Why nurses are angry (1993)

From the November 1993 issue of the Socialist Standard

In September nurses from University College Hospital (UCII) in central London went back to work after a six-week strike. What made them angry enough to strike?

Why is it that approximately two months ago south London hospitals were crying out for extra nurses to care for patients on the wards, but there was not an agency nurse to be found?

A recent survey done by the Institute of Manpower Services found that one nurse in four would leave the NHS if they could. Why?

The creation of the internal market within the NHS has meant there is increasing pressure on trusts to keep within their budget. With the old system it did not matter if budgets weren’t kept to, the money was just replaced. In the new system if you don’t keep within your budget, then you don’t meet your contracts and eventually you go bankrupt like any other business.

In trusts most of the money goes on nurses’ wages (they are the majority of the workforce).

Constant pressure

There is constant pressure to cut this budget and this lias been addressed in a variety of ways.

First, freezing posts as nurses leave. Second, possible redundancies, though on the whole this has not been widespread as yet. However in the College of Health Studies where I work, there has been an amalgamation of two colleges of nursing which involved redundancies. The College is about to amalgamate with a further two colleges of nursing and more reductions are planned. It has been suggested that the 183 teaching posts in the three colleges will be cut to 52.

Third, alteration to nurses’ hours. Nurses have traditionally worked a shift system of earlies, middles, lates and nights. The hours are different from hospital to hospital but used to be roughly: Early: 7.30am to 3.30pm; Late: 1.30pm to 9.30pm; Night: 9pm to 7.45am.

Managers did not see why there should be an overlap of nurses on duty between 1.30pm and 3.30pm. This did not appear to be cost effective. What were the nurses doing during this time? On investigation it was found that education of students and professional updating of staff went on. As the extra nurses were not directly involved in patient care, managers felt it was a waste of time having them and altered the hours accordingly. Extra money was also being paid to the night shift for working "unsocial hours"; again managers fell this could be tampered with in some way.

At one particular hospital the nursing shift hours are now: Early: 7am to 3pm; Late: 2pm to 10pm; Night: 9.45pm to 7.15am. This hospital may have reduced the nursing budget on hours, but its sickness rate has soared and it is having to pay agency staff to work.

Finally, alteration in ward skill mix. There is a trend to employ more care assistants (unqualified nurses) instead of qualified staff, who are paid more. This leads to a decrease in the quality of nursing care given to patients.

Two research studies (Skill Mix and the Effectiveness of Nursing Care, Centre for Health Economics; York and Ward Nursing Quality and Grade-Mix, Report No. 504, York University’s Health Economics Consortium.) showed that where wards were staffed wholly by qualified nurses the standard of care given to patients was high, but where wards were staffed with combinations of unqualified and qualified nurses the standard of care delivered to patients was lower.

Fragmented care

This appears to be because unqualified staff cannot give the total nursing care to the patients. For example, they lack the knowledge to interpret signs and symptoms and cannot give out drugs. This means that patient care becomes fragmented and patients have to wait for qualified nurses to gel to them to give them the appropriate drugs or interpret symptoms.

All these points mean that there is an increase in pressure on nursing staff which results in frustration because they cannot give the nursing care they want to.

A Trust’s survival depends on getting contracts from Health Authorities and GP fundholders. Since the reforms there has been an increase in productivity within hospitals. This increase in throughput of patients has a tendency to mean early discharges, which puts extra pressure on nursing staff to ensure that discharge arrangements are ready and that there are enough beds for patients coming in. It may also mean patients go home too early — and have to be readmitted. The government says that wage increases will come from increased productivity. But if contracts are completed early. Health Authorities and GP fundholders have no more money to buy more treatment for their patients. So hospitals simply have to stop work. Eventually this will mean that hospitals cut the number if nurses so that, although the amount of work remains the same, there are fewer people to do it and it takes all year to complete. This situation is worse in London due to high overheads and London weighting etc. For example Camden and Islington Health Authority stopped all elective surgery at some central London hospitals in September because it had used up all its money with these expensive Trusts.

The planned reduction in junior doctors' hours means that some things previously done by doctors will become the remit of the already overburdened nurse. Again, nurses are cheaper to employ than increasing the number of doctors.

All these things mean that the nurses are increasingly having to alter the way they care for patients and are increasingly leaving the patient's bedside, for which they have been trained, to deal with administration issues such as discharge arrangements or managing bed vacancies.

No wonder the nurses at UCH said enough is enough.

If the Tories win another general election, the next step is obvious. Trust hospitals will simply become private hospitals, contracting with both private health insurance companies and Health Authorities for their income. And Health Authorities themselves will simply stop buying some treatments. A Labour government would be no better as they would still face the fundamental problem of how' to finance an NHS which will need more and more money for research, new drugs and so on.

Within capitalism it is impossible to deal effectively with disease and illness with the NHS or any other healthcare system as the emphasis is on profits rather than peoples' health and researching into causes of ill health. The only way in which to have a proper Health Service is to form a society which is based on peoples' needs: socialism. Finance and the fundamental problems it brings will disappear as it would be a society based on need rather than profit. Emphasis would be on prevention — at the moment this is too costly. The McKinleys’s river approach ( where individuals are falling into a river and drowning and Health care staff pull them out. patch them up and send them back to the top of the river, where they fall back in again) would stop and society will address the reasons why people fall into the river, such as bad housing, air pollution, etc. All individuals would be looked after in the appropriate place hospital or community. In hospital, there would not be the pressure on beds that there is now and people could spend as much time there as they need, and when discharged to the community there would be the proper resources available

Adele Atkinson