The Rt Hon Jeremy Hunt MP

Secretary of State for Health

30th January 2018

Dear Jeremy,

Testimony from a nurse, midwife and doctor - Brighton Pavilion

I am writing to ensure that you are personally aware of the concerns being raised with me by the NHS nurses, midwives and doctors working in the front-line in my constituency. 

I have pasted below an example of messages I have received from a nurse, a midwife and a doctor.  It is plain from these messages that the Government’s ongoing policy of underfunding is inflicting grave harm on patients, staff and our NHS.  Beyond these heartfelt communications, there is clear and repeated evidence of this harm. For example at Brighton Sussex University Hospital (BSUH) the 95% 4 hour A&E target has not been met since December 2013 – ie for over 4 years. 

It is clear from the statistics relating to other Trusts up and down the country, and the persistent winter crisis reports, that BSUH is not unique.  NHS services are at crisis point across the country because of strategic mismanagement and the underfunding decisions that come from the top of Government.

I should therefore be grateful for your response to the very powerful and specific points raised in the three communications I am sending.

Letters from a senior nurse and a midwife

As you will note, the midwife explains that she has done her share of shift work for 14 years and simply can't do any more bank shifts on top of her job - it would break her.  She is painfully frugal, yet faces a never ending cycle of a gradually growing overdraft and increasing loans just to try and make ends meet.

The senior nurse explains that, because of low wages and being unable to keep up with the rising cost of living, she spent the early years of her career accumulating debt.  Despite loving her job and colleagues, she is now at a point where she would not recommend nursing as a career option.  I hear the same message from nursing staff over and over again. A combination of increasing demand for care and limited funding makes it difficult or impossible for dedicated professionals to do their jobs properly.  In my constituent’s words, “The public are receiving sub optimal healthcare, due to a lack of staffing, poor skill mix and a lack of resources.”  

The senior nurse asks some vital questions following on from the Autumn Budget.  She and other nurses and midwives writing to me with their stories were not impressed by the Chancellor’s ‘deepest gratitude’ followed by his offer of ‘jam tomorrow’.  Nurses and other health workers want and deserve a meaningful pay award now, so they do not have to slip gradually into debt in order to pay their bills.  Promises that they will get some unspecified deal, loaded with conditions, sometime in the future constitute a worrying insult.  Staff need to know what actual money is on the table, and when. 

It is a particular affront that any pay deal will be conditional on improved productivity, when it is nurses and other staff who have been holding the fort, frequently working extra hours unpaid.  She is deeply concerned at how understaffing creates a dangerous environment.  I would be very interested in your response to this direct question from the nurse’s testimony:

“Who judges the productivity? The resources have been cut so significantly I cannot do my job properly, hence I would be deemed as inefficient and would not receive a pay rise anyway. Such precondition, as you have already highlighted, is insulting to say the least.”

Please also confirm to the other detailed points raised, including whether the unsocial hours pay supplement will be cut. As my constituent makes clear, nurses have relied on this to boost their inadequate wages. 

I should be grateful for your personal response to this letter and to the points raised in the communications I have passed on to you.  These concerns come from dedicated professionals and collectively they are very clear that the Government must end its policy of under-funding and running down the NHS. 

Yours sincerely, Caroline

Text of constituent letters referred to above:

Message from a midwife:

Subject: RE: Nurses and midwives pay

Dear Caroline

Please can you support the rcm campaign for a 3.9%pay increase for nurses and midwives? 

I'm a midwife, qualified in 2004 and have steadily seen my standard of living decrease over the years. Now, age 53 more than half my salary goes on rent alone. My 18 year old daughter has not yet managed to find work, my husbands work is precarious and never paid during school holidays. With council tax, bills, food on top, we are in a never ending cycle of getting slightly bigger overdraft and increasing loans just to try and make ends meet. 

We don't go out hardly at all, we virtually never eat out, we shop economically at aldi but it is really really hard and wearying. My husband has mental health problems and can't take much pressure. I'm a mental health midwife doing a job I love and work really hard. I've done my share of shift work for 14 odd years and can't do any more bank shifts on top of my job as it would break me now I think. All my midwife friends are struggling, both in a hugely demanding job and to make ends meet. We shouldn't be pressured to live to work but should be paid a decent wage that makes the increasingly punishing and gruelling pressure  of shift work tolerable. It's not enough to do it for the joy of our jobs. Of course participating on this journey in a family's life is a privilege and a pleasure and we all do amazing work with the women we encounter. But the work gets harder and harder as more and more is expected of us. At the very least, having enough money to pay the rent and do more than just survive should be our right. It sickens me when MPs (tories) talk about the rewarding nature of our work, as if that is substitute for a fair and reasonable wage. We are one of the most dedicated and hard working professions I know and regularly go above and beyond what would seem possible to do on a shift.

Here is the rcm link to the campaign details :

https://www.rcm.org.uk/pay?utm_source=Adestra&utm_medium=email&utm_term=

An NHS Midwife

Brighton

Messages from a senior staff nurse:

Dear Caroline,

I am writing to you in regards of state of nursing within the NHS.
I would like to give you some personal information about myself so you can understand the plight of one nurse in our crumbling health system.

I have worked as a senior staff nurse on the intensive care unit at Royal Sussex County hospital for 8 years. Currently I am on a sabbatical year travelling with my husband, something we have saved to do for many years.
Nursing over the past 9 years has changed from a profession I was proud of, into a job that I need to escape from, as it holds no respect from its conservative government who simply do not value its workforce.
It is clear that our current health minister plans to privatise the NHS, however if he continues to do so in this manner there will be no nurses to work either publicly or privately.

The implications from Mr Hunts proposals of changing our agenda for change pay scale is incredibly significant. After 9 years working in the NHS, including completing a post grad degree to specialise within Intensive Care, I would stand to loose £3000 to £4000 annually should our health minister remove our unsocial hours pay. Reducing my wages to the basic salary of £27,000. Combined with the insult of removing the incremental pay rises which are only given if you have met additional training needs within your yearly appraisal, nurses will leave the profession in droves.

Before leaving for my sabbatical year I was completely burnt out. I had spent the early years of my career accumulating debt due to my low wages and being unable to keep up with the rising cost of living. The only reason I am no longer in debt is solely due to the support of my husband. These pressures on top of an incredibly stressful job both physically and mentally, is why I would not recommend nursing as a career option to anyone.

During this year I have decided I would weight up my options regarding my career. I used to love my job, however the increasing demands with the limited funding the NHS now receives means I can no longer do my job properly. The public are receiving sub optimal healthcare, due to a lack of staffing, poor skill mix and a lack of resources. When working in this environment it makes me wonder what good am I doing? I love the unit I work on, my colleagues are wonderful people and I would not want to work anywhere else in the NHS. However I cannot make a difference any more and the stress levels nurses are suffering with on a daily basis are horrendous.

I will be watching the news regarding the fate of nursing over my remaining 6 months of my leave. Should the incremental pay scale and unsocial hours pay be removed in time for my return as per Mr Hunt’s wishes, I will endeavour to leave nursing. I cannot continue to sacrifice my own health for the governments grand schemes. I am an educated person and will be able to find a respected and rewarding job elsewhere. Due to my non competitive basic wage it will not be too difficult to find another job that will match my annual income. Therefore the NHS will loose another nurse.

This is just my story. There are thousands of other stories like mine up and down the country, and I believe our health secretary has little awareness of what reality on the front line is actually like. He needs to be held accountable for his actions towards all NHS staff, however I have no faith in our current government leadership and believe instead of being reprimanded he will be rewarded when he finally destroys the NHS.

I do not know if you can help, however I value your strong voice within government and I believe if anyone could be an advocate for NHS staff it would be you.

I believe the removal of the agenda for change and incremental pay rises will be the end of the NHS, as staff will not be able to afford to live and there will be no moral left, resulting in a mass exodus of health care professionals. If you can be a voice for our predicament I would very much appreciate it. I wish you strength and luck in your efforts, and upon my return if can be any assistance to your fight I will support you however I can.

Sincerely,

Further points:

My anger is driven by the way the NHS staff are treated. Jeremy Hunt and the government have treated the NHS staff with disregard far too long. I feel this has gone beyond the breaking point. I have already witnessed the effects through low staff morale on the shop-floor, inability of our hospitals (BSUH NHS trust) to retain staff, anger amongst the staff when Jeremy Hunt visited our hospital and cowered away from questions.

In response specifically to the potential future pay rise to nursing staff mentioned within the budget red book, ‘Any pay deal will be on the condition that the pay award enables improved productivity’. Who judges the productivity? The resources have been cut so significantly I cannot do my job properly, hence I would be deemed as inefficient and would not receive a pay rise anyway. Such precondition, as you have already highlighted, is insulting to say the least. 

Behind the above banner of alleged pay rise, unsocial hours pay supplement will be cut. Nurses have relied on this to boost our wages, particularly the single parent amongst the profession. 

Childcare is expensive and not easily accessible for a nurse. The 12.5 hours day shifts on my unit start before crèche opening times and end after crèche closing times. There are no affordable childcare facilities that cater for our hours. For many, volunteering for night shifts and the charity of friends or family members who help with childcare are the only solution around the issue. 

The staffing crisis within the NHS is not being addressed appropriately. Trusts cannot retain their staff. There is no incentive to stay. The majority of nursing staff on my unit are junior and need support from senior ranks which are wearing thin as we speak. Most either do not stay long enough to become senior or indeed senior enough to see through the government’s scandalous schemes and, like me, have lost the passion and enthusiasm to stay in the career. Poor skill mix within my department is evident. This is a dangerous environment to work in. On a number of shifts last winter I was operating specialist intensive care machinery for patient care that only 2 other nurses on shift was trained to do, all of us were overstretched. Consequently I could not go to the bathroom for up to 6 hours at a time. 

Abuse towards NHS staff is becoming the daily norm. Last winter I dreaded going into work, as every day at least one of my colleagues was attacked by patient and I would just be thankful when it wasn’t my turn. There is limited security staff within the hospital so it’s down to luck if the hospital security are available. Team work drags us through the shift, but we are not protected and I feel it’s just a matter of time before I sustain a serious injury. As a nurse I do not feel valued by our current health secretary, there is no reason for my loyalty, so why should I sacrifice myself? 

The problems in the NHS are plentiful, and staff are at the end of their tethers. Agenda for change pay scale had been acceptable until proposed removal of unsocial hour pay. It will be the nail in the coffin for the NHS. 

Why should I risk injury at work? Why should I continue with my hours when my wages would hardly afford childcare costs? Why should nurses sacrifice family life for years of night shifts and weekends when there is no appreciation from the government? My loyalty to the NHS is wavering. I feel that contacting you is my last resort to get my voice heard, and sadly I have very little hope for the future of nursing as a profession in this country. It is heart breaking that I have dedicated all my working life into what has now become a dead end job. 

Please use my experiences to support your case against the cuts and for your continuing support of fair pay for nurses. 

An NHS Nurse

Brighton

Message from a doctor:

Sent: 26 January 2018 10:08
To: LUCAS, Caroline <caroline.lucas.mp@parliament.uk>
Subject: NHS

Dear Caroline Lucas

I am writing to you as my MP because I am struggling to think of another avenue available to me to make my concern on this issue known. I would be grateful if you could take the time to read this email and consider whether this is something that you would be willing to raise as an issue. 

I am not sure how much you are aware of a case that has recently been heard in the high court regarding a trainee paediatrician called Dr Bawa Garba. I will enclose a link to a summery which will provide you with more information however I will summarise in case you don't have the chance to read it. Dr Bawa Garba was a paediatric registrar in Leicester. On the day that she returned from maternity leave (to a hospital she hadn't worked in before and had been provided with no induction) she was expected to cover not only her role as the ward registrar but also that of another registrar, a junior and also was expected to do this in a situation where one of the two consultants was also absent. She was working on an unusual day where the hospitals blood results systems had failed and results weren't getting relayed to the medical teams appropriately. She assessed a little boy who had downs syndrome and a previous heart problem on a prescribed medication and made a provisional diagnosis and initiated appropriate treatment of intravenous fluids and further investigation in the form of bloods and and a chest x-ray. In response to this initial management the child showed initial signs of improvement. He was moved from the assessment unit to the ward and placed in a room in replacement for another child who had a do not resuscitate order in place and who Dr Bawa Garba had attended an arrest call for earlier that day. At that point he was given an unprescribed does of his heart medication (without it being run by Dr Bawa Garba or any member of the medical team). At this point point his blood tests became available which were seen by both Dr Bawa Garba and her consultant and it appears that neither of them acted on them (working as a doctor the consultant has ultimate responsibility for patients and the fact that he didn't act is incredibly concerning). The little boy in question then had a cardiac arrest, Dr Bawa Garba was confused and initially said that she thought that he was not for resuscitation and attempts were halted for 2 minutes (none of the people in the room including more senior colleges and people who knew him better challenged this. The little boy sadly passed away.Later that week the responsibly consultant took her to a public cafeteria to do a "debrief" where he pressured her into writing a reflective account and then sent her home while he typed it up and uploaded it to her e-portfolio. Over a year late two weeks after delivering her second child she was taken to a police station and interviewed for many hours being kept from her solely breast fed baby and that interview was then used against her in court. She was put on trial and convicted of manslaughter. Her case was then reviewed by a branch of the GMC which covers reviews for trainees and she was given a suspension or one year. The GMC then took her to the high court to try and over turn their own bodies decision and yesterday they were successful and she was struck off. 

Here is more information for you to read: http://54000doctors.org/blogs/an-account-by-concerned-uk-paediatric-consultants-of-the-tragic-events-surrounding-the-gmc-action-against-dr-bawa-garba.html

While I know that you are not able to directly intervene in this specific legal case especially as she was not one of your constituents. What I wanted to highlight to you was actually the wider implication of this which is something that does impact on me and any other doctor who might be living in your constituency. 

Firstly what I think this case quite clearly demonstrates is a doctor being held responsible for the wider failings of the NHS structures. She was being made to cover multiple colleagues (which is something that is more and more common with growing rota gaps) and working in a system where computer systems failed and information wasn't be relayed to her. Rather than this being looked at as part of a wider symptom of the chronic underfunding of the NHS this was actually deemed inadmissible in her manslaughter trial. I find it terrifying that doctors are being forced to work in less safe environments due to chronic understaffing while being punished when things inevitably go wrong. This could happen to any doctor in any clinic setting with the pressures that we are being put under. 

Secondly and almost more worrying is the way that Dr Bawa Garbas clinical reflection was then later used against her. I am not sure how much you are aware of reflective practice. This is something that as a GP I have been encouraged to do throughout my career. It is basically a practice by where you look at things which either didn't go as well, a consultation or patient encounter which was emotionally or practically difficult and using a electronic portfolio reflect on what happened, what you could have done differently and through that improve your practice. It is a vital part of continuing to develop your professional knowledge and improve your practice. It is something which as a GP makes up a large part of my yearly appraisal which determines my ongoing fitness to practice. The fact that this learning process was then used against her will have catastrophic impacts for doctors of all levels as we will no longer feel that we can reflect in the same way for fear that it will be used against us in the future. The loss of learning opportunity will have far reaching consequences. 

Thirdly this is just another example of the GMC having moved further towards a blame lead culture. There have been to many examples to name of doctors who have suffered severe mental health problems or in some cases even attempting suicide due to the way that they are treated during the course of an investigation. The GMC is funded by doctors but is in no way being a fair regulator body at the moment. As an organisation it is something that needs review. A blame based culture has significant risks to patient care. As this quote by David Grant a consultant paediatrician sums up that this precedent "will undermine all attempts to create a culture of openness and learning aimed at improving patient safety through proactive healthcare systems improvement.” and “Without such a system and culture in place, organisations and healthcare systems will continue to learn the same lessons over and over again, while patients continue to come to preventable harm.”.

Thank you for taking the time to read this email. This is a case that has concerned me significantly and as I have mentioned does have implications for doctors over the country. It is a time where we are feeling that we are being scapegoated for the problems that this government through its restructuring and chronic under funding.

An NHS Doctor

Brighton