Editor's Comment


More and more with less and less

Source: NHE Jul/Aug 15

Money is the main topic in this latest edition of NHE – how to do more with it, and the unfortunate fact that there is not enough of it. The amount spent on agency staff, especially nursing and medical staff but clerical too, has been rising massively – our FoI investigation on page 26 shows by exactly how much. The Department of Health and regulators are already onto the problem, though many would say their ‘clampdown’ is tackling the symptoms, not the cause.

Is Lord Carter (interviewed on page 30) right that there is ‘defensive nursing’ going on – trusts employing more staff (especially agency staff) as a default response to the Francis recommendations and safety concerns, instead of thinking smarter about their rotas? He told us he has seen evidence that makes this clear, though the sheer scale of the spending at some trusts we investigated – including community and mental health organisations, not just acute hospitals – shows there is something serious happening. The detailed piece by my colleague David Stevenson includes not just the figures but lots of analysis on what it means and how to solve it, with input from organisations including the Nuffield Trust, the King’s Fund, NHS Providers and NHS Professionals.

In the news section we have more about the merger of Monitor and the NHS Trust Development Authority (oh how they squirmed on stage at the NHS Confederation conference when asked why they didn’t do exactly that, but couldn’t then say anything about it), to be named NHS Improvement. Did Jeremy Hunt forget that there was a different organisation called NHS Improvement around as recently as two years ago, or did he just not mind resurrecting the name? The old version was closed down and folded into NHS Improving Quality in 2013. Either way, the ‘new’ NHS Improvement will have a very different and far more regulatory mission than the old body.

Elsewhere, NHE’s new online reporter, Luana Salles, explores the issues of choice and consent with caesarean sections on page 14, while we also feature a typically high-profile and incisive clutch of commentators and practitioners from across the health sector throughout this edition. You can find some of my particular favourite pieces in the ‘Editor’s Choice’, overleaf.

It’s great to see The Cumberland Initiative putting its ideas into practice at its new facility in Slough – more about that on page 50.

Also in this issue, we have reviews of the Commissioning Show 2015 and the NHS Confederation annual conference and exhibition, plus an interesting look at a typical CQC inspection – but from the inspectors’ point of view (p42).

I hope you enjoy this edition of NHE.
Adam Hewitt


Ruth Bruce   04/10/2015 at 20:16

I found this an interesting article mainly because of the statement that clerical costs were increasing massively along with Clinican staff costs. In the age of digital data transfer, the opposite should be true. Like all change to the way people work, you have to stop and reflect on how something is done and what might meet today's needs. However, easier said then done when you are in the middle of a torrent of care.

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