Gaby Hinsliff’s article on NHS pay (Sunak is the ‘too little, too late’ PM. That’s why he’s failing over the NHS and this wave of strikes, 22 December) raises some excellent points about the need to reclaim “reform”. I work as an inpatient physiotherapist in the NHS and we have also recently voted for industrial action. The main reason that is mooted for this, and for supporting our nursing colleagues, is that we are voting for the future of our professions. The pay freezes in the name of austerity have inevitably created an almost unbridgeable inflationary gap, hence the Royal College of Nursing’s request for a 19% pay rise.
The pay freezes were not the only issue. Readjusted safe staffing numbers created ratios of one nurse to eight patients in acute care, and one to 12 in rehab. These levels are designed to be the minimum, but have become the target. These levels are not guaranteed by law in England. Add in staff vacancies and sickness, and you start to get to very low numbers. The sad fact is that as senior nurses filled the gaps on strike days, we saw better staffing levels than we did on the days either side. Evidence shows that low staffing numbers result in patients being less mobile, increasing deconditioning. These pressures reduce the likelihood of adequate communication and increase tension between staff, patients and relatives.
To provide the much-needed reform from passive entitlement to “care” towards more active engagement in prevention and recovery, we first need the numbers and future recruits. This is only possible through fair recognition – a pay rise.
Recently a fellow nurse and I published an account in the International Journal of Nursing Studies of the failings in nursing care we received while in hospital. We were castigated online by senior nurses for our disloyalty and ostracised for our temerity in describing these lived experiences. Gaby Hinsliff is right: laud the founding principles of the NHS, but challenge the archaic managerial, professional and clinical vested interests that prevent real reform.
David A Richards
Emeritus professor of mental health services research, University of Exeter
One of the great problems in the UK is the old slogan “free at the point of delivery”. Here in Italy – or at least in Umbria – we are not frightened about charges for health services. First and foremost, the low-risk, high-cost treatments, such as a major operation or long stay in hospital, are completely free. This is a great form of security for people.
Routine tests – blood tests, ECGs etc – and prescriptions do carry a charge, but this is based on income, with three levels. The lowest is free. It sounds complicated, but it is all in a barcode on your health card, which is swiped – and bingo, your payment is calculated in a split second.
The NHS has certainly been privatised by stealth (Letters, 21 December). When I was informed that I had been put on a 14-week waiting list for a minor medical complaint, I asked to be removed from the list as I would seek a private consultation. I was immediately transferred to another NHS department and told that for a fee of £200 I could see a consultant within 48 hours. The consultation lasted approximately 10 minutes, ie £1,200 per hour for the consultant – nice work if you can get it, but a huge disincentive for anyone to work at NHS rates of pay.
Dr Allan Dodds