(issued by BMA Scotland Sunday 27 Jun 2010)

Recruitment freezes and unfilled vacancies mask the true impact of economic pressures on the NHS according to a new UK-wide survey of doctors published by the BMA today (Sunday, 27 June 2010).

Launched on the eve of the BMA’s annual conference, where NHS finances are likely to dominate doctors’ debates, BMA research shows that, despite reassurances that there will be no compulsory redundancies in Scotland, NHS organisations are already taking actions which could have devastating and long-lasting consequences for the NHS.

The survey of Local Negotiating Committees (LNCs) [1] found:

• • Around one in four respondents (24%) said redundancies were planned in their NHS organisation.
  • Almost two thirds of respondents (62%) said that there was a freeze on recruitment. Seventy per cent of respondents reporting a freeze indicated that it covered medical posts and 80% that it applied to nursing posts.
  • Just over half (55%) of those with no explicit freeze indicated that there were unfilled vacancies.
  • Nearly three quarters of respondents (72%) indicated that clinical service or infrastructure developments were being postponed for financial reasons and two in five that access to treatments or therapies was being limited.
  • Just under half (45%) of responding LNCs were being consulted on cost and efficiency savings. The amount of savings being sought varied considerably around an average of just under 6%.

Commenting on the research, Dr Brian Keighley, chairman of the BMA in Scotland, said:

“NHS Boards in Scotland have been upfront in publishing planned cuts to the NHS workforce, however these figures may not tell the whole story. Hospital doctors across the UK report that some NHS employers are freezing recruitment whilst medical and nursing vacancies remain unfilled.

“The Cabinet Secretary, Nicola Sturgeon, has already made a commitment to work with us and the other NHS Trade Unions to scrutinise NHS Board plans and it is in this spirit of partnership that I will be writing asking her to clarify the situation in Scotland regarding the findings of this survey.

“We recognise that there is intense pressure to make savings in the health service and as the NHS budget begins to shrink, Boards will inevitably have to consider cuts to frontline services. However, making indiscriminate cuts is not only short-sighted but could cause irreparable damage to the NHS.

“Even changes to back-room functions or administrative processes have consequences for front-line staff, who in many cases, have to pick up the work themselves; this means less time for patients.”

Although the Scottish Government has made a commitment to protect NHS funding the growth in spending in real terms is likely to be minimal and efficiency savings still have to be made. NHS Boards are already under pressure to make their funding go even further, eliminating waste and improving productivity. The BMA accepts the need to be realistic but says that involving clinicians and local populations in decision making is key.

Dr Keighley said:

“There are areas in the NHS where there is a genuine need to examine ways of working and service delivery to ensure that they are delivered in the most cost-effective manner – without affecting the quality of patient care. But all too often we see indiscriminate cost cutting decisions made, seemingly taken for political and financial expediency rather than because of good clinical evidence.

“Doctors and other health professionals should be actively involved in the decision making processes. I am pleased at this government’s commitment to work with us to scrutinise NHS Boards’ workforce plans but I also urge the urge NHS managers to work with us and focus on identifying areas where they can truly eliminate waste and achieve genuine efficiency savings rather than be tempted to make arbitrary cuts and introduce poorly thought out policies.”

Scottish hospitals could save £6 million a year by more efficient use of locum doctors

Posted: 17 June 2010

The NHS in Scotland could save almost 15 per cent of the money it spends on locum doctors in hospitals – or about £6 million a year – through better planning and procurement.

An Audit Scotland report, Using locum doctors in hospitals, says health boards spend around £47 million a year on locum doctors in hospitals. Locums are doctors of any grade or specialty who provide temporary staffing cover at any time. This spending has doubled in the past decade but, in many cases, health boards are not always clear about why locum doctors are being hired and how long they are using them for.

Auditor General for Scotland, Robert Black, said:

“Locum doctors have an important role in ensuring hospitals are adequately staffed and provide good quality patient care around the clock. In recent years, the demand for locum doctors has risen due to workforce issues such as increased difficulty in filling vacancies and the impact of European legislation governing working hours.

“Health boards need better information about why and when they use locum doctors; the grades and specialties of doctors they are hiring as locums; and whether locum doctors are existing employees or from agencies. With better information, boards could improve their workforce planning and use locum doctors more cost-effectively.”

The report also says the NHS needs to get better at managing the potential risks to patient safety of using locum doctors. This is particularly important for locum doctors who are hired through private agencies as they may be unknown to the board and unfamiliar with the hospital in which they are working.

Health boards across Scotland need to be consistent in the way they screen and induct locum doctors and the way they manage their performance. For example, pre-employment checks are not always formalised, induction arrangements are variable across different health boards, and feedback on locums’ performance is mainly verbal, with few written assessments or records. There are no formal systems for sharing information about individual locum doctors between boards.

Click the link for further information from Audit Scotland

Exclusive: Kate Foster

30 May 2010

Patients will be assessed by nurses instead of consultants and spend less time in hospital under controversial cutbacks to meet waiting time targets in Scotland.

Many follow-up appointments will be scrapped altogether and patients could be discharged from hospital at weekends under the scheme.

The groundbreaking plans to “streamline” the NHS have been revealed as hospital managers prepare to meet an ambitious target that no patient should wait longer than 18 weeks from a GP referral to the date of their operation.

The move will allow thousands to be treated faster but last night doctors and politicians raised fears it could compromise patient care.

The sweeping changes have emerged in official advice to NHS managers from the Scottish Government’s 18-week Referral to Treatment Time Programme, staffed by doctors and health officials.

Key changes proposed by the experts, revealed in a briefing to health boards, include using specialist nurses and health professionals such as physiotherapists to “reduce consultant appointments” by assessing whether the patient needs a specialist or just requires advice.

Nurses will also be trained to carry out some follow-up appointments and many outpatients will be seen at weekends.

The advice also states day surgery should be “the norm” rather than traditional overnight stays and patients discharged “as soon as they are ready”, including weekends which previously hospitals have avoided due to scarce community services. Health boards are also told to eliminate unnecessary follow-up appointments by scrapping them or replacing them with phone calls.

The move applies across all specialties for non-urgent patients as part of a £230 million three-year scheme to improve NHS infrastructure.

Managers must consider making the changes to free up consultant appointments and hospital beds.

Follow the link to read more about plans to replace consultants with nurses in  NHS Scotland

A major new report published today by Healthcare at Home Ltd explores which technologies and models used in the US for chronic disease management could successfully be adopted here in the UK.

The report – Lessons from the US: using technology and homecare to improve chronic disease management – is based on the observations of a US study tour of NHS and Healthcare at Home representatives who visited colleagues in Kaiser Permanente and HealthTech to look at how they use remote technology to manage chronic disease. Whilst they found there to be some exciting hi- and lo-tech innovations and lessons to glean, the group found that the US was not as far ahead in this field as expected.

Ruth Poole, Group Clinical Director, Healthcare at Home Ltd, says: “We were pleasantly surprised to find that the UK is in many ways better resourced and structured than the US to overcome the challenges related to increasing demand for services and chronic disease management. Specialist out-of-hospital care providers like Healthcare at Home Ltd are well established in the UK, and the NHS is already embracing innovation and major transformation in service design in certain areas, but we need to see this progress on a much wider scale if the NHS is to achieve the significant benefits that can be gained.

”The report found that in the “[US] healthcare follows the money, not the population’s health needs. The UK has an opportunity to look beyond this and concentrate on longer term benefits”.

One of the key recommendations is that the move to deliver more care closer to the home has to be underpinned by new models, technologies and systems: “If we simply transplant the same model of care used in hospitals to another setting we will not achieve the changes needed”.

Other reflections and recommendations from the report include:

• The UK must concentrate on longer-term benefits and consider the population’s health needs as much as the return on investment
• The NHS set-up allows it to look beyond immediate costs and benefits to start developing more innovative solutions that will lessen the cost of future services.
• Technologies delivered through everyday devices such as TVs and mobile phones will encourage greater compliance
• SHAs have access to innovation funds and should therefore take the lead in system development
• Transplanting the same model of care to another setting closer to home will not achieve the necessary changes
• Enabling an efficient flow of information between different health organisations is essential to effective disease management
• Capital investment should not just be about buildings
• Commissioners need to look beyond their usual providers and pathways and embrace more imaginative commissioning
• GPs and other primary care staff will play a key role in providing care closer to home
• The NHS must place more emphasis on managerial analytical competency

The overall purpose of the study tour was:

• to explore how diagnostics and care are delivered in the home
• to see how clinical interventions are managed using technology and support workers for increased value, and
• to glean any lessons for the UK from how the US is addressing these issues.

Hospital closures are inevitable, many believe

Politicians are “not being open and honest” about the issue of hospital closures, a coalition of charities and patient groups says.

Jeremy Taylor, head of National Voices, said the parties were happy to talk about the need for savings and moving care into the community.

But he said they were “shying away” from the flip-side – services closing and even whole hospitals shutting down.

All the main parties claimed they had clear policies to tackle the issue.

Mr Taylor said his organisation did not oppose hospital reorganisation and in many cases it can make sense medically.

Read more about hospital closures

ATLANTA, GA (March 1, 2010) – A new Jackson Healthcare survey of hospital nurses found that nurses estimate spending one quarter of their twelve-hour shift on indirect patient care.  Respondents cited regulatory requirements, redundant paperwork and logistical challenges as the primary contributors of time spent away from the patient’s bedside.

The study, which targeted nurses, nursing managers and chief nursing officers (CNO) across the U.S., was conducted in partnership with StatCom and Travel Nurse Solutions.  It was based upon an online survey of 2,439 nurses, and focuses on the 1,663 who work in hospital settings.

Nurses reported having to document patient care information in multiple locations, in addition to having to complete logs, checklists and other redundant paperwork that prevented them from having more time with their patients.  Beyond these paperwork redundancies, nurses reported significant time being wasted trying to secure needed equipment and supplies.

When asked for solutions to these challenges, nurses recommended a combination of ancillary staff support, hospital-wide communications technology and reductions in redundant regulatory requirements.

According to Jackson Healthcare Chief Marketing Officer, Bob Schlotman, the results reveal a concerning trend.  ”Nurses are being taken away from the patient’s bedside by non-patient activities.  Unfortunately, due to the regulatory nature of healthcare, we know that some of these redundancies won’t go away.  However, the good news is methodology, in the form of process improvements, and adaptive technology now exists to help minimize and manage these frustrations for our nurses.”

The survey found several significant differences between front line nurses and CNOs.  CNOs were more concerned with the coordination of patient care, whereas nurses felt overworked and in need of additional staff support.

The survey summary data is available at Jackson Healthcare.

SURVEY METHODOLOGY-Between October 22 and November 30, 2009, Jackson Healthcare conducted a web-based survey of 2,439 nurses.  Results reported in this press release focused on the 1,663 of those nurse respondents who work in hospital settings.  Jackson had a response rate of 4.45 percent from the 54,764 invitations distributed.  The survey has an error range of +/- 1.29 percent, at the 95 percent confidence level.

Is this an opportunity to improve systems and technology??

New European rules reducing junior doctors’ hours to a maximum of 48 per week came into force at the weekend.

NHS Grampian revealed it had employed 60 additional staff in order to comply with the European Working Time Directive.

Read the article HERE