Wednesday, 18 January 2017

Vote of no confidence in the Chief Nursing Officer of NHS England

On Wednesday, the governing Council of the BMA will take the unprecedented step of debating a vote of no confidence in the Chief Nursing Officer, Professor Jane Cummings. I am the member of council that has proposed the motion of no confidence. I took this step on the basis of Jane Cummings' recent interview with the Telegraph, in which she quite rightly called for more investment in community care, but at the expense of cuts to acute care NHS beds [1].

This is a dangerous and negligent approach in the context of an ongoing crisis in the NHS with many hospitals on blacks alert (hospitals at full capacity, closed to further admissions), routine operations being cancelled including cancer surgery [3], a lack of provision of mental services, a collapsing social care system, and general practice in meltdown. If she had based her argument solely on the idea of investing in community & social services to help deal with the major problem of delayed discharges (patients fit to leave hospital, but lacking necessary social care discharge arrangements), then I would have supported her. However, she did not call for extra investment to achieve her goal. On the contrary, she called for yet more NHS "efficiency savings" by openly supporting the Department of Health policy of Sustainability and Transformation Plans (STPs). 

These plans are driven by a mandate to achieve a further £22bn of NHS "efficiency savings" by 2020, which will not only reduce funds for acute care, but also inevitably result in cuts to the very community services that she supposedly wants to bolster. Not surprisingly, all of the 44 STP "footprints" (regions) have plans to save money by closing services.

Worse still, Jane Cummings should know better, because she was involved at senior level, in the previous Government's £20bn "efficiency savings" program called the "Nicholson Challenge" or QIPP (Quality, Innovation, Prevention, Productivity), which lasted for four years and only achieved £16bn out of the £20bn target. Sir David Nicholson, the former CEO of the NHS, who had the responsibility to deliver the "Nicholson challenge" has stated that this level of "efficiency savings" wasn't repeatable. And you only have to look at the current state of the NHS to understand why - the "Nicholson challenge" has crippled the NHS. It is one of the main reasons why the NHS is in its current crisis. Even Andrew Lansley, the former health secretary, thinks the NHS needs more money. 

Yet, Jane Cummings thinks that STPs are the way forward with another £22 billion worth of efficiency savings on top of the previous £20bn. She is clearly completely out of touch with expert opinion. The Health Select Committee and the main health think tanks have stated this is unachievable without compromising patient care and safety [4]. Since her her employer, NHS England states
"A core role of the Chief Nursing Officer will be to drive quality improvements in patient safety and patient experience", her support for STPs and £22bn of "efficiency savings" is clearly incompatible with her role as Chief Nursing Officer.

The CNO also has a responsibility for NHS finances and efficiency and it is now becoming clear that excessive "efficiency savings" are actually making the NHS less efficient according to health economists from the Health Foundation [5]. For example, NHS staffing has been cut to the bone which has led to a spiralling locum bill for doctors, nurses and other healthcare professionals. In addition, the current crisis in emergency care has led to the cancellation of routine operations, with significant financial consequences for NHS trusts. Moreover, the £200m cut to the public health budget has also damaged the most efficient and cost effective way of reducing demand for healthcare - tackling preventable diseases.

One therefore has to question why Jane Cummings has taken the position to defend a government policy that will inevitably harm patient care. Clearly, she is an employee of NHS England and has a responsibility to her employer. However, this must be balanced against her professional judgement about patient care, the state of the NHS, the health of the nation, and the greater good. Politicians have a long standing record of using clinical leaders in important positions to back their positions. Nigel Lawson, the former Tory Chancellor of the Exchequer under Margaret Thatcher, expressed this very well in his diaries [6]. In relation to Thatcher's NHS reforms, Lawson stated:

"The professionals, once they knew it was going on, wouldn't be backwards in giving us their advice, and more fruitfully we could always get the opinions of politically well-disposed practitioners informally".

The public trust nurses and doctors and therefore politicians are keen to use them to promote bad policies. It is therefore vital that our clinical leaders are able to speak truth to power and don't succumb to this political interference. The culture of "yes men and women" has damaged the NHS over the years and must be challenged. This is why I think a vote of no confidence is so important. Jane Cummings must be held to account for her actions. She is either guilty of supporting a government policy that will clearly harm patient care, or she is guilty of lacking understanding & knowledge of the consequences of another £22bn of NHS "efficiency savings". Either way, I think her position is now untenable.

NHS staff up and down the country are working incredibly hard to keep patients safe, often under very stressful and intolerable conditions. Despite this, patient care is clearly being compromised and lives increasingly put at risk. In fact, we know that "exit block" in A+E departments increases mortality, so it is very likely that lives have already been lost and will continue to be lost [7]. 
NHS staff and the public deserve better and shouldn't have to put up with this type of misguided leadership.

[1] Cummings interview. Telegraph:
[3] Cancer operations now being cancelled amid NHS crisis, surgeons' leader warns. Telegraph.…/cancer-operations-now-canc…/amp/…
[5] Hospital finances and productivity: in a critical condition?…/HospitalFinancesAndProductivity.…
[6] View from No11. Nigel Lawson's diaries.…/sta…/719107080834129920/photo/1
[7] Exit block in emergency departments. RCEM

Dr Clive Peedell

NHS crisis at Paddington St Mary's Hospital revealed in BBC2's 'Hospital' as staff forced to choose between patients

The BBC2 episode followed two patients who need life changing treatment, but resources were short.

Lesley Powls, site director at St Mary’s describes her job as an “air traffic controller"

A severe shortage in beds showed the NHS crisis in its true light as BBC2's new documentary, 'Hospital' , followed the story of two patients at St Mary's Hospital.
Viewers were left astonished after watching Paddington staff members in the six part series torn in a dilemma involving a cancer patient and a woman needing immediate surgery.
Wednesday night's (January 11) programme followed Janice who was shown being rushed to the hospital after suffering from a ruptured blood vessel.
At the same time, cancer patient Simon is seen prepped and waiting for surgery to remove a tumour from his oesophagus.
Simon is told that, if Janice survives the ambulance ride, she will take the remaining space in the operating theatre

Both need to be in the intensive care ward - but, while there are enough surgeons to perform both operations, there is only one bed remaining.
Heartbroken viewers watched as surgeons admit Janet could bleed to death if she was not attended to, yet Simon had already had his operation pushed back before.
Simon is told that, if Janice survives the ambulance ride, she will take the remaining space in the operating theatre.
If she dies en route, Simon's operation will go ahead and the 67-year-old cancer patient is asked how that makes him feel.
Fighting back tears, he answers with just two words: "Guilty, actually."
In this case, the blocks fall against Simon, whose surgery is postponed for a second time.
Viewers were in for a further tragic revelation however - although Simon did actually get his operation, just a day later, he died six weeks after contracting a blood and immune disorder known as HLH.
West Londoners took to Twitter to express their heartbreak after watching the every day struggles NHS staff have to make.
It is so sad to see what underfunding has done to the NHS  

While some mentioned a lack of funding, others blamed the government for being "naive" about the situation.

Teresa May should really watch  on BBC2 RN so she won't remain quite so naive about the state of our NHS @ImmyWM

Hospital continues next Wednesday at 9pm on BBC Two
  • 12:31, 12 JAN 2017
  • UPDATED12:33, 12 JAN 2017

​If you missed the first episode, you can watch it here:

Pressure on Charing Cross A&E as new figures show rise in patient numbers and missed targets

Campaigners say increase in patient numbers is further proof the emergency unit should not be axed or downgraded.

Charing Cross Hospital has seen extra pressure on its A&E

Latest NHS figures show the number of people needing emergency treatment at Charing Cross Hospital’s A&E is on the rise.
Hospital chiefs at Imperial College Healthcare NHS Trust have released figures showing the increased demand for the hospital’s emergency department last summer.
From July to September 2016, the new data shows that compared to last year:
  • The most serious (Type 1) of A&E visits are up 12.5%
  • Overall A&E visits are up by 7.9%
  • The number of patients arriving at A&E by ambulance is up by 7.7%
The figures come ahead of the annual winter spike and flu season, and as the A&E department was extended with a new 13-space acute assessment, as well as a new 35-bed acute admissions ward.
There has been a 35% increase in A&E patients at the Fulham Palace Road hospital since Hammersmith Hospital lost its A&E.
A spokesperson for Imperial told getwestlondon that the NHS Trust was facing similar pressures to other A&Es across the country.
Hammersmith and Fulham Council is one of several Labour-run local authorities in west London fighting the SaHF plans.
Council leader Stephen Cowan said: “The plan to close the A&E at Charing Cross is foolish.
"These figures show how vital it is to the growing population of west London.
Charing Cross Hospital in Fulham Palace Road, Hammersmith
“Shutting the A&E Hammersmith Hospital was a mistake and contributes to the pressure.
"And unfortunately patients and local residents are suffering as a result.
"As the Mansfield Commission report made clear the planned A&E closures would be dangerous and should be abandoned.”
The extra numbers were also placing more pressure on not only Charing Cross’ A&E, it has been said.
Imperial reported it missed its October target for the speed in which A&E patients were seen, with 87% treated under four hours - well below the 95% target.
At St Mary’s Hospital, the figure was lower, at 79%.

'Plain irresponsible'

Merril Hammer, chairman of the Save Our Hospital Group, said: “A key problem is that there are just not enough beds.
"Bed occupancy is at record levels – well above what’s recommended.
"To talk about closing Charing Cross as an acute hospital is just plain irresponsible.”
According Hammersmith and Fulham Council, the SaHF programme would see patients diverted to "out-of-hospital" care so Charing Cross can be downgraded to a "local" hospital.
“This means shutting the A&E and replacing it with an Urgent Care Centre on just a fraction of the current site, with most emergency cases diverted to St Mary’s,” a spokesman claimed.
When Hammersmith and Fulham Council asked about the impact of rising demand from patients on Charing Cross, an Imperial College Healthcare NHS Trust spokesman said: “Despite our efforts, this is having an impact on how quickly we can see and treat patients and on our capacity for planned care.”
A spokesman for Imperial College Healthcare NHS Trust said: “Unfortunately, there are very similar pressures in A&E departments across England.
"The causes are complex and include increasing demand as well as challenges in discharging patients who have completed their hospital treatment but need ongoing care and support at home or in the community.
“We recently gave a public reassurance that there will be no reduction in Charing Cross Hospital’s A&E unless and until we are able to reduce demand through out-of-hospital services, and that any plans must be developed with local communities.
“With the support of Imperial College Healthcare Charity, we are currently making significant improvements to a range of facilities at Charing Cross, including A&E, acute medicine, outpatients and theatres.”
  • 06:00, 11 JAN 2017
  • UPDATED08:48, 11 JAN 2017
Please check the Get West London website and watch Vanessa Redgrave hitting out at A&E closures:

'I go home and weep': Hell of working on front line of cash-strapped NHS exposed

After the Red Cross claimed there was a 'humanitarian crisis' in England's hospitals medics reveal their tears and frustration at the way the service has become perilously overstretched.

Lesley Powls says she is struggling to find enough beds (Photo: BBC)

Week after week trying desperately to paper over the cracks in the cash-strapped NHS takes its toll on hospital boss Lesley Powls.
The ex-nurse, who manages beds across five hospitals, said “It’s not like I don’t go home some days, walk through the front door and start crying – because I do.”
She is just one of the medics to reveal the tears and frustration at the way the NHS has become perilously overstretched .
Doctors warn hospitals have ground to a halt because of the lack of beds – with lifesaving surgery delayed or cancelled.
Theresa May yesterday rubbished the Red Cross claims of a “humanitarian crisis” in England’s hospitals. But evidence from medics in a TV documentary this week tell a different story from the PM’s denial.

The staff of St Marys Hospital A&E cannot cope with patient numbers (Photo: BBC)
Lesley, site director at St Mary’s hospital in London, says: “It feels like all we do is manage beds but what we really do is manage people who need us to help them.
“I do the right thing all the time in this job, but it’s not always right for one person.
“I do the right thing for the hospital and that’s really difficult because that does mean there will be people who, today, we haven’t done the right thing for.” They are put on red alert when there are hardly any empty beds. It happens every few days.
On Friday it emerged that because of overcrowding A&E departments were forced to shut their doors to patients 143 times last month. The number in Christmas was 42 – a new record.
The BBC documentary will show the awful dilemmas faced by NHS staff.
Staff at St Mary’s in West London found their resources were so overstretched in the autumn that a flu epidemic this winter would have left them “completely stuffed”.
The problems are the same across the other four hospitals in the Imperial College Healthcare NHS Trust – which has allowed TV cameras in to film for the first time – and hospitals across the country.
St Mary’s consultant surgeon George Reese is shown being put on hold for an operation on a cancer victim because there is no available bed in the high dependency unit for the patient to recuperate.
He says: “Beds are so bad... it seems rare you can actually do an operation.
“At some point somebody will be telling me whether we’re allowed to do any work.” Another surgeon, Richard Gibbs, says the situation is the worst he has ever seen.
He adds: “I sometimes feel I spend as much energy trying to organise and manage beds – in order to allow us to... do what we want to do, which is to operate.”
The picture is repeated around the country as whistleblowers warned of “hellish” conditions. A nurse at the Leicester Royal Infirmary said patients are being put at risk because of staff shortages.
The nurse said: “Patients on oxygen are being cared for in corridors – no one should be in the corridor, let alone when they are on oxygen.”
At Stafford County Hospital ambulances were diverted away from the A&E department last week because of a shortage of beds. Hospitals in Essex, Cumbria, Bristol and Cambs issued pleas on Twitter for people to stay away.
It comes after two people died at the Worcestershire Royal Hospital after waiting for hours in corridors.
The BBC filmed its documentary in October and November. Dr Ali Sanders, chief of service for emergency and ambulatory care, said: “We’ve just had our worst 10 days on record. There’s nowhere in the hospital to move anybody.
“What’s happened in the last two years is the whole system, countrywide, has ground to a halt.
“It just makes us feel as though we are firefighting every single day.
“We are not unique at Imperial. We’re just struggling to keep afloat. Everyone’s working as hard as they can and I think they’re fed up of being told to be more efficient all the time...
“When people are working this hard day in, day out, they get tired. You hope they don’t make mistakes.”
Dr Sanders added: “It’s felt on many days as though we’ve had the tipping over the edge of a cliff phenomenon where you get to a critical point and you can’t function for the admitted or the non-admitted because you are full.”
Yesterday director of medicine Professor Tim Orchard said. “Our two A&E departments continue to be very stretched and our beds are rarely empty. The whole NHS is under real pressure.”
In an email last night on the NHS, Labour leader Jeremy Corbyn told party members: “It is a crisis made in Downing Street by this Government. It is a national scandal.”
  • Hospital will be screened on BBC2 on Wednesday at 9pm.

Now hospitals need our care to survive crisis

John Ashworth: Shadow health Secretary

Jon Ashworth, Shadow Secretary of State for Health (Photo: Getty Images Europe)
There is no doubt hospitals across the land are going through one of the most difficult winters on record.
They are overcrowded,
overstretched and underfunded.
Last month, a third of hospitals issued warnings that they needed urgent help to cope with the number of patients coming in.
Seven hospitals admitted they were unable to give patients comprehensive care.
And A&E departments turned patients away more than 140 times.
The health system is being pushed to breaking point.
And yet Ministers are pushing ahead with plans – drawn up behind closed doors – to cut the number of beds, ration treatment and close or downgrade A&E departments.
Labour will always support change in the NHS when it is in the best interest of patients. But when plans to shut an A&E department are made to plug a hole in finances, then that is not the solution.
It will simply push patients to other parts of the NHS that are already overstretched.
It’s time Theresa May took responsibility for the crisis facing the NHS on her watch.
I am calling on the Prime Minister to bring forward the planned £700million of extra funding for social care to ease the pressure on hospitals. And also to bring forward a new funding settlement for health and social care in March’s Budget so this never happens again.
The NHS has been there to care for us for nearly 70 years. It’s time for us to care for the NHS.
The Mirror

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