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Hello and Welcome…

August 10, 2015

Hello and welcome to the new NHS fun games show ‘How Essential Is Your Job‘?! Leaving aside the obvious caveat that if you’ve got time to play it, your job probably isn’t essential, let’s have a peek at some sample questions!

Question 1: A ward has an outbreak of C Diff. Your role is a) assist and comfort soiled patients; b) ensure sufficient staff are available to assist and comfort etc; c) co-ordinate/investigate/monitor/contain; d) draw ward’s attention to overspend on nursing wipes. Question 2: A patient needs to be specialed. Your role is a) act as special b) ensure extra nurse is available to act as special; c) co-ordinate rapid transfer to environment less likely to cause distress; d) inform the ward (by phone, obvs) that a special is unaffordable and will need to be found from within existing resources, goodbye.

Now tot up your scores! Mostly A’s, B’s or C’s – sorry, your job is not essential. You are advised to contact your nearest Job Centre. Mostly D’s – congratulations! Your job has been rated ‘essential’ and is not at risk. How do I know this? Actually, I don’t – but in the absence of any clearer definition of ‘essential’ in Monitor Chief Exec David Bennett’s recent letter to Foundation Trusts (FTs), I think we’re free to assume that for the next few years, saving money will be more important than saving lives.

To be fair, after publishing his letter, in which he warned that ‘almost unprecedented financial challenges’ meant FTs should consider filling vacancies ‘only where essential’, Bennett did backtrack to the extent of issuing a statement saying that ‘this section of the document related to non-clinical staff’. As the esteemed Basket Press OTP observed in a below the line comment on this story, you could be forgiven for thinking Vicky Pollard is in charge of Monitor these days (‘but yes but no but yes but no but yes…’).

But even after this so-called clarification, questions remain. Bennett’s spokesman added that he would be ‘surprised’ if Trusts interpreted the letter as an instruction to stop hiring clinical staff. ‘Surprised’ eh? As a sanction, it’s not really up there with being barred for life from ever darkening the door of public sector employment, is it? I can’t imagine that Finance Directors up and down the land are quaking in their boots about the prospect of making a spokesman feel mild-to-moderate ‘surprise’ when the s*** from the next Mid-Staffs hits the fan.

More worrying still, Mr Mild Mannered Spokesman also declined to elaborate on another of Monitor’s recommendations: that safe staffing guidance should be ‘adopted in a proportionate and appropriate way’. Sorry mate, but what does that even mean? You’ve got the guidelines – you either stick to them or you don’t: it’s that simple. Like the Highway Code, safe staffing guidelines are there to protect everyone, all the time, and not – repeat not – only when it suits. Forgive the bluntness, but this is how people end up dead.

I suppose (if we were desperate) we could always turn to Jeremy Hunt for some leadership. In a Q&A session after a speech delivered at the Kings Fund in July, he said he was against introducing a different safe guard – mandatory minimum staffing levels – because ‘you could have two trusts – one with higher levels of staff who spent “a lot of time filling out forms” and another with lower numbers but with “vastly safer care because they worked out systems and process which means staff can spend 80% of their time on patient contact”’. It’s a completely spurious answer of course. Such wide variations should not even be tolerated, much less used as an excuse. True leadership is about turning ‘the best’ into ‘the norm’.

As others pointed out after the Bennett letter broke, the workload remains the same however many staff are available to do it. So while some staff may look ‘non-essential’, all that’s achieved by removing them is reassignment of their work to those who remain. And historically, this has usually meant ‘the nurses can do it’ – after all, they’re available 24/7 and although there might be muttering before home time, they rarely make any real trouble.

NHS nursing is facing a perfect storm. With work on safe staffing apparently sidelined, plus the prospect that we will increasingly be asked to shoulder the work of ‘non-essential’ others, Jeremy Hunt is effectively asking the question ‘what is nursing?’. Which of the following then, is most likely to be his answer?: a) a confident, independent therapy, essential for the delivery of collaborative health care; b) the workhorses of the NHS, there to keep their heads down and get on with the job; c) whatever politicians need it to be at the time; d) form-fillers – didn’t we classify that as non- essential?

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