What state is the NHS really in?

HEALTH Secretary Patricia Hewitt thinks it has been the "best ever year" in the NHS. But thousands of demoralised health workers beg to differ.

As anger at her comments mounted, delegates to health workers' conferences in Bournemouth and Gateshead were speaking about the possibility of industrial action this week.

Uncertainty, fear over jobs, and the suspicion that the Government's real agenda is privatisation of the health service by the back door have contributed to a militant mood.

Dave Prentis, general secretary of public service union Unison, told members at their conference in Gateshead: "We will not stand by and watch staff facing privatisation and job losses suffer in this climate of fear.

"Unison will support members who feel they have no option left other than industrial action."

Meanwhile, Beverly Malone, general secretary of the Royal College of Nursing, which is holding its conference in Bourne-mouth, warned that her members were considering a "work to rule". "The reality gap between what the Government is saying and what we are experiencing at coal-face level is very wide," she said.

In York, morale is as low as anywhere. The primary care trust is £23 million in debt, a mental health rehabilitation unit is to be closed and York Hospital - which has already announced that 200 jobs are to remain unfilled and that hospital beds will close - faces cutting £16 million from its budget over the next five years.

So what is the truth about the health service? We spoke to the chairman of York Hospital and two nurses to find out.

Professor Alan Maynard, chairman of York Hospital

IN SOME ways, Prof Maynard admits, the Government "dropped a clanger" by being so generous on doctors' pay.

The average GP salary is now nearing £100,000, while consultants with three to four years experience earn £90,000-plus.

Prof Maynard is not convinced that, in a health service where resources are stretched, such pay necessarily represents the best value for money.

British doctors are the best paid in Europe, he says. They are also among the hardest working. "But I think we have to look very carefully at whether we are getting the best out of them in terms of patient care, and I think there needs to be more transparency about what they are doing."

British nurses are also some of the best paid in Europe - but that does not say much, because across Europe nurses are badly paid.

He can understand why some nurses should be jealous of doctors' pay - especially given that nurses now have more and more responsibility, carrying out many of the tasks doctors have traditionally done, and doing them just as well.

The problem is that because there are so many nurses, giving them the salaries they deserve would be prohibitively expensive.

Despite the low morale in the health service, however, he believes the panic about the future of the NHS has been blown out of proportion.

Yes, he says, nationally health trusts are in debt to the tune of £700 million - but that is out of an NHS budget of £75 billion. In that context, he says, the £700 million debt is manageable.

It is a similar picture at York Hospital. The £16 million that needs to be saved over the next five years works out at about £3 million a year, but that is out of an annual hospital budget of £175 million.

Nevertheless, he accepts, it is true that in North Yorkshire the primary care trusts - the bodies which fund health care - have got their finances "out of balance".

It is not only the Selby and York trust with its £23 million debt that is in difficulties. Trusts in Harrogate and Scarborough also have financial problems.

The reason is that historically in North Yorkshire there are more family doctors per head of population than the average.

In one way, that is good. Nationally, Prof Maynard says, there is a "hidden iceberg" of undiagnosed illness, mainly affecting elderly people who do not wish to complain or make a fuss.

Because in North Yorkshire we have lots of good GPs, they are able to identify many people who would otherwise be suffering in silence, and make sure they receive treatment.

That costs money - and because we are doing it better here than in many other areas, it is causing budget problems for the local health service.

The other reason for low morale within the NHS, apart from finances and the fear of job losses, is a fundamental shift in the way it operates, Prof Maynard says.

The Government has talked of creating a period of "constructive uncertainty", he says. What that means is finding better and more efficient ways of doing things.

There is an emphasis, therefore, on treating patients who need non-urgent operations such as hernia operations or hip replacements on a day-care or single overnight stay basis. So they go home to recover, instead of staying in hospital for several days as an in-patient.

"That's good all round," says Prof Maynard. "It reduces costs for the hospital, but it's also good for you the patient, because it gets you out of hospital so that you can recover at home in your own environment."

Freeing up beds has a knock-on effect on the quality of care given to more seriously ill patients, who do need hospital treatment. For example, because of the reduced demand for beds, four or five beds have been removed from York Hospital's Ward 16, which looks after seriously ill patients requiring surgery for cancer.

That creates a better environment for patients, and also frees staff to spend more time with them.

Doing things better, therefore - and even closing hospital beds and reducing the number of hospital admissions - does not necessarily mean treating fewer patients, Prof Maynard stresses.

He even feels there is some truth in Health Secretary Patricia Hewitt's now-infamous claim that this has been the health service's "best ever year".

Standards of care, for example for cancer patients and heart patients, are improving, while hospitals are mostly meeting their six-month waiting times targets.

The problem is that as a large, bureaucratic organisation the NHS is frustratingly slow to change. There is still much that could be done better. Traditionally, patients who have had minor surgery return to hospital as outpatients for a check-up.

"That's a waste of time. They can judge for themselves if they are OK - and if they have any problems, they can go to their GP."

The NHS has also been slow to adapt to the new day-case model of providing operations, although York is far ahead of many other hospitals.

He understands the low morale of some health workers, but insists that industrial action would solve nothing. In York, he says, every effort will be made to ensure any job losses will be by means of natural wastage.

"Really we ought to be able to work with health staff to make sure that we provide the best service for patients," he says.

The nurses: Alison Sayer and Anita Murray

NURSES at York Hospital and those working for the primary care trust (PCT) are not about to go on strike. But a work-to-rule, in which they refuse to work longer than their contracted hours, may be on the cards. The reason? Nurses are worried about their jobs, their workloads, their careers - and the direction in which the NHS is moving.

"Morale is low," says Alison Sayer, a nurse at York Hospital and chairman of the York branch of the Royal College of Nursing.

"York has never been a very militant area. But when the Health Secretary talked about the best ever year... I have been in the health service long enough to see quite a few things go around and come around, and I would have to say it is the worst ever year.

"Nurses are worried about their jobs, about the extra work they are going to have to do because of the job cuts, about the fact there is going to be no place for work training programmes."

The sheer number of changes in the NHS was also causing uncertainty, she said.

"We just get one thing up and running, and it changes. The primary care trust is going to merge with three other PCTs. We've gone through the strategic health authority, area health authorities... we need a period of stability.

"I think that the health service is in big trouble, and I don't know what the answer is."

Fellow RCN member Anita Murray, a mental health nurse with the primary care trust, said staff were worried about the merger with three neighbouring PCTs in October.

Some 800 middle and senior managers would be affected, with many inevitably losing their jobs. And she said she was not convinced the merger would improve the efficiency of health care.

"We will have a York and Yorkshire PCT covering a huge area from the east coast and Scarborough right up to Northallerton and across to Harrogate. Will it be more efficient? It will be a mixture of urban areas, rural areas..."

What many health staff were really worried about, however, was the creeping privatisation of the NHS - an example of which is the new, privately-run NHS treatment centre in York.

"The real fear is that we are creeping into the private sector by the back door."

Nurses in the York area would not be going on strike, Anita said, but there may be a work-to-rule.

She considered herself to be a nurse of the old school and, as such, would be reluctant to do that, out of concern for patients. But some younger nurses may feel it was "the only way of getting anywhere".

Updated: 09:25 Wednesday, April 26, 2006