When winter comes can pressure on the NHS be far behind - except it's now a government secret
About this time last year, Marlborough News Online began an occasional series of reports highlighting the winter pressures on England's NHS hospitals - with special reference to the Great Western Hospital, which serves the Marlborough area.
After last winter, the pressures hardly reduced when spring arrived and demand for NHS hospital services kept on growing. And now it's winter again. But this time the figures are not being released as they were last year.
We will not now get weekly figures on A&E waiting times, cancelled operations, beds closed by norovirus outbreaks, or delayed transfers of care (DTOCs aka blocked hospital beds.) This winter's weekly figures were due to start on December 11.
But now only figures for cancelled operations, patients waiting over four hours in A&E and DTOCs will be released - and only released on a monthly basis and with a six-week delay. NHS England says it is 'seeking to minimise the bureaucratic burden on frontline hospitals and GPs'.
That is a really lame reason - or excuse: the figures will be collected and collated anyway - it's just the person who presses the 'send' button who will have for an extra cup of tea. You can tell it is an excuse by the use of the weasel phrase 'frontline hospitals' - are not all NHS hospital's 'frontline'?
At the GWH board meeting today (January 7), the directors learned that in November the emergency department treated 89.3 per cent of patients within the 4-hour wait target - the standard is 95 per cent. In the autumn GWH had hit the target percentage several weeks running.
Achieving targets are not the hospitals only problem. There is also the combined problem of the national nursing shortage and spiralling costs for agency nurses.
The GWH board members have before them a paper on nurse recruitment. This is a vital part of the GWH's strategy to cut its deficit and still keep patients safe.
Nursing numbers have been hit by the coalition government's disastrous cut in training places, years of low pay rises, the lure of agency pay scales and growing numbers nearing retirement age. Now hospitals are also having to take into account the dichotomy between safe staffing and a capped spend on agency nurses.
Part of the answer has had to be recruitment of nurses from overseas - running the gauntlet of Home Office entry rules, costs of recruiting overseas (which some national newspapers find offensive) and finding nurses with the right English, the right qualifications and a desire to work in England that will not prove too short-lived.
GWH's recruitment plans for 2016-2017 had been costed at £300,000. But this new paper adds another £221,400 to those the costs.
Costs are not the only hurdle. New rules come into force on January 19 to make sure overseas nurses have the 'appropriate' level of English language skills. The new level is equivalent to a master's level qualification and it is thought that only about five per cent of the overseas nurses who have joined GWH would have passed this new and stringent test.
The economic revival in Spain and Portugal and these new language rules will mean fewer suitable candidates will be found within the EU. So the GWH Board is being asked to agree an extended recruitment programme outside the EU - with a focus on the Philippines.
The quality and quantity of nursing recruits from the Philippines will be 'considerably higher' than from the EU, but the recruitment costs involved will also be higher and the time taken to get each nurse into post will be longer.
In order to cope with the increasing demand on hospital services and keep within the agency caps, GWH believes it will need to recruit ten EU nurses in each quarter of the next financial year - a total cost of £100,000. They also forecast the need to increase their recruitment during the year of non-EU nurses from 35 to 70 - raising those recruitment costs from an estimated £212,430 to £421,400.
Once these nurses have been at GWH for fourteen weeks, their salary and recruitment costs will make them cheaper than agency nurses.
The paper signs off with this statement: in order to have a full complement of registered nurses at GWH "...a similar international recruitment strategy will be required until 2020 when the number of nurses within the UK is expected to match the demand."