Nurses "at breaking point"

NHS Tayside revenue budget forecast to increase by just over 1 per cent over the next 4 years.

Marlyn Glen

3 November 2011

In these times of diminished hopes, the fears of dedicated but demoralised nursing staff in the NHS were revealed a few weeks ago by RCN Scotland’s survey of members.

It showed that only 30 per cent of nursing and healthcare support staff felt that their job was "secure". This was a drop of over 40 per cent compared with the 74 per cent recorded two years ago.

Furthermore, under 40 per cent would recommend nursing as a career, compared with 54 per cent in 2009.

Nursing staff were described as being " at breaking point".

The doctors’ professional body, BMA Scotland, stated last month that the NHS in Scotland was braced for "unprecedented " reductions in budgets in real terms money, and that the "rising costs of health inflation could jeopardise the range and quality of services the NHS currently provides.

"It is vital that the Scottish government and managers take a long-term view for the NHS and work with health professionals to identify how services can be made more efficient and where cuts should be made without compromising patient care."

The Scottish Government has a different perception of the condition of the health service from those who work in it and use it day-by-day.

Thus, First Minister Alex Salmond claimed in June,

"Even in these difficult times, health employment in every single category—through medical consultants, general practitioners, dentists and nurses to allied health professionals—is substantially up today on the level that we inherited in 2007".

Unfortunately for Mr. Salmond, the figures on the NHS say something different.

The Scottish Government’s own database states that details of the number of general practitioners and dentists employed " is currently unavailable due to changes in methodology and data quality issues"

The figures for the total NHS workforce minus GPs and dentists shows that in the past 4 years it has risen from 130,245 to 131,914 - just a 1 per cent increase - "substantially up today on the level that we inherited in 2007"?

In fact, in each of the past two years, the number of total NHS staff has fallen, and the Scottish Government’s own figures also show that some 2,300 posts in the NHS in Scotland will go in this financial year.

The same database shows that there are now over 360 fewer nursing and midwifery staff in the NHS in Scotland than there were when Mr Salmond became First Minister.

These same figures on staffing, this time for NHS Tayside, tell a different tale as well from the "substantially up" story.

According to them, the number of nursing and midwifery staff in NHS Tayside has decreased by 21 ( full-time equivalents) and is not "substantially up" since Mr. Salmond became First Minister.

In NHS Tayside in "Allied Health Professionals", a category quoted by the First Minister, there has been a average rise of just 5 more staff in each of the past 4 years from a base of 803 - "substantially up on the level that we inherited in 2007"?

Some Allied Health Professionals in NHS Tayside have fallen in number.

In Occupational Therapy there are 23 fewer compared with 2007.

Over recent months ( March to June), there have been  a fall in the number of staffing posts in Dietetics, Orthotics, and Therapeutic Radiography.

In the past 2 years, 12 posts have been lost in physiotherapy.

We are constantly told by Scottish Government Health Ministers that they are now providing "record funding" for the NHS.

The same can be said of generally of employers who are providing "record wages" for their employees.

However, do these "record wages" keep up with those record prices in the shops , in energy bills and transport costs?

It’s when the Scottish Government’s "record funding" is scrutinised in this light that the real picture emerges.

The Scottish Government’s " Spending Review and Draft Budget for 2012-13" provides its preliminary ( but not finalised) figures for NHS expenditure till 2014-15.

The total expenditure , in real terms, taking inflation into account, is forecast to fall by £319 million by then.

To give just a few possibilities in individual specialities, in real terms expenditure ,

General Medical Services face a cut of £53 million

General Dental Services face a cut of £30 million

Ophthalmic Services face a cut of £7 million

Nursing Education and training face a cut of over £11 million

Clean Hospitals/MRSA Screening face a cut by £2million

Alcohol Misuse programmes face a cut by £3 million

NHS Tayside’s initial revenue allocation budget, currently just under £600 million a year, is anticipated to increase by less than £1 million in real terms in the coming year, an increase of just 1 per cent.

By 2014-15, it will rise by just over £6 million in real terms on the initial budget to just over £600 million. Over the four year period, the overall rise will be just over 1 per cent.

However, health service inflation costs - drugs and equipment in particular - are currently running at around 4 per cent.

On top of that are the "efficiency savings" .

These are serious financial demands.

3 per cent "efficiency savings" were ordered from budgets this year, with no real let up forecast for future years.

The Christie Commission reported on the struggle that the public sector services such as the NHS have in meeting increased demand, chiefly from an ageing population and chronic health problems , while the Scottish Government has set itself upon a low-taxation policy.

The Commission estimates that the shortfall in funding to meet this demand could rise to £3 billion by the middle of this decade.

It said,

"Our public services are now facing their most serious challenges since the inception of the welfare state.

"This rising demand for public services will take place in an environment of constrained public spending.

"In the absence of a willingness to raise new revenue through taxation, public services will have to achieve more with less."

This means nursing and other clinical posts vacancies being left unfilled and the re-deployment of existing staff.

It means front-line posts disappearing.

It doesn’t mean that the same standard of service for patients can be provided with fewer staff.

This is what happens when the Scottish Government’s core policy is a 5-year council tax freeze which no one knows how it can be paid for.

A sweetshop without prices.

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