Frontline: District nurse
A nurse caring for patients in the community warns that fast-growing workloads are ratcheting up the pressure on her hard-pressed team. Winnie Agbonlahor reports.
“For the last five years, I’ve worked as a district nurse in a rural area on the outskirts of a medium-sized city. I head up a team of 10 nurses, who carry out home visits and run weekly clinics at local health centres. We provide healthcare for patients who are house-bound for various reasons, as well as patients who suffer from long term illnesses, can’t administer their medication, or need wound or palliative care.
My work has been affected by the drive to make £20bn of efficiency savings in English healthcare by 2015. Cutting staff is the easiest way to save money; and in my team’s case, the result is that we have more part-time staff – which means less continuity, because we have to do a lot more hand-overs.
Meanwhile, the government wants to see people staying in hospital for shorter periods, and health authorities are also trying to push more healthcare into the community. It’s cheaper to care for people at home than in hospitals, because you don’t have to pay for staff to be there around the clock, and there are no overheads such as electricity bills. What’s more, patients prefer being cared for in their own homes: they can eat the food they like, and don’t have to share facilities with strangers.
However, if people are discharged earlier they need more aftercare, which my team has to provide – and while our job is becoming increasingly important, we are not getting any additional resources.
The NHS is also trying to improve the quality of end-of-life care and allow more people to spend their last moments at home, surrounded by their families and loved-ones. Around 70 per cent of people would prefer to die at home, but at the moment only 30 per cent do; so aiming to change this is a good thing. However, once again this shift increases our workload; and once again we’re not given any more money.
We’d have more time if there was less paperwork; and while much of this paperwork has sensible aims, it often seems unnecessarily labour-intensive. For example, the government wants to reduce the amount of pressure ulcers, or bedsores. This aim is only to be commended, but the result is that we have to fill in a report whenever a patient suffers from a bedsore – and these reports can take an hour and a half to complete. Patients still require just as much care, though, so the result is that my team and I do an ever-increasing amount of unpaid overtime: we’re constantly tired, worn-out and stretched to the limit, and people suffer from health problems such as back pains. This also leads to more nurses leaving the job; which, again, causes more discontinuity.
There’s also discontinuity between different public services – and the swingeing budget cuts are making the problem worse. One obvious meeting point is the one between healthcare workers like us, and local authority-run social care staff. If a patient has a catheter, for instance, and the bag fills up, the social carers used to empty the bag and change it. It’s a matter of five minutes. But now, because they’re under increasing pressure from their bosses to save time due to shrinking budgets, they refer the patient to us, because the catheter is a ‘health’ rather than a ‘social’ problem.
With the amount of patients a social carer looks after every day, if they avoid changing catheter bags they can save up to an hour by the end of the day. But if a full bag is reported to my team, one of us may have to drive five miles just to carry out this five-minute job.
On the other hand, some government policy changes have had a positive impact on our work. Integrated computer systems are currently being introduced, for example, so we all have laptops which run on a common server. That means that if I update a patient’s records, the GPs and district nurses involved in their treatment can see the changes. Not all private GP practices are signed up to it yet, but hopefully they all soon will, because sharing information in this way saves time for everyone.
One imminent change involves the clinical commissioning groups taking over from primary care trusts this April. That means GPs will decide what the priorities should be in their areas, and how money should be spent. The government says that this will create clinically-driven commissioning system that’s more sensitive to the needs of patients. However, I think it will lead to inequalities and something of a postcode lottery in healthcare.
If I could speak to Jeremy Hunt, the secretary of state for health, I would point out that the NHS is the most cost-effective health system in the world – but it is only as good as the people who run it. At the moment, it is relying on their goodwill. We need to make sure there are enough staff to share the workload, because otherwise we will lose some of our most highly skilled workers due to stress.”