I don’t know if you’ve noticed, but the last few weeks have seen a number of reports in the medical and lay media that seem to be leading to a rather startling conclusion. Namely, that dumbing down in healthcare provision is widespread and may be a bad thing. It may even end up with the frankly bizarre suggestion that doctors have a useful purpose to serve.
But let’s not get ahead of ourselves. We’ll start with The Times’ report on the issue of the poor quality of nursing in our hospitals (I’ll link to some of those reports, but only those of you contributing to Mr Murdoch’s pension fund will be able to access them). It began with the now customary and justified complaint that nurses spend too much time in the classroom and not enough on the wards learning how to look after patients, with even Peter Carter, President of the RCN joining in the condemnation.
This then morphed into an argument that there weren’t enough qualified nurses on the wards because cash-strapped trusts have been replacing them with an army of health care assistants (HCAs) who now undertake most of the jobs traditionally performed by nurses, a move which today’s Times headline trumpeted as ‘a disaster in waiting’.
We’ll pause there for a moment to allow you to savour the image of nurses complaining about the usurping of their role by less highly-trained workers. There - you enjoyed that, didn’t you?
Incidentally, the first of those articles prompted a letter from someone asking why, if this decline in nursing standards had been going on for so long, the doctors hadn’t spoken out against it. I couldn’t be arsed to reply that we had, and that I, for one, had had a letter in The Times stating that we were raising a generation of nurses more at home with a clipboard than a bedpan. And of course the result of letters and articles in that vein, coming from doctors, is the accusation of arrogance and elitism - usually from nurses. As is so often the case, we’re damned if we do, and damned if we don’t.
Which would bring me on to skills mix, and the rise of the ‘practitioner’, but we’re all sick of reading diatribes about noctors, and the arguments for and against have been rehearsed at tedious length here and elsewhere. For what it’s worth, and at the risk of repeating myself, I believe that role extension, properly instituted and monitored, can rationalise the use of highly-trained staff and improve the service. I have even been actively involved in the training of radiographer practitioners who fulfill a very useful role in many of our imaging departments. There’s no doubt, though, that this whole process is now running out of control, driven by managers hell-bent on cutting costs, with no regard for quality of service or patient safety.
And then we have the recent report on the capital’s health services, telling us that more consultants are needed to cover junior staff, and that this could save 500 lives a year. In other words, from top to bottom, we are seeing a downshift in the grading structure of NHS staff, with an over-reliance on less highly-trained, and cheaper, staff. And this can only get worse as Lansley and Cameron drive through their ill-considered ‘reforms’, fragmenting the service further and exposing it to the wholly commercial motives of ‘any qualified provider’.
But as I say, if you follow the HCA/nurse argument up the food chain, it does at least look as if there may eventually be a grudging admission that doctors have some small contribution to make to the health of the nation. Which would be nice.