It’s difficult not to notice the almost daily news reports about the current stresses on many NHS Accident and Emergency departments (A&E). Admittedly, we really only hear about the NHS when it’s either under pressure or over-capacity, so the question really might be: ‘What’s new?’ or even ‘What can I do about it?’
There’s an argument that says that Military Service-leavers could be more useful to the NHS now, than they ever have been before. The NHS is a massive organisation; in fact it is listed as one of the top five employers in the world.
You don’t need to be an expert in either human resources or healthcare to imagine that the challenges of the NHS within the UK are unique and of an unprecedented scale. Maybe that’s why it’s still not functioning as it should; in fact it appears at times to be creaking, dangerously.
During 2014 several high profile voices within healthcare (including several NHS Trust leaders) declared that the NHS was facing the biggest challenge of its entire existence. Rising demand means that the costs of running health services rise every year by around 4% above inflation at a time when budgets are under severe scrutiny.
Part of the reason why the NHS is struggling is because it is seemingly growing out of the circumstances that it was designed to operate within. There are now more people with multiple long-term conditions and an increasingly older population. The NHS was essentially designed to undertake mainly acute action and deal with a population where far fewer people became truly elderly.
TARGETS AND INTENTIONS
The NHS Confederation met in May 2014 to set out its 2015 Challenge Declaration. This was published in association with medical royal colleges, local government and patient organisations and puts forward the challenges that the NHS is facing in black and white; something that commentators have accused political parties of not doing before the last General Election in 2010.
More and more people are visiting A&E departments and minor injury units and this is stretching resources. On any given day these can be stressful working environments since the challenge of meeting the needs of literally anything that comes through the door is incredibly challenging anyway, but pile on top of that the issue of overcrowding and it becomes an increasingly difficult and dangerous situation – all of which requires a cool head – and an ability to prioritise cases – when all about you are losing theirs.
It does seem that the major issues are at the front and back doors respectively. In other words, seeing too many people arrive (possibly as a result of a shortage of GP coverage or mishandling of cases by the controversial NHS 111 helpline) and not being able to discharge them once they’ve received treatment.
These two bottlenecks mean that services are squeezed to a point where there’s absolutely no space for any genuine emergency scenario where ordinary levels of service might acceptably be stretched to fit. As we go to press, mercifully, there has been no winter epidemic such as flu to contend with. Critics suggest that such a challenge would surely tip the NHS into genuine crisis – a word that Government, in particular, have so far steered well clear of using.
The front and back door difficulties relate back to the point listed by the NHS Confederation regarding ‘design’. The NHS needs to be re-designed away from being a destination where people ‘end up’ to becoming more of a route to recovery. Hospitals, in particular, need to be given the space to do what they do best – treating sick and injured people – rather than, treating sick and injured people and then accommodating them (either in waiting rooms or on wards).
The solution to this is broadly recognised as finding new ways for different parts of the health and social care services to work together – and more cohesively. Naturally, it wouldn’t be fair on patients to have a system that simply boots vulnerable people out with nowhere to go or nobody to look after them. Besides which, they would very obviously, simply find themselves back in hospital care, possibly in a worse state than when they had their original issue.
This management issue might be the biggest single change in the way the NHS is run and it’s going to take people skilled, not only in logistics and human resources but also people with heads for data and figures – arguably the same skills that senior officers have built up in places like Camp Bastion in Afghanistan where they run massively complex operations and direct thousands of people.
Indeed, on his first day in the job, the newly appointed chief executive of NHS England, Simon Stevens, made a speech saying:”Our traditional partitioning of health services – GPs, hospital outpatients, A&E departments, community nurses, emergency mental healthcare, out-of-hours units, ambulance services and so on – no longer makes much sense.” He also added that: “I know that for the NHS the stakes have never been higher. Service pressures are intensifying, and longstanding problems are not going to disappear overnight.
Successfully navigating the next few years is going to take a team effort – involving the biggest team in the biggest effort the NHS has ever seen.”
The state of the NHS hasn’t suddenly become an issue overnight and various measures have been tried and tested with mixed results. Curiously, one of the other minor General Election issues overlaps with that of the state of the health service: immigration and the debate over ‘British jobs for British workers’. Whilst it’s true that most people would rather see a foreign doctor or healthcare professional than none at all, many see them as a poor alternative to a doctor who in their view, speaks comparatively pristine English and also understands (to a deeper) level our unique culture and national idiosyncrasies. Coupled to this is an idea (however erroneous) that immigrants that travel across Europe are just ‘in it for the money’ and have scant regard for their patients rather than a genuine vocational drive. People, of course, also worry that with something as specific as medicine that any slight miscomprehension on the part of the physician could result in serious jeopardy.
In fact, as it stands, the British healthcare sector relies heavily on foreign talent to a greater extent than the English Premiership! Figures suggest that some 11% of all healthcare workers and some 26% of doctors working in the sector are non-British. There are two sides to this debate then: will anti-immigration style rhetoric and policy damage the NHS or is there a genuine case for making sure that healthcare staff remain predominantly British? Whatever the answer, the comparative popularity of British staff in our healthcare sector is likely to mean that home-grown applicants could also become a target recruitment area for the NHS in future years – and that includes Service-leavers (although this would still have to be within the parameters of anti-discrimination legislation).
Another issue that has been highlighted is a reliance on temporary staff (some of which are recruited from overseas) to cover gaps in services. Some regions in the UK have seen spending rises of 25% since 2013 for locum doctors, bank and agency nurses. One hospital in Leeds has reported that costs of temporary nurses are up by 87% to £9.4m. This all adds up to a sector spending way beyond its means – which is highly unsustainable.
The answer, if we had five or 10 years would, of course, be to train new medical staff but as we’ve seen, the challenge is facing us now and within the next few years it may get even bigger. Whilst nobody likes a profiteer, Service-leavers might well find themselves, in the right place, with the right skills, the right mindset and at the right time to make a difference.
It’s a rare thing to see a ‘quick-fix’ solution that’s sustainable in the long-term but Service-leavers with medical training and qualifications might just be it. There’s no doubt that the next ruling political party will have to put in place longer term initiatives to beef up staff levels in the NHS through training just to keep up with growing demand for services but at least for the moment Service-leavers are an attractive option.
Service-leavers bring a genuinely rounded skillset to the table. Firstly, of course, their medical skills are just as solid as anybody else’s but further to that they have experience of a very different sort of pressure situation. As Civvy Street Magazine has explored the options open to Service-leavers in the healthcare sector over the last few issues the same message has been echoed from directors through to staff involved with front line services, that Service-leavers provide leadership and have the desire and drive to see complicated tasks through to the end through sheer process.
Further to that, leadership skills which are going to be essential as more and more services become centralised are already in great demand and are one of the Service-leavers’ perceived strengths amongst all of the human resources people we’ve spoken with.
Roles that you thought you were familiar with are changing fast so it’s important for anyone aiming to enter the sector to keep up to date. Nursing, for instance has seen huge change over the past 10 years and will undoubtedly become a more important role moving forward as every individual healthcare employee will be expected to carry more of an increasing patient burden.
This isn’t to say that nurses and other healthcare professionals will be hammered into the ground but it will mean that their role will become more diverse in scope. Changes are likely to include more responsibility for harvesting, handling and interpreting data as well as furthering specialist clinical knowledge on conditions that are likely to affect the health sector’s new client type.
Nurse are likely to need to know more about issues that affect older people in particular as well as diabetes, obesity and oncology and they are likely to need to sharpen up on pharmacology too.
The new landscape will likely require every healthcare worker to be able to pass on and receive patients to and from different departments or agencies with enough information that the next health care practitioner doesn’t have to go back to the start – asking about symptom details that should already be in treatment, for example.
These moves are intended to meet the financial challenges that the sector faces, head on. The health service in England has been asked to save £20bn or in real terms a 5% increase in productivity. If this wasn’t already a stiff enough challenge the fact that the sector has been getting less productive during the past decade simply highlights the difficulties ahead.
Perhaps the most notable strength Service-leavers bring to the fore is an ability to deal with a change environment.
The next few years, is going to see huge upheaval in the health sector, irrespective of who wins the next General Election. Opposition politicians and public pressure will undoubtedly mean that the new government will be required to put fresh ideas in place.
Of course, people that have been in the same job for years and years are likely to shy away from change. After all, even when things aren’t going well, there is some security in knowing that today will simply be another bad day.
Service personnel treat change in exactly the same way that they treat consistency. The process and work ethic remains the same and the job, although under different circumstances gets done. Over recent years the British Armed Forces have been deployed to regions across the world, often in times of volatility and hostility.
As they’ve processed their mission, things have changed and where they were say, dealing with open hostility they might now be dealing with a peacekeeping mission and where they might have been deployed as disaster relief, they may now be taking on a logistics operation.
The ability to turn up and achieve results under fluid circumstances is one that the NHS could certainly use.
It’s time to get your CV in.