Whether the outcome is death, life long impairment, or long term physical and mental health issues, these are very significant events for all concerned.

Campaigners in Liverpool campaign for SEN funding to be returned. 2019

If a baby is born with life-changing impairments, the baby is left facing catastrophic difficulties and the mother and family can face major heartbreak and hardship. The huge love we have for our kids (may it long continue), whatever their issues, does not prevent the financial, housing and employment issues families with disabled children face. Nor does it guarantee the best educational opportunities, SEN is being battered by cuts. but parents and teachers are fighting back.

 

The cost of financial “compensation” from an injury to a newborn is huge because it is life long. The cost of this “compensation” used to be carried by the government but the system changed to make hospitals “buy” insurance from a government body which is set up like an insurance company. The cost to the hospital is charged on the basis or earlier claims, like car insurance. Obstetrics make the highest claims of any section of the NHS.

Liverpool Women’s Hospital had a huge case (not about babies) some years ago, arising from a surgeon who left many women damaged after incontinence operations. Their total bill, over 5 years, according to the Echo, was £58.8 million. “The NHS trust has been forced to pay out £58.8m in the last five years for both recent and historic negligence cases.

The limited work we do, as a campaign, in holding the hospital to account, leads us to believe lessons have been learned by the hospital. However, in every hospital, there are pressures which could lead to problems. These pressures include financial and organisational, problems of management ethos, and the potential for bullying, the distrust by the staff of their management, and disrespect for whistleblowers.

The NHS has gone through years of reorganisation after reorganisation. In that time the financial and government pressure has been to complete the re-organisation, or face catastrophic consequences so very many hours of admin and senior doctor time has been wasted on this process. That time could have been focussing on saving babies.

At STP and national level, there are other problems. The NHS is intensely political. There are deep structural problems. (We believe the NHS should return to the Bevan Model of health care)

The NHS is not only deprived of adequate funding, but it has also been forced to implement many market-based changes, including the internal market, outsourcing and commissions of services to for-profit companies. These market-based structures are expensive.

The NHS has also seen dire staff shortages resulting from stupid decisions like removing bursaries, not training enough doctors and the hostile environment to migrant staff.

There are moral and financial issues in all cases of such errors. The hurt to the babies is our priority.

Baby deaths and severe injury at birth have complex roots. Though what happens in the hospital is crucial, it is not just what happens in the hospitals that matter. The stress, poverty and anxiety many mothers endure during pregnancy do sometimes affect the outcomes for the child. Many women are still sacked for being pregnant but families can rarely cope with just one wage (do fight back against sacking pregnant women!). See Maternity Action for details. Both mums and midwives can call Maternity Action for advice.

Low pay or the dreaded universal credit can make food heating and rent all too expensive. This can lead to food poverty. Women do not yet have real equal pay but mothers have the worst pay of all  Benefits are no longer allowed for a third child. even though most claimants are working. Whether parents are working or not, every child has a right to food and shelter, be they first or 10th child. The child gets no choice!

Not every pregnant woman is in a stable caring relationship. Housing, especially private renting, becomes more difficult when women are pregnant. Who can forget the story of the homeless woman giving birth to twins in the street? Pregnancy is often the time when domestic violence is inflicted on a woman but it is the time when women are least able to walk away. Poverty kills babies too.

Please join us in campaigning for better outcomes for all mothers and babies in the NHS and across the globe. We want this to start a discussion, so please send us your views. and information

 

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All the Tory contenders to be prime minister should categorially rule out the NHS being part of any future US/UK trade deal, Unite, Britain and Ireland’s largest union, said today (Wednesday 5 June).
Unite, which has 100,000 members in the health service, said the new prime minister ‘should not offer up the NHS as a sacrificial lamb to US president Donald Trump’.
Unite national officer for health Colenzo Jarrett-Thorpe said: “The Tory prime ministerial contenders need to put the national interest – in this case, the safeguarding the NHS from US privateers – before the personal ambition of getting their hands on the keys to 10 Downing Street.” 
Concern about what a US/UK trade deal could mean for the NHS has heightened this week following remarks by Donald Trump and his ambassador in London, Woody Johnson about the NHS being included in a future US trade deal
Colenzo Jarrett-Thorpe added: “The NHS is the UK’s greatest achievement – but for Trump and his ilk, who despise the very idea of universal healthcare free at the point of delivery, all they can see is the money to be made from the sick, frail and vulnerable. 
“This was made obvious by the US ambassador’s very frank comments about his country’s intentions towards the NHS in any future US/UK trade deal, a point that was again made by Trump himself. The president’s comments today are not reassuring in any way. Unless the government categorically says that the NHS is not for sale, then patients and staff will face increasing uncertainty and worry.
“The Tory leadership hopefuls need to state categorially to the British public that the NHS is not up for sale to profit hungry US private healthcare companies as part of a future trade deal.
‘Leading Tories and their cheerleaders in the media may think that the US offers a blueprint for how a post-Brexit Britain should be – however, it should not be forgotten that millions of Americans don’t have any health insurance which does not inspire confidence.
“We strongly believe that the NHS should not be offered up as a free trade sacrificial lamb to the mercurial whims of Donald Trump – our sick, frail and vulnerable deserve so much better.”

 

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Responding to the Health Secretary’s pledge to overhaul mental health and wellbeing services for NHS staff following the launch of a Health Education England review, BMA mental health policy lead, Dr Andrew Molodynski, said:

“Staff are fundamental to the delivery of patient care in the NHS and without a healthy workforce our health service can barely function, let alone thrive.

“Given the current pressures that the NHS workforce is under, the Secretary of State for Health and Social Care’s commitment to improving mental health and wellbeing support for staff is both timely and necessary.

“We know that doctors’ mental health and wellbeing has been adversely affected by the increasing demands of their work and this is true also for medical students who are dealing with stress, fatigue and exposure to traumatic clinical situations, very often without adequate support on hand.

“The BMA recently for greater provision of mental health support for NHS staff as their report¹ found that only about half of doctors were aware of any services that help them with physical and mental health problems at their workplace – while one in five respondents said that no support services are provided.

“While these measures will go a long way to providing much-needed support for NHS workers who are struggling with their mental health and overall wellbeing, more must be done to address the wider pressures on the system, such as underfunding, workforce shortages and rising patient demand, so we can reduce the number needing to seek help in the first place.”

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Wednesday’s budget delivered grim news of poor economic growth over the next few years, compounded by even grimmer jokes. However amongst the cautiously delivered statement seemed to appear one pearl of  policy that should of set every NHS employees heart a flutter. The announcement that funding would be provided to facilitate pay rises for some staff, but this was not the monumental announcement abolishing the pay cap or a U-turn on austerity that some may have hoped for. This announcement came as more of a carrot on a very long string with a few hoops to jump through along the way and it would appear the devil was in the detail. The Chancellor confirmed that this increase in pay would be linked to productivity and pay reform, something that has been mooted before without being fully explained. So the question of whether or not there would be a pay rise has left many nurses, midwives and paramedics scratching their heads.

Union bosses criticised Mr Hammond’s announcement. Unison’s Dave Prentis showed concern that the chancellor was raising the hopes of nurses without putting any extra money on the table, where as the RCN’s Janet Davies warned that any pay rise should not be linked to staff working harder highlighting the fact that nurses have had their pay frozen for the past 7 years and that any increase would only deliver what had been lost. So what could this announcement mean for nurses ?

It is no secret that the NHS faces a funding black hole despite receiving an extra 2.8 billion this budget, with the government hoping the restructuring of services will help plug the gap. Many NHS staff are paid via an agreement called Agenda For Change which allows for universal pay across the NHS as well as providing incremental pay increases linked to progression.

2016 saw Health Secretary Jeremy Hunt embroiled in a row with doctor’s over contracts that many labeled unfair but the government said were necessary to modernise the health service. It is thought that the same will happen again with Mr Hunt setting his eyes on aspects of the Agenda For Change agreement particularly surrounding enhanced unsociable hours payments given for night shifts and weekends when he submits evidence to the NHS Pay review body in the next few weeks. It is  also felt that the Government will attempt to redefine the working day in line with their 7 day service strategy. This could see unsociable hours pay kicking in much later in the evening and being abolished at weekends. Other possible changes could include smaller incremental progression pay rises as well as getting rid of any overlapping pay structures between bands. meaning those nurses who reach the top of their band, don’t progress or rely on extra hours payments may see the long term pay drop further despite any pay increase.

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The pace of change in health visiting over the past few years has been hectic, traumatic at times and stressful, but have the rewards promised been delivered?
Health visitors welcomed standards and national recognition but the next phase is not certain at all. We, as with our School nurse colleagues transferred to Local Authority Commissioning this year. We have worked hard to ensure commissioners were ready for us and know what we do, how we respond to populations and need. Lots of good standards have been written down but sadly this is where I fear the wheels fall off.
 Government cuts have hit Local Authorities. Hard. The honeymoon period has been short for our school nurses who now find themselves an expensive service that no one wants. Commissioning is looking at getting a complex professional service but finds there is not the money to pay for dedicated, well educated  professional SCPHNs.

Is this the future also for Health Visiting?

Currently many health visiting services are finding that managers are looking at how they deliver the service that is being “paid for” and “counted” rather than the comprehensive complex relationship building, nurturing service that health visitors are trained to do. Yes I celebrated the enshrinement of the 5 mandated contacts and the 4,5,6 model but this is a bare minimum, what if a provider interprets that as a set service delivery standard? Do we continue to anticipate need? A core principle of health visiting is the search for health needs

I’m a Health Visitor in the NHS. My job is to provide a universal service to children until they go to school that will monitor their health and well being and safeguard them

The safeguarding of children depends on so many factors. But it’s not just the job of health visitors to protect children, it’s the role of families and families currently are under massive pressure.  Cameron’s government talked about Troubled Families but those of us working day to day are finding families in trouble, they have more stress than ever before. Mums and dads are working 2/3 part time jobs. We are there to support them.
 These children and their parents have little expectation of us. They become lost to services and when, as we have heard so much recently, they are living in fear there is no one to trust, no one to support them. Safeguarding children does not start with social workers, it’s about visible children supported in their communities but we need commitment to maintain universal services from Health Visitors and School Nurses to ensure our children are never unseen or unheard.

No one else will

So, we move forwards to the here and now.
health visitor
Is this is it? I’m in consultation phase and I’m at risk of being down banded or made redundant. So too are my colleagues across England.  So have we lost the fight? Do we give up now, go back to our areas and tough it out, having our own individual battles? When it’s done do we reflect on when things were good, what we could have done who’s at fault?
Just the sound of this is too awful to imagine.
So what do we do?  We look for inspiration. Whether it be current or past. The Practice teacher that inspired you, the mum that fought against the odds for her child, women like Marie Stopes, the women that started us off in 1862, those that went on to do their bit for women’s suffrage.  We take their example and adapt, we owe it to our children and communities to stand up and fight these cuts to a service we built for them.
It’s not just a job. It’s a service that will disappear unless we shout out. We are the invisible support. There’s a presumption we will always be there from our colleagues in Health and Social care and by the public.
In Worcestershire recently we raised the “What if” question and were bombarded by mums and families asking what if their health visitor had not been there, asked, enquired? They showed how much health visiting affects families.
Last week I heard stated that we shouldn’t worry about the lack of follow ups a and chasing contacts. She cited the example that “no one else does, a GP wouldn’t call to see why an appointment is missed”. But that’s exactly the point. No One else does. The under 5s are too easily invisible and we have seen again and again the tragedy of invisible children, lost from the eyes of their neighbours.  Women with post-natal depression are not wont to shout for help, we know that often unless the health visitor asks no one else does. The Domestic Abuse question, so vital to women and children, if no health visitor who will ask? No one.
I could go on, but I think I’m preaching to the converted.  I know you get the importance and significance of the job. So how do we go forward?
The only way I know is by raising awareness, sharing experiences and campaigning.  We are not reinventing the wheel. So many nurses have had to fight for services in the past.  Health visitors fight daily for housing, safeguarding, GPs to listen to concerns they raise. This should be simple for us. Why so careful?
We have leaders who have given us inspiration, Professor Dame Sarah Cowley spelled it out for us and continues to do so, Dame Elizabeth Anionwu coins the phrase the Radical Health Visitor. It’s my belief that if we aren’t radical we aren’t fulfilling the job description!  They weren’t Dames when they did their work, they were you and me, turning up, doing their best. Use the resources you have, your voices and your Union as so many before have done. No one does this alone.
Support each other, speak out, speak up, challenge, organise and don’t give up. It’s a nothing to lose moment, were in good company with the rest of our NHS and Local Authority colleagues.
So, I’m at the March in London on March 4, I want a block of red ❤️YourHealthVisitors up front – indulge me!  If we don’t fight this No One will.
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Students applying for nursing or midwifery courses in 2017 will already be aware that they are no longer eligible for government bursaries, which have been scrapped by the Tories in a bid to save £800m of public spending. While this change will result in financial uncertainty for many students, the removal of bursaries could spell even greater uncertainty for the National Health Service in the next few years.

Under the bursary system, Health Education England funded a fixed number of places based upon local ‘workforce plans’, designed to fulfil the needs of the NHS locally. The government argues that by removing a cap on the number of funded places, the removal of bursaries could result in an increase of 10,000 places by 2020. Yet some experts disagree. Estimates by London Economics suggest that because of the removal of bursaries, nursing admissions could fall by 6-7 percent in the first year alone, leading to “a significant increase in staff shortages in the medium term”.

There is a distinct shortage of nurses and assistant health practitioners within our health service – a shortage of 15,000 to be precise – so it seems counter-productive to be cutting investment at a time when we should be attracting applicants to study nursing. It is hard to see the logic in shifting the financial burden from the taxpayer to individual students, considering that, on average, 70 percent of students never fully repay their loans, meaning that the taxpayer ultimately foots the bill anyway.

But even if the government’s forecasts turn out to be correct, there is no telling what types of nurses and allied health professionals are likely to be trained under the new system. Without the financial guarantee which bursaries provide, universities may be tempted to cut the numbers of less popular, specialised courses like child psychology, while expanding upon popular courses such as physiotherapy. HEE warns that,

If the commissioning of education is not efficient and effective, then attrition potentially goes up, people leave the courses or graduate with the wrong attitude…this impacts on the tax payer in a number of ways.”

By replacing workforce plans designed to meet the needs of the NHS with a system driven by market values, it is possible that an unfunded system could result in a shortage of highly valued and specialised nurses and AHPs, while unneeded specialities become flooded with new graduates. As none of this training will have occurred with specific vacancies in mind some graduates may find themselves struggling to find a job, despite having incurred thousands of pounds of student debt.

The political choice to detach recruitment from the needs of the NHS runs the risk that many graduates may end up taking jobs elsewhere. One particular weakness of government-funded places was that graduates could take up jobs within the private sector or abroad, with absolutely no obligation to work within the NHS after they graduated. But whilst the bursary system was far from perfect, the new system does even less to incentivise people to study nursing in the first place and to pursue careers within the health service.

What is particularly uncertain is who exactly will be responsible for meeting the workforce needs of the NHS once funded places have been completely abolished. If HEE remains ultimately accountable for NHS staffing, it will have to look at other non-financial incentives and soft ‘nudging’ to convince people to take up nursing in spite of the associated debts.

While the rest of the NHS is supposedly getting to grips with Sustainability and Transformation Plans and the devolution of healthcare, the removal of nursing bursaries seems to relinquish some of the control which would make local workforce plans easier to plan and carry out. The full effect of these bursary cuts will not be felt until 2020, when the first cohort of students who enrolled in 2017 will finish their courses. If Labour were to win the next general election, therefore, they could find themselves having to explain an NHS workforce crisis conceived under the Tories.

This was first published by the Fabian Society in Anticipations winter 2016

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In its early days, the NHS was an institution that valued and worked in accordance with a strict hierarchy. Consultants and other doctors occupied the top positions, with nurses taking their much lowlier place close to the bottom of the pile. The gender of those who staffed our hospitals and surgeries also reflected a wider societal gender divide, with almost exclusively female nurses existing primarily to enact the wishes of almost exclusively male doctors. Decision-making rights were concentrated amongst the males, at the top of the NHS power structure.

Nursing today is a very different proposition and, rather than being ‘trained on the job’ in a piecemeal way, the vast majority of nurses today either hold a degree or are studying towards one. Additionally, many of the qualifications nurses are achieving are in specialist medical areas. Nurses are no longer auxiliaries to the main medical prowess of doctors- they are experts in their own right, holding valuable knowledge and insight in areas like diabetes, obesity, obstetrics, pharmacology, pain control… the list is endless. With their new expertise, these nurses have achieved higher pay scales, with many reaching the earning power of their doctor colleagues.

So, why are these changes taking place?

There are a number of reasons, both societal and scientific. In society more broadly the lines between traditionally ‘male’ and ‘female’ roles have become very blurred. Although nursing as a profession remains dominated by women, that too is gradually changing. There are far more male nurses today than there were even a few decades ago, and there are also a much greater number of female doctors. In fact, today more women go to medical school than men. In the UK, in 2013, some 55% of first year medical students were female. As the old-fashioned division between male / female, doctor /nurse breaks down, so to does the way we, as patients and colleagues, perceive the roles. However, changes to the nursing profession don’t only reflect a shift in gender roles; the way the role is changing is also down to major technological and scientific advances.

New nursing methods, innovative machines and better research have freed nurses from many of the labour-intensive chores that once defined their working lives. Like housewives of old, a nurse’s daily life was once full of cleaning; a constant fight against infection and filth. Today, with machinery bearing the brunt of this work, nurses are more likely to be found processing illuminating data or contributing to important research than they are scrubbing floors.

A hierarchy of nursing still exists, as anyone observing a nursing teams’ colour-coded uniforms (which correspond to different band roles) will attest. However, nurses today have opportunities to climb a pay scale ladder and / or to branch off into interesting and rewarding specialisms; something simply not possible 100 or even 50 years ago. Inarguably, these are positive developments, for nurses of either gender, but also for the patients who rely on them.

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