It’s about the NHS, stupid. To adapt the truism about all general elections, the state of the NHS matters as much to us if not more than the economy. We humans, while brilliantly designed, are inherently flawed. We get cancer, heart disease, diabetes; we break our legs, our hips give way, we go blind. As we get older, we need medicine to intervene more and more. Education matters, but not everyone has children. But everyone will, at some stage, need to go to hospital. And if people lose confidence in the NHS, the Government of the day will be punished at the polls.
So how are ministers responding to the appalling scandals at Mid-Staffordshire hospitals and elsewhere? The Government is promising action to turn around failing hospitals. But, as research showed yesterday, there is an immediate crisis in the most fundamental part of hospital care: nursing.
Analysis by King’s College London’s National Nursing Research Unit found that 43 per cent – nearly one in two – wards have dangerous staffing levels: that is, where there are more than eight patients per nurse on duty. This means nurses are unable to provide even basic levels of care, such as keeping an eye on hydration and medicine, let alone making cups of tea and finding time to have a chat. And in nursing, when a visit by a consultant or junior doctor is fleeting, surveillance is key. We were led to believe that the horrors at Mid-Staffs, where patients were forced to drink out of flower vases, and hundreds died unnecessarily, was a rare scandal. That nearly half of all wards have staffing ratios at danger level suggests that the crisis goes far deeper – that a hospital near you is struggling to get by in providing basic patient care, and that the next scandal could be in your neighbourhood.
The research discovered that wards for elderly people have the worst staffing levels, with an average of 9.1 patients per nurse. In one respect, this is unsurprising, given that many of the patients who died needlessly at Mid-Staffs were elderly. But look at it another way, and this should be a cause of outrage. Surely it is the most vulnerable patients who require the most looking after, given that they are less likely to be able to shout loudest for attention?
The one-nurse-per-eight-patients ratio is for guidance, but it should be made statutory. Perhaps the ratio should be even higher, at one nurse per five patients, as in the US and in New South Wales, Australia. The recommendation by the Health Select Committee yesterday that all wards should provide staffing levels to trusts and patients daily, rather than twice-yearly, should be implemented. But that is just about the publication of data. Ministers now need to look urgently at recruitment of more nurses.
Which brings us to money. During the 2010 election campaign, David Cameron promised to “cut the deficit, not the NHS”. He has honoured both these pledges – sort of. NHS spending has, indeed, not been cut. But it has remained flat, barely rising in real terms. And as we learned yesterday, the extra money has hardly been funnelled to the frontline: hundreds of millions is still going on the NHS IT system that was abandoned two years ago. Coalition ministers can blame Labour for their contract decisions while in government, but they should tear up any remaining obligations the government has with the firms who have failed to deliver, and divert the cash to taking on more nurses.
The Health Secretary, Jeremy Hunt, should also look at training, to make nursing a more attractive career than it is at present. Who would want to go into a profession that is poorly paid, where you are overworked and undervalued? When our loved ones get sick, they deserve the care of the best, most dedicated people. When she is devising a “tough” immigration policy, Theresa May, the Home Secretary, needs to bear in mind the fantastic contribution that immigrant workers make to the NHS. Without nurses from the Philippines, Africa and Latin America, our health service would collapse overnight.
This week it emerged that there is a little bit of extra money in the Coalition biscuit tin for a couple of popular policies that will delight the two parties’ members at conference season. The Lib Dems announced £600m to spend on free school meals for all 4 to 7-year-olds, while dropping their opposition to the Conservatives’ married couples allowance, which will also cost around £600m. Apart from the health benefits that free school meals will bring to the new generation of infants, the estimated £437 a year in savings this will give to families will give them more money to spend – and consumer confidence is what the economy desperately needs. The justification for a married couples allowance, saving around £150 a year, seems less clear, beyond reassuring traditional Tories that the Prime Minister really does care about marriage.
Yet if the Chancellor has some spare cash, he should make recruitment of nurses – and not marriage – a priority. It would certainly represent excellent value for money. Hospitals are already spending vast sums on e agency staff to cover shortages. It is about the economy. But it is also about the NHS.