The crisis in NHS staffing must be addressed
SIR – As a retired intensive care consultant, I despair at what seem to be steadily declining standards of care on NHS wards.
Even before the pandemic, costsaving measures had pared nurse numbers to the bone and working time directives had had a similar effect on medical staffing. Now, against that background and after 18 months of a pandemic, the drive to bring down a huge resulting backlog of work, as well as significant numbers still needing Covid-related hospital admission, are leading to unprecedented pressures on staff. Exhausted and demoralised senior staff are leaving the service in droves and, tragically, these are the ones with the most experience. Empty government promises to recruit more doctors and nurses, even if fulfilled, will never match the numbers leaving.
Continuity of care has been lost, so a patient might not see the same doctor or nurse who knows all the details of their case for several days running. Handover times between nursing shifts have been shortened to save money, making it impossible to pass on to incoming staff all the important information on a ward full of sick patients.
Desperate managers end up having to move specialist nurses away from their areas of expertise. An orthopaedic nurse working a shift on a bowel surgery ward could miss the telltale signs of a postoperative complication, just as an experienced nurse from the surgical ward might miss key signs in general medical patients.
Out of hours and at weekends, only a skeleton medical staff is available to meet the needs of a hospital full of ill patients and cases have to be prioritised, often on the basis of very little information. In such circumstances it is hardly surprising that some patients fall through the cracks.
Doctors, nurses and managers are so busy firefighting that no one has time to step back and think about solutions, and winter is still to come. These are complex and systemic problems, and urgently require a national conversation.
Dr Mick Nielsen
Salisbury, Wiltshire