19. Cuts, or cuts to care?
Southern Branch
(R) That this meeting of RCN Congress urges RCN Council to monitor the impact of cuts on patient care and to campaign against them at UK, national and local levels.
Result
The resolution was passed.
For: 99.79% (469)
Against:0.21% % (1)
Abstain: 0
Debate report
The RCN’s Frontline First campaign has highlighted the “unbearable” and “unsustainable” cuts in the UK nursing workforce in the last two years, said Maureen Dolan.
The declining numbers of nursing staff has an impact on nursing and patient care, she said. As demands increase, health and social care staff are working unpaid overtime to try to provide the best possible care for their patients.
Beng Poh highlighted the potential increase in costs as sickness rates rise as a result of growing numbers of staff experiencing stress, resulting in a negative impact on patient care.
First-time speaker Lisa Naylor asked: “What will it take for this government to stop?” As a student nurse who qualifies in September she expressed concern that nursing jobs will not be available. “We have a voice, please use it,” she added, as she urged delegates to support the resolution.
As speaker after speaker urged delegates to vote for the resolution, Zeba Arif demanded 100 per cent support. She urged members to write to MPs and councillors and protest loudly. “If we’re silent, we’re complicit,” she said. “Let’s make sure everyone in the land knows nurses do not stand for cuts.”
Zeba’s passion was matched by that of the RCN President Andrea Spryropoulos. She said that nurses can help with service redesign as nurses are the solution, not the problem. Sending a message to politicians, she said: “Don’t treat us as if we are idiots...every cut hurts, every cut bleeds, and I’m telling you, you can’t have top-quality first class care on the cheap.”
The resolution was passed.
Background
The NHS must increase productivity by at least 4 per cent per annum if it is to make projected efficiency savings of £20 billion by 2014-15. According to the Office for National Statistics, the average annual growth in productivity for the private sector between 1998 and 2007 was 2.3 per cent. Therefore the NHS is being challenged to significantly outperform the private sector and maintain or improve the quality of care.
The radical restructuring of the NHS in England over the next two years will be an additional concern to NHS leaders at a time when the issues of quality and productivity are paramount (Appleby et al., 2010). Health care providers have opportunities to make productivity gains by tackling variations in clinical service delivery, and improving safety and quality. Efficiencies can also be made in the prescription and management of drugs, which currently accounts for 12 per cent of the total NHS budget.
Commissioners can contribute to the effort by establishing pathways that integrate care across health and social care boundaries, and by decommissioning low-value interventions and reducing the likelihood of unnecessary hospital admissions.
Given that staff costs represent 60 per cent of the NHS budget, it is likely the size and composition of today’s 1.7 million NHS workforce will be changed. But NHS leaders have little evidence to draw on, in relation to the potential impacts on productivity or care quality, when making decisions about altering skill mix (Cookson et al., 2011).
Since 2010, the RCN has been monitoring the number of NHS posts lost or at risk through its Frontline First campaign. By November 2011, this figure stood at 56,058 posts lost or at risk across the United Kingdom. The RCN’s staffing levels guidance (RCN 2010) highlights a clear correlation between staffing levels and patient outcomes.
In Northern Ireland, the RCN monitors and reports monthly on the impact of cuts on service provision and the nursing workforce, both within the health and social care service and the independent sector. Information from this process is used to address issues in partnership at a local level and to highlight the RCN’s influencing work in Northern Ireland.
RCN Scotland is concerned that financial concerns are overriding other considerations, resulting in significant cuts to current and future numbers. By September 2011 there were fewer nursing staff in the Scottish NHS than at any time since 2006, and Scottish pre-registration nursing and midwifery student intake numbers for 2012-13 have been cut by 10 per cent. Since the publication of Taking the pulse of NHS Scotland at the end of 2010, the RCN in Scotland has continued to monitor the financial health of NHS boards and the consequent impact on workforce numbers and patient care. RCN activists in Scotland have been trained to participate in local negotiations and interpret detailed financial and workforce data to help ensure local decisions are transparent and do not harm patient safety.
The RCN sought amendments to the Health and Social Care Bill at report stage in the House of Lords to guarantee safer staffing levels and introduce the statutory regulation of health care assistants but these were unsuccessful.
References and further reading
Appleby, J., Ham, C., Imison, C., Jennings, M. (2010) Improving NHS productivity: more with the same but not more of the same London: Kings Fund Available at http://www.kingsfund.org.uk/publications/improving_nhs.html (Accessed 02/03/12) (Web)
Cookson, G., McIntosh, B., Griffiths, P. (2011) A division of labour: optimising hospital skill mix for output and quality Southampton: University of Southampton: Journal of Health Services Research and Policy Available at: http://eprints.soton.ac.uk/181135/ (Accessed 02/03/12) (Web)
Royal College of Nursing (2010) Guidance on safe staffing levels in the UK London: RCN Available at: http://www.rcn.org.uk/__data/assets/pdf_file/0005/353237/003860.pdf (Accessed 02/03/12) (Web)
