The NHS in crisis: Wiltshire's health services hit by staff shortages - and we have not got to Brexit yet
The NHS is all things to most people. It has been called a super tanker (slow to turn around), Britain's answer to Americans' 'motherhood and apple pie', an organisation so big it can be seen from space (like the Great Wall of China, but much more useful), the Daily Mail's favourite target as a gross interference with capitalism...and, much, much more often than not, it is called a lifesaver.
If the NHS was a stick of rock the word written from one end to the other would undoubtedly be 'workforce'. At a recent meeting of the Wiltshire Clinical Commissioning Group's board, 'workforce' problems were mentioned during discussions on just about every agenda item.
The NHS is facing this crisis of underfunding and a huge growth in demand with one hand tied behind its managers' and clinicians' backs: the appropriately trained and willing workforce is not available.
Jeremy Hunt's promise - made, we should not forget, to raise applause at the Conservatives' conference - of 6,000 more British doctors may be a long-term fix. In the short term it simply tells overseas doctors working in the NHS that they are not valued and may not be allowed to stay. Not totally helpful.
The 6,000 may not fix the problem at all once Brexit has meant Brexit and an unknown number of overseas doctors decide they do not like working here labelled as 'foreigners' and likely to be asked in the street when they are going home.
It is not only a problem for hospitals. The Marlborough Medical Practice have been trying for nine months to recruit a doctor. And now one of their doctors has left, they are one doctor down.
Lets have a look at the impact of this workforce crisis on one of the three acute hospitals that serve Wiltshire: the Great Western Hospital NHS Foundation Trust south of Swindon.
Their board meeting was told (October 6) the hospital has vacancies equivalent to 9.6 per cent of its planned staffing level - that is equal to 366 fulltime staff members.
283 of those vacancies are being filled with locum and agency staff and with staff from their own 'bank' of part-time staff.
The current (July) vacancy figures include a nurse vacancy rate of 11.3 per cent and for Band 5 nurses ('staff nurses') of 18.29 per cent.
GWH lists many risks arising directly from "Staffing levels" and "Staff capacity" and some of these pose threats to 'patient safety' and to the 'patient experience'. Some are at crisis level: "We have a crisis in paediatrics with only five out of eight Registrar vacancies filled in September 2016 and four out of eight filled in October 2016."
Or take another line in their very transparent register: "Risk to patient experience and quality of patient care (including patient safety) by a lack of timely access to in-patient bed capacity. As a result, the four hour access target is at risk of not being delivered resulting in patients having extended waits in the Emergency Department."
This risk is being met with a "review of nursing establishment and the patient flow team..." and writing a business case "to increase the nursing establishment in Patient Flow to cover seven day working." And seven-day working was an unfunded manifesto commitment - so where is the finance for an increase in the nursing establishment?
GWH has made strenuous efforts to recruit nurses - both locally (through their close relations with Oxford Brookes University's training courses in Swindon) and through recruitment visits overseas. Last spring they went to India, but because of the very high level language tests, the nurses they signed up will probably not arrive for another twelve months.
They have had successful recruitment visits within Europe and are about to recruit again in Spain, Croatia and Romania.
Part of GWH's problems with its workforce shortage is due to low retention rates - too many staff leave. Over the last twelve months they had 828 new starters (excluding junior doctors), but 748 staff left the Trust - a turnover rate of 15.15 per cent, which is higher than at neighbouring Trusts. Their target turnover rate is 13 per cent.
There has been some poaching of staff by other trusts waving 'inducements' at candidates - Gloucester offered an eight per cent premium to nurses. And there is talk that the Sustainability and Transformation Plan (STP) for our area will include a 'one workforce' policy to avoid poaching within this STP's 'footprint'.
The GWH board heard the outline of a new Recruitment and Retention Plan with firm policies to create career paths for staff as GWH's service commitments grow. From October 1 they are taking over staff for Swindon's community healthcare for adults. The current provider, the social enterprise organisation SEQOL, are in some trouble and GWH are now 'caretaking' the service until they take over the contract in February.
Why does GWH have such a problem with retention? It is largely to do with post- codes. When newspapers rail against a post-code lottery in health services, do they really believe that there can be some sort of cloned and perfect service in every location - not even a command economy could provide that.
It is a matter of 'urban cultures'. Swindon is not like tourist towns of Bath and Salisbury or like student-filled and vibrant Bristol. There may be a recruitment and retention problem that is simply beyond the remit of the NHS to repair or improve. Without wishing to denigrate Swindon, it is probably not the first place where a young graduate nurse might want to live.