NHS staff "quitting to work in supermarkets because of poor pay"

NHS staff are quitting to stack shelves in supermarkets instead of caring for patients because they are so demoralised by years of getting pay rises of only 1% or nothing, hospital bosses have warned.

The health service is now so understaffed that patient safety is being put at risk and people with mental health problems are experiencing delays and setbacks as a result, NHS leaders say.

The intervention in the general election campaign comes from NHS Providers, which represents almost all of England’s 240 NHS hospital, mental health and ambulance trusts. They told ministers bluntly on Monday that the government’s longstanding policy of holding down NHS staff pay is wrong and is damaging the service by deepening its already severe staff shortages.

“Years of pay restraint and stressful working conditions are taking their toll,” said Chris Hopson, NHS Providers’ chief executive. “Pay is becoming uncompetitive. Significant numbers of trusts say lower paid staff are leaving to stack shelves in supermarkets rather than carry on with the NHS.”

He urged Theresa May to abandon her plan to limit NHS staff’s pay increases to 1% a year until 2020 and not pursue it during the next parliament as a way of making the NHS’s books balance.

He added: “Trust leaders tell us that seven years of NHS pay restraint is now preventing them from recruiting and retaining the staff they need to provide safe, high-quality patient care. The NHS can’t carry on failing to reflect the contribution of our staff through fair and competitive pay for five more years.

“Pay restraint must end and politicians must therefore be clear about when during the lifetime of the next parliament it will happen and how.” He repeated the organisation’s demand for £25bn in extra funding to help the NHS in England get through until 2020 and warned that staff are also leaving because they are exhausted from having to work so constantly to keep up with the unprecedented demand for care.

Hopson added: “We are getting consistent reports of retention problems because of working pressures in the health service causing stress and burnout.”

Medical royal colleges, health trade unions and health charities such as Cancer Research UK have been highlighting in recent months the damaging effects on patient care of widespread shortages of doctors, nurses, GPs, paramedics and many other NHS staff groups.

Norman Lamb, a former coalition government health minister, said NHS pay restraint – which had operated since 2010 – was “stupid” and had gone on so long that it was proving counterproductive.

“The Conservatives expect NHS staff to take year-on-year real-terms pay cuts in order to try to stave off financial disaster in the NHS,” said the Liberal Democrat health spokesman. “You can’t possibly justify this over such a long period. It is also stupid because great staff will vote with their feet and leave.” s

He contrasted his party’s plan for a 1p increase in income tax to generate extra funds for health and social care with May’s refusal to commit to any tax increases for that purpose. With the Tory majority set to increase, “this guarantees a bleak future for the NHS and for its staff under the Conservatives”, claimed Lamb.

Jeremy Hunt, the health secretary, repeated his pledge of more money for the NHS if the Tories are re-elected and said that nurses’ pay should go up. Responding to a question from the BBC interviewer Andrew Marr about some nurses going to food banks, Hunt replied that average nurse’s pay is £31,000.

“Is that enough considering the brilliant work that they do? I think many people would say they want to pay them more. I think they do an incredible job. If you want more money to go into the NHS – and this government recognises we will need to put more money into the NHS and the social care system because of the pressures we face – then the question is how you get there,” said Hunt.

He also insisted that key NHS waiting time standards, such as the four-hour target in A&E and 18-week wait for planned hospital care, were not particularly useful measures of true NHS performance. Lives saved from cancer and heart disease as a result of better care showed the service was doing well, he added.

Jonathan Ashworth, Labour’s health spokesman, said Hunt’s agreement that it was unacceptable that the A&E target had not been met in England for more than two years was “an admission of failure straight from the horse’s mouth: the Tory-made A&E crisis is simply ‘not acceptable’”.

Responding to Hopson’s comments on NHS pay, Ashworth added: “This is a stark warning from NHS Providers about the Conservatives’ catastrophic management of the NHS workforce. It is incredible and disgraceful that NHS staff are leaving to work in supermarkets instead because NHS pay has been squeezed so far. The country’s shortage of paramedics, nurses and consultants now threatens a raft of NHS strategies to provide better services for patients.”

NHS Providers are also warning that understaffing is so serious in mental health services that patients are now suffering delays in receiving treatment, taking longer to recover and having a bad experience of NHS care. “We are particularly worried about the pressures in the mental health workforce,” said Hopson. “These are resulting in delays in treatment, people are taking longer to recover, and as a result their care is more expensive and their experience is worse.”

A Conservative spokesman declined to respond directly to Hopson’s warning. He said only that: “As NHS England say, outcomes for every major disease in this country are now better than they’ve ever been. But the truth is that in order to continue to invest in the NHS, grow staff numbers and pay, and improve patient care, we need to secure the economic progress we’ve made and get a good Brexit deal. That is only on offer at this election with the strong and stable leadership of Theresa May.”

NHS staff "quitting to work in supermarkets because of poor pay"

Labour will give pay rise to "overworked and underpaid" NHS staff

NHS workers who have been “taken for granted” by the Tories will get a pay rise if Labour wins the election, the shadow health secretary is to announce.

Jonathan Ashworth will say in a speech on Wednesday that NHS staff have been “undervalued, overworked and underpaid”by the Conservative government, with cuts to pay and training forcing workers out of the health service and putting young people off applying.

This has led to short staffing that is a threat to patient safety, Ashworth will say.

In March, the government announced that around 1.3 million NHS staff would receive a 1% pay rise but critics pointed out the rise would see nurses, midwives and radiographers earn barely £5 a week more.

The settlement for 2017-18 is the sixth year in a row in which NHS staff’s annual pay rise has been lower than the cost of living – inflation is running at 3.2%.

Labour plan to lift the 1% cap on pay rises for NHS staff and move towards public sector wages being agreed through collective bargaining and the evidence of independent pay review bodies.

At the Unison Health Conference in Liverpool, Ashworth will say: “Our NHS staff are the very pride of Britain. Yet they are ignored, insulted, undervalued, overworked and underpaid by this Tory government. Not any more. Enough is enough.

“NHS staff have been taken for granted for too long by the Conservatives. Cuts to pay and training mean hard-working staff are being forced from NHS professions and young people are being put off before they have even started. Now Brexit threatens the ability of health employers to recruit from overseas.

Labour also plan to create legislation requiring NHS trusts to have regard for patient safety when setting staffing levels, as “Tory mismanagement” has left the health service “dangerously understaffed”.

It will ask the National Institute for Health and Care Excellence to assess whether legally enforced staffing ratios should be introduced in some health settings. The party will also reinstate funding and support for students of health-related degrees and incentivise NHS jobs to boost staffing levels.

Ashworth will say: “What is bad for NHS staff is bad for patients too. Short staffing means reduced services and a threat to patient safety. Labour’s new guarantees for NHS staff will help keep services running at the standard which England’s patients expect.”

The move was welcomed by unions and representative bodies.

Jon Skewes, director for policy, employment relations and communications of the Royal College of Midwives, said: “These are very welcome commitments from the Labour party. They recognise the effort, determination and commitment on the part of our hard-working midwives and other NHS staff to deliver the safest and best possible care for those using the NHS.

He also criticised the government for abolishing NHS bursaries, which has led to a fall by 23% of applications by students in England to nursing and midwifery courses at British universities.

The government’s policy of a 1% pay cap amounts to a drop in real wages, the TUC has calculated. Adjusting for inflation, a nurse, for example, would have earned £30,929 in 2010, but only £28,462 last year.

There are currently 24,000 nursing vacancies, according to the Royal College of Nursing as roles become harder to fill.

Frances O’Grady, general secretary of the TUC said: “Under the government’s current plans, NHS workers will lose thousands of pounds from their salaries. This is unfair, it will demoralise staff and it will increase the number who decide to quit.

“We hope all the parties will make an election pledge to scrap the unfair pay restrictions and give our hard-working NHS staff the pay rise they deserve.”

Unison general secretary Dave Prentis said NHS staff are “struggling to get by” on below-inflation pay rises and lifting the 1% cap would make them feel valued.

Conservative health minister Philip Dunne said: “We’ve protected and increased the NHS budget and got thousands more staff in hospitals. But all that’s at risk with Jeremy Corbyn’s nonsensical economic policies that would mean less money for the NHS. Just look at Wales where Labour’s economic mismanagement means they had to cut funding.”

Labour will give pay rise to "overworked and underpaid" NHS staff

Burnout, depression and anxiety – why the NHS has a problem with staff health

When Laura-Jane Smith took time out of her clinical training for a PhD, she found she was constantly unhappy, and suffered from palpitations, nausea, severe headaches, and breathlessness among other physical symptoms.

The hospital doctor’s days were dominated by negative thoughts. She recalls: “I once walked for 30 minutes with ‘I hate my life. I hate my life’ on a loop of internal monologue that I feared had no end.” Eventually, Smith was diagnosed with depression and anxiety and ended up leaving the PhD.

She is not alone. Countless healthcare professionals suffer from burnout, depression, anxiety and addiction. Estimates from Public Health England put the cost to the NHS of staff absence due to poor health at £2.4bn a year – excluding the cost of agency staff to fill in gaps and the cost of treatment.

In his independent review looking at the impact of staff health on NHS performance, former medical director Steve Boorman, who is honorary professorial fellow of the Royal Society of Public Health, found that health workers often did not prioritise their own health. “They did not want to take time off as they felt patient care would suffer when temporary cover was needed to replace them,” he explains.

Dr Clare Gerada, medical director for the NHS Practitioner Health Programme, explains why this is so: “You only have to look at what you’re trained to do as a doctor or a nurse. You’re trained to put patients first and to put their needs above your own.”

NHS England now has a specific programme, supported by chief executive Simon Stevens, that advocates health checks, access to early physiotherapy and mental health support, and improvements in food available on site and staff vaccination uptakes. But Boorman admits that progress is inconsistent and staff health is still a low priority for leadership and for NHS staff themselves.

“Good staff health isn’t about token Zumba classes or lettuce leaves for the worried, but about helping people understand the impact poor health may have on themselves, their family and those around them – in the case of NHS workers, the vulnerable patients that need care,” he points out.

Smith, who is back at work after seeking help from the NHS Practitioner Health Programme and undergoing therapy, says that finding a space in life for creativity also helped her.

Anxious to prevent a relapse, she has made herself a number of promises: “I will take all my annual leave, I will say ‘no’ more often to extra work tasks, I will value activities that make me happy. By making time for the things that recharge me, I am now more effective – a better colleague and a better doctor.”

Burnout, depression and anxiety – why the NHS has a problem with staff health

NHS to fast-track nurses as record EU staff leave service after Brexit vote

NHS England is to launch a new nursing training programme to help plug the gap created by the record number of Europeans leaving the service in the wake of Britain’s vote to leave the European Union.

Simon Stevens, the chief executive of NHS England, acknowledged that the service relies on international staff, including more than 12,000 nurses who are EU nationals out of the 315,000 nurses on its payroll.

Speaking on the BBC Radio 4’s Today programme before the launch of a five-year plan for the NHS, he announced a training programme to “grow the workforce from within this country”.

The moves comes after new figures revealed that a record 17,197 EU nationals, including doctors and nurses, left the NHS last year.

Asked if he was worried about the impact of Brexit, Stevens said: “The NHS has always relied on international staff as well as staff from this country. It is about 4% of our nurses who come from the rest of the European Union. We are grateful for the work that they do.”

But he suggested newly trained British nurses could help fill the gap left by EU nationals once Britain leaves the bloc.

Stevens said: “We have got a curious situation where many more people in this country would like to train to be nurses than we have nurse training places. So we want to expand the number of nurse training places and the routes into nursing so that we can grow the work force from within this country as well.”

He said the new training programme would be modelled on an initiative to recruit more teachers.

“We are announcing a new programme called Nurse First, which is the equivalent of the Teach First programme, whereby new graduates can fast-track into nursing alongside other apprenticeship routes … so that we can expand the number of nurses we have.”

The programme will boost the number of newly qualified nurses by up to 2,200 more a year in 2019 when the UK is due to leave the EU.

In a wide-ranging interview, Stevens denied he was abandoning the 18-week waiting time target for non-urgent operations by relaxing the deadline for hospitals to meet the deadline.

He said: “Fifteen years ago you might be waiting 18 months for your hip or your knee operation, now for nine out of 10 people it’s 18 weeks. The average wait for an operation is 10 weeks. Over the next couple of years we want to have more funded operations on the NHS, but we recognise that the rate of growth is probably going to have to be a little bit slower than it has at points in the past, because we also want to make big improvements in cancer care, in GP services and in mental health services as well.”

The Royal College of Surgeons said the new guidelines amounted to “waving the white flag on the 18-week target”.

Asked if the target had been jettisoned, Stevens said: “It hasn’t. The reality is that there are pressures right across the health service. Under those circumstances we have to make a start on sorting out particularly those pressures in A&E departments which we have seen over the course of the last winter. But over the course of the next several years we want to continue to expand the amount of surgery that is being done, so that waiting times stay low.”

He also announced that all major A&E hospital departments will have to provide GP services to help emergency medics focus on the sickest patients. Steven said: “You can find about 60 hospitals right now that have got this arrangement. This is going to be rolled out to all major A&Es.”

Stevens confirmed that the NHS wanted to stamp out an estimated £4m spent on homeopathic medicine. He dismissed homeopathy as a “placebo at best” and said it was a “classic example of what we want to see less of”.

NHS to fast-track nurses as record EU staff leave service after Brexit vote

Pay poor countries for NHS staff they train | Letters

Recruiting NHS staff from other countries saves the British taxpayer the very substantial costs of training them.

However, the proportional financial cost to poorer source countries is much greater than our saving. John Holme (Letters, 21 March) mentions Malawi as one source for NHS staff: six years ago a study published in the BMJ estimated the loss of returns to Malawi just for doctors then working in rich, predominantly white countries, at $ 1.41bn. Of those countries, it was the UK that benefited most, with a net transfer of wealth from nine sub-Saharan countries struggling with HIV/Aids of $ 2.7bn.

Getting poorer countries to pay for our medical training appears to be a deliberate UK policy rather than just the mighty free market, given the cuts in training places and funding.

Rather than selfishly celebrate this neocolonial asset-stripping, we should insist that countries of origin should be fully compensated for the loss. And that the UK should pay its own way in future.
Peter McKenna
Liverpool

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Pay poor countries for NHS staff they train | Letters

Constant restructuring of NHS is demoralising staff, survey finds

The number of NHS reorganisations in recent years is a key reason for the health service’s struggle to retain staff, a poll has found.

The NHS has been struggling to meet rising demand with a chronic shortage of staff and the results of a survey, published on Friday, suggest that a feeling of constant upheaval is at least partially to blame.

The poll by Wilmington Healthcare UK of more than 2,000 nurses, GPs and hospital doctors across the UK found that 64% blamed staff retention problems on the continuous and “demoralising” national changes in NHS workforce planning that had occurred since 2000.

The concerns about the state of flux are revealed as as the health service faces further big upheaval, in the shape of the controversial sustainability and transformation plans (STPs), which are intended to improve productivity and efficiency and so plug the NHS funding gap. The STPs will mean some hospitals and beds lost and more services being delivered in the community.

Wilmington Healthcare’s managing director, Gareth Thomas, said: “Our survey shows that continued changes in workforce planning since 2000 have been a major factor in NHS staff retention problems.

“This is of particular concern as the planned introduction of STPs in April 2017 is set to bring the biggest shake-up to NHS services since the publication of the Five Year Forward View.

“As the NHS moves towards a truly devolved health and social care system, it is clear that urgent action must be taken to support staff and help them manage the huge changes that are envisaged.”

Changes in NHS workforce planning, due to organisational changes, and said to have affected staff retention, included the establishment of primary care trusts, workforce development confederations and strategic health authorities, all since abolished (within three years of their creation in the case of WDCs). Primary care trusts were replaced by clinical commissioning groups.

Other key factors cited by respondents as adversely affecting the NHS’s ability to retain staff were low morale (92% of respondents) and poor pay and rewards (72%).

With concerns raised that the UK’s exit from the EU would exacerbate the shortage of NHS staff – 59,000 NHS staff are nationals of other EU countries – the survey also asked respondents about the impact of Brexit. Just under half (48%) said it would bemore difficult to recruit and retain staff, 45% said it would make no difference and 7% said it would be easier to recruit and retain staff. According to the Nuffield Trust, 10% of doctors and 4% of nurses are from the EU.

More than eight in 10 respondents (85%) said access to training and development was the key requirement of the future NHS workforce, closely followed by flexible working and career progression (both 78%).

An NHS England spokeswoman said: “This poll is wide of the mark and at odds with our own thorough and robust staff survey which garnered 423,000 responses. It found 80% of frontline NHS staff say they are able to do their job to a standard they are personally pleased with, 90% of staff say their job makes a difference for patients, and 92% of staff feel trusted to do their jobs, which does not seem to suggest a low morale workforce.”

Constant restructuring of NHS is demoralising staff, survey finds

Over half of NHS staff work unpaid overtime every week, survey finds

This past year has sent shockwaves through an already challenging working environment in the NHS. From the withdrawal of nursing bursaries and junior doctors’ strikes to the uncertain impact of Brexit on 58,000 EU nationals currently working in the health service, workforce pressures continued to build for an already overstretched service.

So what do the findings of the latest NHS staff survey, released on Tuesday, tell us about how staff are coping? Covering 316 participating NHS organisations, the survey is the biggest in the world, capturing the experiences of more than 423,000 healthcare professionals across the country.

The good news is that despite the tremendous pressures the NHS faces, nearly three quarters of staff remain enthusiastic about their job, while 70% said they would be happy with the standard of care provided by their organisation if a friend or relative needed treatment. The proportion of staff who reported feeling unwell due to work-related stress is at its lowest since 2012, down to 37%.

Responses addressing another key aspect of staff motivation – feeling empowered to contribute suggestions for improving work practices – also signalled positives. More than 70% of staff said that there are frequent opportunities to show initiative in their role, and 75% reported making suggestions to improve the work of their team or department. The survey did indicate room for improvement, however. Only a small majority of staff (56%) stated that these suggestions were actually acted upon – staff feedback does not appear to always translate into tangible change.

As is to be expected in such a pressured working environment, the survey does highlight some challenges for the NHS. More than half of staff (56%) report having attended work in the last three months despite feeling unwell, due to pressure from either their manager, colleagues or themselves. This is, however, a significant improvement since 2012, when 64% attended work despite illness. Most of this pressure comes from staff themselves (92%), rather than from managers (26%) or other colleagues (20%).

Generally, staff report feeling that managers are invested in their health and wellbeing. Most say that their immediate manager takes an interest in their health and wellbeing (67%) and that their organisation more broadly takes positive action on the health and wellbeing of staff (90%). These figures are on a par with those from last year’s survey and describe a workforce committed to working together and supporting one another to deliver high quality care – one that struggles more with heavy workloads and external pressures.

A key aspect of wellbeing is maintaining a healthy work-life balance and this is another area that contains some worrying figures. Staff report being satisfied with the opportunities to work flexibly – but 59% are, on average, working additional unpaid hours each week. Overall, the proportion of staff working additional hours is 72%, indicating that not enough has been done to alleviate workloads in light of similar results in recent years. The steady increase in both paid and unpaid overtime since 2012 is concerning as research repeatedly suggests that relying on tired and over-worked staff can lead to poorer standards of care.

The results of the 2016 staff survey suggest NHS staff are showing remarkable resilience despite the huge pressures that have been placed on the system. However, with external pressures such as Brexit likely to exacerbate existing problems in future years, a concerted effort is required from the government and NHS England to ensure that the positives to be found in staff motivation and engagement this year are not lost. NHS staff are subject to immense pressures that are unlikely to ease without significant support.

• Rory Corbett is a senior research associate at Picker, a charity that co-ordinates the NHS staff survey on behalf of NHS England
  

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Over half of NHS staff work unpaid overtime every week, survey finds

NHS staff: tell us about the impact of social care cuts | Sarah Marsh

The government’s austerity programme is squeezing funding to both social care and the NHS – leading to serious problems in both. The Care and Support Alliance this month has found almost 9 out of 10 GPs think reductions in social care are leading to extra pressures in their surgeries. Even more (93%) think that the lack of social care is leading to extra pressure on A&Es and contributing to increased delayed hospital discharges.

We’re looking for NHS staff who have been affected by the cuts for Frances Ryan’s Hardworking Britain column, which looks at the stories of individuals whose lives have been negatively impacted by government policy.

Share your experiences

Are you a GP seeing the impact of social care cuts? Or do you work in A&E and cannot discharge patients because there’s no support for them at home? Share your stories and views.

NHS staff: tell us about the impact of social care cuts | Sarah Marsh

NHS admin staff keep services running - but we"re being hit by cuts

Secretaries, waiting list and medical records clerks, clinical audit facilitators, business analysts and IT technicians and other support staff pull together to keep essential lifesaving NHS services running smoothly. To a staff nurse, the help of a ward clerk to retrieve a patient’s medical history can be just as crucial as that of a senior consultant. Data quality officers ensuring patients are properly admitted and discharged on computer systems can have an immeasurable impact on the management of bed capacity.

Yet those of us in NHS support services work in less-than-ideal circumstances. I work in an office that is a converted ward. Save for wheeling out most of the medical equipment, it remains an abandoned clinical area. I’m always wary when manoeuvring around our cramped kitchenette – imagine the embarrassment of accidentally leaning on one of the emergency call buttons and having the rapid response CPR team come crashing in.

Plates and cutlery stand stacked precariously atop the tiny dining table and fridge (kindly donated by another admin department, who were throwing it out). A locked walk-in cupboard adjacent to the kitchen would be ideal for storing these. However, due to budget and staff restrictions, logging a job with estates to get a new Yale lock installed has proven fruitless on several occasions. Jobs deemed non-essential are often cancelled. With a leaking radiator pipe, broken window and an unexplained beep from above the ceiling tiles failing to see a quick response, reporting anything else can make one feel rather hypercritical.

The already cramped office still holds a partly dismantled bed hoist, condemned imaging machines and a box of surgical tubing, seemingly forgotten. We have jokingly discussed eBaying the lot to raise funds to buy desk lamps; dim strip lighting doesn’t quite work in an office.

I was lucky enough to suffer a full-scale-beyond-repair PC meltdown one day, so IT had no choice but to provide me with a reconditioned model from their storeroom. However, some of my colleagues are working on machines so old they take upwards of 20 minutes to boot up in the morning. The high-pitched whine of the struggling fans is maddening. Stretched IT staff struggle to keep up with demand. While problems with direct patient impact understandably take priority, waiting three days for a simple but essential fix is excessive.

For a team dependent on computers for their jobs, this can mean time wasted recording information on paper, only to have to transfer it to a digital source once systems are back up and running. It’s easy to see how this can contribute to huge backlogs and missed deadlines. Panicked managers pleading staff to take budget-stretching overtime is often the result.

Cheap or outdated equipment with a tendency to crash or throw up errors only adds to the problem. False economy reigns supreme, when an inadequate version is eventually replaced with the one we should have had all along. An ancient printer once cost my department half a day of productivity, as IT spent hours searching for a withdrawn ink cartridge so we could run off essential documents.

A friend in another department is responsible for requesting essential office supplies. To ensure he’s not buying luxury items the trust can’t afford, all orders are approved by executive-level staff. A recent attempt to gain a few pencil sharpeners saw 12 members of staff told to share three. Mouse mats are definitely off limits.

Understaffing is not just a problem on the frontline. Although there have been cuts and restrictions to what is made available, access to support and training for admin staff is still admittedly good, and it’s not uncommon to hear of a new recruit using NHS resources to gain experience and qualifications before handing in their notice to take a similar role in the private sector. Vacancies are often not re-advertised. While the wary jump ship, those left behind are expected to absorb the roles of colleagues, often without a wage increase.

I am proud to say I work for the NHS. It means much more to me than private sector benefits like a shiny new Apple Mac to work on or an all-expenses paid Christmas do. I enjoy knowing that I am, albeit in an indirect way, contributing to saving people’s lives. There is a sense of community in the health service I don’t sense in corporate organisations; we still join unions, strike together, are aware of each other’s problems.

Yet, just like the healthcare professionals feeling the stress and strain of the continued NHS cuts, we support staff feel we can do only do our best when we’re comfortable at work and morale is high. Since beginning my NHS career, although I’ve advanced and been promoted, I also feel that things are sliding backwards. While frontline medical staff are still undoubtedly in the most direct line of fire, we feel the impact under the surface too and there’s a definite feeling that things are getting worse.

• Some details have been altered to protect the identity of the writer

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NHS admin staff keep services running - but we"re being hit by cuts

Social care staff, what is your experience of working with the NHS?

Integration between health and social care has long been touted as an answer to the gargantuan problems faced by both sectors.

But now a scathing report by the National Audit Office (pdf) has revealed that integration is not working and that barriers preventing it remain intact. In a piece about the report, Richard Vize, former editor of the Health Service Journal, wrote: “The failure to break down these barriers leads to the crazy situation where health and care staff can only succeed in working more closely together if they fight the very system that employs them.”

Health and social care leaders regularly debate how integration could – and should – work. We want to know what those on the ground think about the obstacles to closer working with the NHS and how they can be overcome.

Are you a social care professional with experience of working with the NHS? Do you feel the current set-up is conducive to working together? Do you have any experiences that highlight how things are not working? What are relationships between health and social care professionals like?

We also want to hear success stories. Do you work in an area of the country where integration is working well? Tell us about it.

To share your thoughts and experiences, please fill in the form below. A selection of responses will be used in our reporting. You may remain anonymous if you wish.

Social care staff, what is your experience of working with the NHS?

Staff shortages are threatening the NHS | Letters

The recruitment crisis shows just how badly the government is managing the NHS (Report, 4 February). The proportion of doctors joining specialist training in the UK – including general practice – has fallen for the fifth year running, with just over 50% of doctors who completed the foundation programme going on to enter British specialist training – compared with 71% in 2011, according to the figures from the UK Foundation Programme Office.

GP recruitment has slumped by 20% and a recent report by the National Audit Office warned that poor access to GPs during the working day could be fuelling Britain’s A&E crisis. It said that rising numbers of patients are being forced to wait a month to see a family doctor, with estimates of a shortage of up to 10,000 GPs by 2020.

Almost every hospital in the UK has a shortage of nurses, but the government has confirmed plans to end bursaries for student nurses and midwives from next year. At the same time the number of nurses from Europe registering to work here since the Brexit referendum has fallen by 90%. Janet Davies, chief executive of the Royal College of Nursing, said: “If this is the beginning of a long-term drop in the number of nurses coming to the UK from other parts of the EU, that’s a serious concern at a time when we’re already facing a crisis in nurse staffing numbers. With 24,000 nursing vacancies across the UK, the NHS could not cope without the contribution from EU nurses. Without a guarantee that EU nationals working in the NHS can remain, it will be much harder to retain and recruit staff from the EU.”

Without staff the NHS cannot function effectively and the march towards privatisation will become unstoppable.
Dr Richard Turner
Harrogate, North Yorkshire

• The government was warned when it removed nursing bursaries it was risking the future of our NHS. Now the reality is becoming clear – fewer people willing to train to work in our hospitals, putting our health system under even greater strain. We already have a huge shortfall in nursing staff, and now the government is making it even worse. At the same time, the government’s half-baked plans to crack down on EU immigration have left 10% of those working in our NHS in limbo. The government cannot go on telling people it cares about the future of the NHS while it cuts support for training, stands by while nurses’ salaries suffer a massive drop in real terms and allows spending per person to sink to dangerous levels.
Norman Lamb MP
Liberal Democrat health spokesman

• As cancellations, delays, and rationing of non-urgent surgery increase in the NHS (1,700 face long surgery delays amid cash crisis, 3 February) the government remains surprisingly unfazed. But if, as I assume, most of its members would buy themselves out of trouble through private medicine, why not?
Michael Sheldon
Norwich

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Staff shortages are threatening the NHS | Letters

Sobbing teenagers, angry staff and threats: my week in NHS payroll

Monday

I arrive at my desk just as our manager approaches a colleague suffering from back pain and asks how she’s doing. She replies that she is in a lot of pain. Our manager responds: “I’m not interested; I’m asking if you’re going to meet your deadline. If you don’t complete your work by 10am you can explain to 5,000 people that they haven’t been paid due to your failure to do your job properly.”

I am personally responsible for the distribution of millions of pounds of public money: I pay domestic, portering, maintenance, clerical, nursing and medical staff, senior managers, chief executives and apprentices. My in-tray is brimming with timesheets, expenses claims and new starters to set up.

Among the 43 emails that have arrived over the weekend, there are queries about sickness entitlements, reports of unpaid enhanced hours, and a request for a salary advance “because I’ve spent all my money”.

Tuesday

A team member announces her pregnancy. We are happy for her but it means extra work for the rest of us. Any absences for maternity, paternity, sickness, career breaks and in many cases leavers, are dealt with by sharing out the workload among those of us still present.

I check reports, set up new starters and calm a sobbing teenager who thought she’d be paid the living wage rather than apprentice rate. I have four overpayments to calculate, all due to failure by departmental managers to inform us of two leavers, a reduction in someone’s contract hours and a member of staff suspended. I have to produce a report for each to pass to NHS fraud investigators. The managers apologise to me for the extra work, but leave me to deal with their upset and angry staff.

Wednesday

I plough through a huge report detailing changes to employee records made by HR and departmental managers. To do this thoroughly would take several days but I have an hour so a perfunctory scan and crossed fingers will have to suffice.

I receive a beautiful handmade thank you card from a grateful payee I arranged an urgent payment for after her manager forgot to send us her timesheet for a whole month of night shifts. It is the second one I have received in over 20 years in the job and it will be treasured. I am happy all day.

Thursday

An angry man calls and tells me his expenses payment is wrong again; he insists his claim detailed an overnight stay in a hotel and several hundred business miles. I fax him a copy which displays 22 miles and a 60p parking ticket. He tells me his sister-in-law works in HR at our trust and will have me fired.

Not speaking my mind when my managers and people are rude to me is difficult. Senior managers tell us we are there to support them, middle managers focus on their next promotion and the line managers carry their workload. Their frustration is not reported due to a culture of fear and blame, and is instead directed at us.

A colleague has the flu but is afraid to stay off as it will trigger a sickness review: three short absences in a year, or just one long-term can lead to job loss. I make her hot drinks and cover her work for her.

Friday

An electrical fault has affected our telephone line and for once it is quiet. The peace is short-lived. When the line is repaired, people accuse me of switching off my phone to stop them getting through. I calm each one down and deal with their problems and queries. I notice it is 6.30pm and I have been working for free for the last hour – again.

Some details have been changed

If you would like to contribute to our Blood, sweat and tears series which is about memorable moments in a healthcare career, please read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more about issues like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

Sobbing teenagers, angry staff and threats: my week in NHS payroll

NHS intensive care "at its limits" because of staff shortages

The NHS’s network of intensive care units is “at its limits” because they are overwhelmed by staff shortages and the sheer number of patients needing life-or-death care, senior doctors are warning in an unprecedented intervention.

Intensive care units (ICUs) are becoming so full that patient safety is increasingly at risk because life-saving operations – including heart, abdominal and neurosurgery – are having to be delayed, the leaders of the specialist doctors who staff the units have told the Guardian.

“Intensive care is at its limits in terms of capacity and struggles to maintain adequate staffing levels,” said Dr Carl Waldmann, the dean of the Faculty of Intensive Care Medicine (FICM).

“It is important that bed occupancy rates do not exceed 85% in order to ensure there is capacity for emergencies. The reality is that many units are quickly reaching 100% capacity whenever there is excessive hospital activity,” he added.

The Guardian can reveal that, in a stark example of the growing problems, Hull and East Yorkshire Hospitals NHS trust last week ran out of intensive care beds at its two hospitals and was struggling to provide normal care to the many patients needing treatment for life-or-death conditions.

In a letter to its nurses, it said: “The critical care units have been working under considerable and sustained pressure. This is as a direct consequence of both the high number of patients requiring critical care support, and the intensity of each patient’s needs. This is in excess of the established number of level 3 [intensive care] equivalent beds on both hospital sites.”

Dr Liam Brennan, the president of the Royal College of Anaesthetists, voiced similar concerns. “In order to care for acutely unwell patients, surgery is being postponed because of lack of ITU [intensive therapy unit] beds. The combination of inadequate staffing levels in intensive care units together with a shortage of high-dependency beds is having a very real impact on patients, which are needing to have critical surgery such as major abdominal or chest surgery, or neurosurgery, delayed for their own safety,” he said.

“I’ve had reports from anaesthetists and intensive care specialists across the country of 100% occupancy rates in intensive care units and of major surgical cases, including cardiac cases which are potentially life threatening, being cancelled because the beds required for the post-operative care are needed for other critically ill patients,” Brennan added.

Steve Jessop, the trust’s nurse director, added that as a result, “at this time the service is currently unable to deliver critical care services to the high number of patients that require treatment resulting in: cancellation of life-saving operations for patients requiring critical care support, including neurosurgery, cardiothoracic surgery, vascular surgery and cancer operations.

“Currently the critical care units are caring for patients which are significantly above the number of patients we are resourced to care for.” Jessop offered nurses increased pay for working extra shifts to help relieve the pressure in its critical care units in Hull and Cottingham in east Yorkshire.

Doctors working in intensive care have told the Guardian how ICU bed shortages have become even more acute during the NHS’s “winter crisis” and forced patients needing life-or-death treatment in an ICU to wait many hours before getting a bed. One told how a patient with sepsis, the blood infection that kills an estimated 44,000 people a year, had to wait more than 12 hours in A&E for an ICU bed to become free. Another patient, an elderly man who was known to be dying after a cardiac arrest, ended up passing away in an A&E unit rather than in a side room in the hospital’s ICU as doctors hoped because it was so full.

Waldmann and Brennan also fear that patient safety is at risk as a result of ICUs becoming overloaded. “Multidisciplinary teams have maintained patient safety, but in future years this may increasingly come at the expense of quality of care,” said Waldmann.

The disclosure that ICUs are under such intense strain challenges both Theresa May’s recent insistence that the unprecedented problems seen in hospitals are in line with normal winter pressures and the claim by the health secretary, Jeremy Hunt, that the NHS is “performing well”. Copious official data shows that hospitals, GP surgeries and ambulance services, under the heaviest pressures on record, are routinely breaching NHS-wide targets for seeing and treating patients fast enough.

NHS-wide shortages of specialist doctors and nurses means ICU beds often lie unused because there are no staff to care for patients, added Brennan. One in three of the 220 ICUs across the UK have a vacancy for at least one consultant, according to new survey data collected by the FICM. “Bed capacity figures still do not give a true reflection of the situation on the ground. A number of seemingly empty beds have to remain empty as there are not sufficient doctors and nurses in place to support them,” said Waldmann.

Jonathan Ashworth, the shadow health secretary, said: “Reports that intensive care is at capacity and without adequate staffing should set alarms bells ringing in Downing Street, but instead we have a prime minister utterly lacking in her response to the NHS crisis.

“The truth is problems are getting worse and more widespread than in previous years with even life-saving cardiac, abdominal or neurosurgery operations being cancelled. Theresa May needs to get a grip of the crisis and explain what action she’s going to take to make sure that hospitals can get in place the number of staff they need to keep patients safe.”

NHS England denied there were any serious problems. “At this time of year it’s not unusual for specialist intensive care units to become busy, but tracking data on occupancy rates show hospitals have teams in place to ensure the right care is available. This can include moving patients to other hospitals or bringing in extra staff where necessary,” said a spokeswoman.

NHS intensive care "at its limits" because of staff shortages

Home Office refuses to enforce privacy code on NHS staff using video

The government has rejected a request by the surveillance camera watchdog to allow it to monitor the increasing and unregulated use of body-worn video cameras in hospitals.

The cameras, which record sound as well as images, are being increasingly deployed in hospitals in an effort to tackle abuse of frontline health service staff.

On Wednesday, it emerged that surveillance camera commissioner Tony Porter had warned ministers last year that the privacy of millions of NHS patients was put at risk by the unchecked use of the cameras.

In a call backed by privacy campaigners, Porter recommended adding NHS trusts to a list of public bodies required to comply with a code of practice on the use of surveillance in effort to promote greater transparency and accountability.

Now the Home Office, the department to which Porter reports, has rejected the requests.

A letter to Porter sent last week from the home office minister, Brandon Lewis, and released by the government on Wednesday, said the recommendation was unnecessary as: “We had not exhausted the possibilities of increasing voluntary compliance.”

In letter in November, also released on Wednesday, Porter warned that the voluntary approach had twice been rejected by NHS Protect, the body responsible for hospital security, “on the ground that they could not enforce compliance”.

Porter’s letter added: “Despite our best attempts, voluntary adoption has not worked … and it will difficult without government intervention.”

Under the code, which is overseen by Porter as the surveillance camera commissioner, public bodies such as the police must demonstrate a “pressing need” for the use of surveillance cameras, and warn the public of their use and how images will be stored and used. Porter, a former senior counter-terrorism officer, has been working with the police to ensure how public privacy can be protected as forces roll out body-worn video for frontline officers. He wants to do the same in the NHS.

In his November letter, Porter warned Lewis that he was becoming increasingly concerned about the use of surveillance in the NHS.

He said: “The NHS trusts are complex organisations that use surveillance camera systems in public areas where people under surveillance are likely to be vulnerable and distressed, and where the privacy requirements and burden on those conducting transparent, legitimate and proportionate surveillance is surely at its highest.”

It pointed out that millions of people use hospitals each year, and added: “The introduction of body-worn video cameras at several hospitals has increased my concerns. Body-worn video cameras are a particularly intrusive device as they capture audio and video simultaneously without the option of switching either off whilst recording.”

Porter said the government’s decision to allow surveillance to go unchecked in the NHS raised a series of questions about the privacy of patients.

In a statement to the Guardian, he said: “Surveillance cameras play an important role in maintaining public and staff safety, preventing and resolving crimes. Yet in the healthcare sector they are not subject to scrutiny and standards, and therefore can we be reassured that they are fit for purpose and are doing what they are meant to be doing?

“Are we sure that security officers using body-worn video are doing so without invading an individual’s right to privacy when they may be at their most vulnerable? NHS Protect have twice rejected recommending that trusts adopt the surveillance camera code of practice as it’s not mandatory for them – the code is designed to ensure cameras are used effectively, transparently and efficiently to protect individuals’ freedoms.

“In the absence of any mandate to adopt the code, I’m continuing to work with government to look at how we can encourage NHS trusts and hospitals to voluntarily adopt the surveillance camera code of practice.”

Daniel Nesbitt, research director at Big Brother Watch, urged ministers to heed Porter’s warning.

He said: “The government shouldn’t be standing in the way of effective oversight. The NHS controls a large number of CCTV cameras and the public have to be able to trust they will use them properly.

“Giving the surveillance camera commissioner the power to oversee how trusts use their cameras should be a no-brainer.”

Home Office refuses to enforce privacy code on NHS staff using video

A receptionist saved my life and other love letters to healthcare staff

It was the receptionist who took me seriously when I said I had a headache which turned out to be a brain haemorrhage

I’d gone to A&E in Derby, where I was staying for Christmas, with the most dreadful headache. I’d been a radiographer at St Thomas’ hospital in London for 18 years and knew something wasn’t right. It was the day after Boxing Day and there had been heavy snow so it was busy with people who had fallen over.

I was at the reception desk and I’d already been told how busy it was and asked whether it could wait until after the weekend. The receptionist who eventually booked me in reiterated how busy it was but I pleaded with her and told her I knew something wasn’t right – I didn’t get headaches. She could tell how unwell I was and booked me in.

She kept an eye on me in the waiting room and could see how much pain I was in. She kept checking where I was in the queue and made sure I was ok. She told the nurse in charge that I needed to be seen ASAP.

What none of us knew at that point was that I was having a brain haemorrhage. If she hadn’t believed me I’d probably have gone back home and would not be here today.

I never got the chance to tell her that she was perfect at her job, that she showed me care that I will never forget.

Even when I then saw the triage nurse, he made me feel like I was wasting his time and I’d got a cold and a headache. When I was waiting in the minors area she checked on me to see if I was ok. I waited another hour to see a doctor who referred me for a CT scan which showed a haemorrhage due to a ruptured cerebral aneurysm. I went for surgery at 1pm the next day.

I’ve worked in the NHS and I know how rare it is for patients to say thank you. It doesn’t matter if you’re a doctor or a receptionist, a gesture, care and compassion means an awful lot. Although I was saved by a neurosurgeon, Hillary on reception was the only one to believe me. I’ve never forgotten what she did for me.

Jane Gooch, London

A midwife picked up that my newborn baby had had a stroke after the GP had dismissed me

My newborn baby was due for a routine post-partum check. He had been twitching suspiciously, and we had been to the GP, who had dismissed us. We were so concerned about our son’s random movements and subsequent deep sleep that we took a short film of his movements. When I showed this to the midwife asking for her advice, she looked very alarmed and asked to take the film to be checked by a doctor. She came back within minutes and took us to the neonatal intensive care ward, where my son was admitted and medicated.

It was soon discovered that he had had a stroke during birth, causing the epilepsy-like twitching. The diagnosis was very difficult to come to terms with, but now, a few years on, he appears to have fully recovered, consistently scoring above average on all the many cognitive and motor checks he has undergone. He is a sunny and happy child, without a hint of his difficult start.

We will forever remember that midwife’s quick action and astuteness during those first days of his life. Had she dismissed us as the GP did, his fits would have continued and might have caused more brain damage. Her intervention and quick action allowed him to be diagnosed and medicated early on, giving him the gift of a full life, and us the immense relief of having a healthy and happy child.

Anonymous, south-east England

The care one nurse gave me and the kindness in her heart made every difference to my hospital stay

I live with a rare heart disease and have had several operations, including open heart surgery, aged nine; I now rely on a pacemaker.

I’ve spent a lot of time in and out of hospital over the years and have been treated by many medical professionals – some I have known since birth and others I have met once and never seen again. In June 2016, a mature first year nursing student looked after me and she is someone I will never forget.

She was calm and collected and so attentive to everything she was learning. She asked questions about who I was, removing the patient element and getting to know me, as a person. No matter what she was doing, she always had time. I know she had children of her own, and when she was looking after me, I feel she treated me as one of her own.

At the end of her shift, she always came to say goodbye. We shared giggles and at times I shared the sweets I had been gifted with her. Haribo hearts and cola bottles were her favourite. When in pain, she was the first by my bedside, to hold my hand and stayed until I felt better.

The afternoon I was discharged, she overheard me crying in my bed. My family weren’t there and she came in to see me. While I explained that I was happy to be going, she understood my frustration that I still had no answers. I had been in for a week and no test or procedure had revealed what was wrong with me. She drew the curtain around my bed and while I sat and cried, she cradled me in her arms.

The care she gave me and the kindness in her heart made every difference to my stay. She has two more years to go but I know that she will make the most amazing nurse.

Hannah Phillips, London

I never got the chance to thank the surgeon for saving my life. The event led to me becoming a doctor

When I was 15, I was hit by shrapnel on an army cadet training exercise. I was taken to hospital and had emergency surgery.

I never got the chance to properly thank the surgeon or his team for saving my life. I don’t remember the surgery but I do remember how kind he was in the follow-up appointments and how he laughed and joked with me. He also kept my mum from falling to pieces during the first few days after my accident.

The whole event led to many changes in my life including a career change; from wanting to join the army I decided instead to pursue a career in healthcare. It took me a while longer but I qualified as a doctor in 2008 and have subsequently developed an interest in major trauma surgery.

Alex Bell, Sheffield

I don’t know what I would have done without one nurse. Her hand in mine rescued me

I was living in the US when I sadly had a string of miscarriages. On one occasion one became complicated and I was rushed to the hospital with haemorrhaging. I had an emergency procedure in a cubicle in the emergency room – fast, with no anaesthetic.

There was a nurse who took care of me from the moment I arrived. I was hers, she told me, when she disagreed with a young medical student’s view that I could walk to the bathroom alone. She was going to keep me safe.

The procedure I underwent was quick and successful, but painful and I was terrified by the amount of blood and by the looks on the doctors’ faces. This nurse held my hand the whole way through. I don’t know what I would have done without her. I clung to her. Her hand in mine rescued me.

I never got the chance to tell her that she was perfect at her job, that she showed me care that I will never forget and that her tender kindness helped me heal.

Louise Harland, London

I’m able to deal with my mental health problems thanks to the doctor who encouraged me to get the help I needed

I was visiting my local clinic on a routine appointment to get a contraceptive device removed from my arm, when the doctor told me that she wouldn’t be able to put a new one in unless I lost some weight. I burst into tears and she immediately started comforting me as she thought I was upset about the weight comment. I told her that wasn’t it and so she asked me what was really wrong.

I poured my heart out about everything that had gone wrong for me in the last year or so: my mum dying, the crushing anxiety I was experiencing, my OCD and depression, the massive argument I’d had with my father which meant I hadn’t spoken to him for six months and so much more. She listened to me and then she cried too.

I remember thinking that if I could make a doctor cry with my story, somebody who must see and hear all kinds of things every day, then perhaps this was really bad. After I had recovered myself, she told me that I had been through a lot and that I needed to talk to someone.

Because of her I finally understood that what was happening to me was serious and that I needed help. I felt that I was authorised to go to my doctor and ask for help – she gave me the confidence to do that. I got the help I really needed – therapy and guidance – that enabled me to get my life back on track. I trained to become a teacher not long after and I now live in Beijing and work as a university lecturer there. I still have depression and the rest – I always will, but I’m able to deal with it now thanks to the help she encouraged me to get.

Lorna, Beijing

I’m so grateful to all the healthcare professionals who saved my boyfriend’s life when he tried to kill himself

Years before I would meet met him, my boyfriend tried to kill himself. I owe my most heartfelt thanks to the 999 operative who took his call, the paramedics who arrived, the nurses and doctors who treated him after he’d lost an immense amount of blood, and the team on the psychiatric ward he was then referred to.

I don’t know who they are, or how I would ever start to find the people I owe so much to. But to me, that’s the exact point. Thousands of healthcare professionals across the country work every day to support people who are going through the same struggle, and many other just as important struggles. Without these professionals, my boyfriend’s life would be just a memory.

I would like those who deal with people who may seem to have given up on themselves, to know that by not giving up on them, they make a difference beyond comprehension. Their effort and hard work during years of training, is appreciated and valued by my boyfriend and everyone who loves him. Without the dedication of those professionals, his life would have been so quickly and devastatingly thrown away.

Anonymous

• In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.
  

If you would like to contribute to our Blood, sweat and tears series which is about memorable moments in a healthcare career, please read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more about issues like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

A receptionist saved my life and other love letters to healthcare staff

London ambulance staff log calls with pen and paper after IT failure

Staff at one of the country’s biggest ambulance services had to log emergency calls manually overnight because of technical issues in the control room, delaying response times.

It is understood London ambulance service’s computer system crashed, forcing staff to record details of calls by pen and paper for nearly five hours on one of the busiest nights of the year.

A spokeswoman said staff were trained to deal with such situations and were able to prioritise responses to those in greatest need.

The deputy director of operations Peter McKenna said: “Due to technical difficulties, our control room was logging emergency calls by pen and paper from 12.30am to 5.15am.

“Our control room staff are trained to operate in this way and continue to prioritise our response to patients with life-threatening conditions, using the same triage system as usual.

“We also have additional clinicians on duty to offer control room staff clinical advice if it is needed.”

London ambulance staff log calls with pen and paper after IT failure

Healthcare staff, tell us your experiences of working at Christmas

For many healthcare professionals, working over Christmas is a given. The thought of working at this time of year can be galling for many but, as Dr Jenny Hughes wrote, it can be the most uplifting time to work.

Teams of staff can pull together and bond over boxes of chocolates on the ward and canteen Christmas dinners. And the odd Christmas miracle may happen, be it the birth of a baby, saving someone’s life or even just being there to listen.

Are you a healthcare professional who has worked at Christmas? We want to hear about it. What have been your memorable moments? What’s the atmosphere like? How did you feel working over the festive season? Have you witnessed or been part of any Christmas miracles?

Please fill in the form below and tell us your experiences of working at Christmas. A selection of responses will be used in our reporting. You can remain anonymous if you wish.

Healthcare staff, tell us your experiences of working at Christmas

NHS staff and managers condemn "passport before treatment" plan

Doctors, nurses and NHS managers have condemned government plans to make hospital patients produce their passport before being treated as unworkable and a burden on overworked staff that will not raise the £500m a year ministers hope.

There are also fears that marginalised groups – such as the homeless and the 13% of the population who do not have a passport – will find it harder to access care if the policy, currently operating only at the Peterborough and Stamford hospitals NHS foundation trust, becomes commonplace.

Despite growing anxiety among NHS staff, the Department of Health insisted that the policy – which its top mandarin admits is “controversial” – may still be rolled out nationally. It is keen for the NHS to increase dramatically the amount of money it recovers from people who are ineligible for free care from £73m in 2012-13 to its target of £500m a year.

Jon Restell, chief executive of Managers in Partnership, the union which represents health service managers, said: “Managers are worried about the unintended consequences for health inequalities, as marginalised groups may find it harder to access healthcare; for public health, where there are currently exemptions, for example around crisis mental health, TB and HIV. Will these continue?

“They are also worried about reciprocal arrangements with other countries. Is now the right time, at the start of Brexit negotiations, to be making these policy changes? What may be the impact on British citizens overseas?”

The likelihood that some patients would not have the two forms of identity envisaged by the DH will create problems, Restell added.

“Who is accountable for the care of a patient who can’t show ID? What happens if their condition subsequently worsens, possibly foreseeably, as a result of being turned away?” he asked. In addition, he added, “ID checks are likely to create delays in clinics and elsewhere as ID is checked and queries resolved”.

He also said the scheme was overly bureaucratic. “Most elective work [non-urgent care in hospitals] comes via referral from general practice, where registration requires eligibility checks. Why create a second check?” said Restell.

NHS managers doubt ID checks would generate any extra money beyond what is already received from overseas visitors and governments under existing arrangements. He added: “The system may well cost more to administer than the extra income it generates. Managers believe government underestimates how complicated this would be administratively. While we do not think it would necessarily burden clinical staff in practice, it would lead to delays and costs.

“The whole issue raises unresolved ethical questions about eligibility for healthcare and about compatibility with the values of the NHS and its staff.”

The Peterborough and Stamford trust saw its annual income from chargeable patients rise from £92,500 to £250,000 after it introduced identity checks in May 2013. Its total budget is £261m. It says 95% of invoices were recouped last year, compared to 37% in 2012. NHS bosses told MPs this week that the scheme “had made a big difference”.

However, the trust admits no formal evaluation of the scheme has been carried out. Four staff are employed on it, though they only spend a quarter of their time processing fees and pursuing unpaid bills. But the trust would not say how much the scheme costs, other than to say it did not outweigh the total income raised through charges.

Although some reports suggested passports would have to be shown to guarantee entitlement to free NHS treatment, they are not required in every case. Residents and EEA visitors who have lived in the UK for the past 12 months must provide two forms of ID such as a utility bill or payslip. If patients have not lived in the UK for the past 12 months, a passport or ID card is required.

Although the regulations enable an NHS trust to refuse treatment on the grounds that a patient requiring a non-urgent clinical intervention did not qualify for free treatment, Peterborough said it had never turned away a patient who said they were unable to pay.

Non-qualifying patients who do not pay invoices over £500 are reported to immigration and debt collectors are sometimes used.

Nurses said they were already too busy to help administer such a scheme and do not want to be distracted from looking after patients. Stephanie Aiken, the Royal College of Nursing’s deputy director of nursing, said: “Nurses and other staff on the frontline go to work to care for patients. While we recognise that the NHS is under extraordinary financial pressure, taking clinical staff away from the core job of treating patients is not the solution and must not be allowed to happen. Patient care must always be prioritised ahead of any administrative procedures.”

Sources at the NHS Confederation, which represents the NHS trusts who may have to implement the policy, said hospital bosses were “conscious of the practical and administrative burdens it would put on the NHS”.

A National Audit Office report last month estimated that hospitals are failing to collect about £200m from patients who should have paid for their treatment. But the chair of the British Medical Association, Dr Mark Porter, said: “We have got an NHS with a deficit approaching 100 times that amount opening up over the course of this parliament. This is little other than a pinprick on top of the actual problems facing the NHS.”

Charges only apply to non-urgent, planned care, not treatment in A&E. Dr Taj Hassan, president of the Royal College of Emergency Medicine, which represents A&E doctors, warned against changing that demarcation.

He said: “We do not believe the proposed plans to require patients to show identification before receiving treatment could extend to the emergency department, due to their sheer impracticality. However, if the plans include the ED, then we would be failing our patients on an ethical level. The patient’s health is – and must always be – the most important thing, not where they are from.”

NHS staff and managers condemn "passport before treatment" plan

Half of Ebola screening staff at Heathrow "were not clinically qualified"

An Ebola health screening programme that was put in place at Heathrow airport to protect Britain against the spread of the deadly virus was hampered by poor organisation, lack of training and lack of resources, a tribunal has heard.

The breakdown in the system was so great that the manager of the screening system called the wrong number for the specialist on call at the infectious disease hospital when concerns were raised on 28 December 2014 when the Scottish volunteer nurse Pauline Cafferkey passed through the airport.

Passengers deemed to require further observation or assessment were to be sent to Northwick Park hospital in north-west London. But the screening manager revealed he rang an incorrect switchboard the day Cafferkey arrived, rather than the infectious disease consultant on call.

David Carruthers, the shift manager the day Cafferkey returned from Sierra Leone, admitted in the tribunal that his team had run out of screening kits and monitoring kits, and that half the staff on the screening team were not clinically qualified and were “office workers” previously.

He was giving evidence at a Nursing and Midwifery Council hearing where one of Cafferkey’s volunteer group, the nurse Donna Wood, is facing being struck off for allegedly concealing the Scottish nurse’s high temperature on the day. Wood has denied the charges.

Pauline Cafferkey. Photograph: Jeff J Mitchell/Getty Images

Carruthers described how the screening team was given passenger numbers for the two indirect flights coming in from Sierra Leone where NHS workers had volunteered at the peak of the Ebola outbreak.

However, he was not aware of how many passengers had actually worked on the Ebola frontline and would therefore have been deemed to be “category 3” passengers with a risk profile.

He said the screening team was unable to cope with the high numbers of category 3 passengers arriving on the Royal Air Maroc flight. But he claimed the Scottish nurse only got past the checks put in place by Public Health England to check travellers entering the country from west Africa after a deception.

“Chaotic is a bit of a harsh term, it was busy and it was a little disorganised,” he said.

Carruthers conceded that the screening system was flawed on some fronts, under cross-examination by Wood’s counsel, but said he was not clinically qualified to manage a health risk.

He said he was reliant on border control and PHE managers to provide passenger lists for any given day. “It wasn’t an exact science, I’m afraid,” said Carruthers, who worked as a Metropolitan police officer from 1984 to 2013.

He said they had only four cubicles in Terminal 4 to deal with passengers arriving on the Royal Air Maroc flight. He said passengers from Ebola-hit countries were not isolated at Heathrow.

Those, like Cafferkey, who had come from “high risk” environments were allowed to mingle freely with other passengers in the screening zone, the tribunal heard. Transit passengers were also able to move freely between terminals before being screened.

“We are talking about a highly infectious and dangerous disease,” said Ben Rich, for Wood.

Carruthers described how he had arrived in the screening area in Terminal 4 the day Cafferkey and her volunteer group returned from Freetown, the capital of Sierra Leone. He noticed that some people were agitated and unhappy with what was going on. Staff also complained that some of the forms had not been filled out properly.

However, he said he did not talk to passengers as he felt this would “exacerbate” things. His job was to manage the process, he said.

The former police officer learned that Cafferkey had been allowed through the screening process with a temperature above 38 degrees at about 6.20pm.

It is alleged that Wood recorded her temperature a degree lower in order to escape the “chaos” at the screening area and “sort it out”.

He said he learned of the alleged “deception” after he received a call from an infectious diseases nurse and then had a telephone conversation with Cafferkey directly.

At this point she was in either the arrivals hall or on the train platform to take her to Terminal 5 for a connecting flight to Glasgow.

“Pauline Cafferkey confirmed her temperature had been recorded as lower than it was,” said Carruthers. “I told her she should return to screening and have her temperature recorded. I assured her there was plenty of time for her flight [to Glasgow] and assured here there was nothing to worry about.”

He told the independent panel that he remained calm and courteous with her as he did not want to panic her as he escorted her from arrivals back to the screening area.

“I did summarise to her that the temperature had been taken at 38.3 degrees but recorded as lower than his. She did not disagree with this. I would describe her as tail between the legs or sheepish,” he said.

He later said: “Ms Cafferkey got through the screening area with what I would call as deception.”

He told how the screening team was made up of eight staff on the day, including a communicable disease expert, three clinically qualified professionals and four non-professional screeners.

In addition, an infectious diseases clinician was on call at Northwick Park hospital in the event of a high-risk patient arriving.

When alerted to Cafferkey’s temperature, he took responsibility in place of the PHE clinician on the team, to contact the expert at the hospital. By mistake, he phoned the switchboard and did not get a reply.

“That’s a breakdown in communication and for that I am partly responsible without a shadow for a doubt,” he said.

After Cafferkey was tested positive for Ebola on 28 December, Nick Gent, a doctor and deputy dead of PHE’s emergency response department was drafted in to assess the efficacy of the body’s screening process.

He interviewed volunteers in Cafferkey’s group as part of a fact-finding rather than evidential operation, he told the tribunal. Gent added that along with Cafferkey and Wood, doctors Hannah Ryan and Mark Willcox were referred to their regulatory bodies.

The NMC hearing continues.

Half of Ebola screening staff at Heathrow "were not clinically qualified"

Patients and staff shut out of NHS transformation plans, says thinktank

NHS plans that could lead to hospital and A&E closures have been kept secret from the public and barely involved frontline staff, a thinktank has said.

NHS England has told local health leaders not to reveal the plans to the public or the media until they are finalised and have been approved by their own officials first, according to published documents and a new analysis by the King’s Fund.

The national body even told local managers to refuse applications from the media or the public to see the proposals under the Freedom of Information Act.

Local managers accused NHS England of being intent on “managing the narrative” about the plans.

Health managers in 44 areas of England have been ordered to draw up strategies to reduce costs, change services and improve care in the wake of a record £2.45bn deficit.

The sustainability and transformation plans (STPs), some of which have been published or leaked, could see some hospitals, A&E units or maternity units close, and other services merged.

The proposal for Cheshire and Mersey includes the downgrading of at least one A&E department, while in south-west London the number of acute hospitals could be cut from five to four.

In north-west London there are plans to reduce the number of sites offering a full range of services, while Birmingham and Solihull’s STP proposes a single “lead provider” for maternity care.

NHS England and some health experts say the changes will improve patient care and are necessary to fulfil the plan of the health secretary, Jeremy Hunt, for full seven-day services. Opponents argue they are just a way of cutting services.

Some councils have objected so strongly to the lack of public involvement that they have ignored NHS England’s demand to keep the documents private until a later stage and have published them on their websites.

The report from the King’s Fund, based on a review of plans and interviews with local managers, says NHS England set very tight timescales, which is partly to blame for patients and doctors being shut out.

Expensive management consultants have been brought in but clinical teams and GPs have often been only “weakly engaged in the process”, it says.

The report says: “It is clear from our research that STPs have been developed at significant speed and without the meaningful involvement of frontline staff or the patients they serve … Patients and the public have been largely absent from the STP process so far.”

One local manager said of the lack of public involvement: “I’ve been in meetings where I’ve felt a little bit like, you know, where are the real people in this?” Another described the secrecy demanded by NHS England as “ludicrous”.

The report says: “As well as the timeline creating a barrier to meaningful public engagement, national NHS bodies had also asked STP leaders to keep details of draft STPs out of the public domain. This included instructions to actively reject Freedom of Information Act requests (FoIs) to see draft plans.”

On management consultants, the report says some leaders “felt that STPs had ‘created an industry’ for management consultants – and questions were raised about why money is being invested in advice from private companies instead of in frontline services”.

However, the King’s Fund said STPs still offered the “best hope” of improving health and care services.

Chris Ham, chief executive of the thinktank, said: “The introduction of STPs has been beset by problems and has been frustrating for many of those involved, but it is vital that we stick with them.

“For all the difficulties over the last few months, their focus on organisations in each area working together is the right approach for improving care and meeting the needs of an ageing population.

“It is also clear that our health and care system is under unprecedented pressure and if STPs do not work then there is no plan B.”

Ham said it was a “heroic assumption” to say out-of-hospital services and GPs could take on more of the work currently done by hospitals, given how under pressure they were.

He said there was “mixed evidence at best” that moving services closer to home improved care.

The NHS medical director, Prof Sir Bruce Keogh, defended the plans. “Advances in medicine mean it is now possible to treat people at home who would previously have needed a trip to hospital. It also means those with the most serious illness need to be treated in centres where specialist help is available around the clock,” he said.

“So this is not a moment to sit on our hands. There are straightforward and frankly overdue things we can do to improve care. We are talking about steady incremental improvement, not a big bang. If we don’t, the problems will only get worse.”

Patients and staff shut out of NHS transformation plans, says thinktank