7 December 2012
“In the long run,” John Maynard Keynes once famously said, “we are all dead.”
And as our population now lives longer, “in the long run” can be contemplated in a different context when we look at how cuts in staffing in the NHS in Scotland are now storing up problems for the future.
In the past three years, over 2,000 posts amongst nursing and midwifery staff have disappeared as a result of UK and Scottish Government cuts.
After the years of continuous high spending in the first period of the last decade , when the number of nursing and midwifery staff rose by over 5,000 in Scotland under the previous Scottish Executive, we are now in a mirror image era with numbers falling.
Nursing and midwifery staff in post (Whole Time Equivalent):
September 2009: 58,428
September 2012: 56,082
Understandably, nursing unions have sought to defend their members’ and patients’ interests as health boards see reducing staffing numbers as the most readily available financial solution when they are being forced to cut their spending.
As a result, there are Increased workloads, skill mixes, job freezes, and a drop in staff morale flourish, piling on the problems for the future.
As well as that, a Royal College of Nursing survey of its members showed that the majority of community nurses who responded had indicated that had witnessed a rise in the number of patients in their caseload, but a reduction in the time that they spent with them.
Another decision with future consequences has been the reduction in the number of training places for nursing and midwifery students
Added to this are the effects of “ efficiency savings” where health boards are under pressure to use their creativity to develop new methods of providing the same level of service with a shrinking money pot , and the effect of the ever-rising cost of drugs and the ever-increasing demand for the NHS services , particularly as the population ages.
So, if according to the Scottish Government, the NHS budget is being protected in real terms, why is the reality in the NHS over 2,000 nursing posts lost, cuts in the recruitment numbers of those being trained for the future service, and a downward drift in morale?
It will come as no surprise therefore to learn of the concerns that health professionals have about the deterrent effect that the current condition of the NHS has upon those attracted to a career in it and upon those it wants to retain in it.
Why is the numbers of nurses important?
What difference do they make?
The RCN quote research studies which reveal that increased nursing staffing levels are related to better patient outcomes and experience where
“Patients and nurses in the hospitals with the most favourable staffing levels (the lowest patient-to-nurse ratios) had consistently better outcomes than those in hospitals with less favourable staffing”
and in the hospitals with the highest patient –to- nurse ratios
“ nurses in those hospitals were approximately twice as likely to be dissatisfied with their jobs, to show high burnout levels, and to report low or deteriorating quality of care on their wards and hospitals.”
“Improved work environments and reduced ratios of patients to nurses were associated with increased care quality and patient satisfaction”
While presiding over a fall in the number of nursing and midwifery staff, at the same time, the Scottish Government has set out what its own prognosis for the NHS in Scotland in the long run
“Over the next 10 years the proportion of over 75s in Scotland’s population – who are the highest users of NHS services - will increase by over 25%. By 2033 the number of people over 75 is likely to have increased by almost 60%. There will be a continuing shift in the pattern of disease towards long-term conditions, particularly with growing numbers of older people with multiple conditions and complex needs such as dementia. Over the next 20 years demography alone could increase expenditure on health and social care by over 70%. “
Long term conditions such as obesity and diabetes will require more not fewer nursing care in the form of more specialist nurses, as will dementia.
Therefore, it makes no sense in terms of long-term planning to oversee a drop in nursing numbers , particularly when the Scottish Government indicates that changes in the population structure towards an older age profile could require a dramatic increase in health expenditure and resources.
My friend and colleague Marlyn Glen , when MSP , obtained information from the Scottish Government on healthy life expectancy in Dundee .
" Healthy life expectancy” is defined as the number of years during which people may to enjoy ‘good health’.
It will become a significant factor in determining the level of care that an elderly person requires.
For men in Dundee , life expectancy in the period 2008-10 was 71.8 years.
corresponding healthy life expectancy was 64.6 years.
This corresponds to the number of years "not spent in good health” is 7.2 years.
For women in Dundee, life expectancy was estimated at 78.0 , and healthy life expectancy at 68.8 years.
This corresponds to the number of years " not spent in good health" is 9.2 years.
If life expectancy increases with no increase in healthy life expectancy, then more care of the elderly will be required, along with more nurses.
Nurses will certainly be at the forefront of the challenges presented by increased longevity accompanied by poorer health, challenges to which there are no simple solutions.
Some of us may be these very people who will need their skills and their care – in the long run.
Studies of nursing numbers and patient outcomes