New Labour must cure the health service's sickness

Helen Weatherly, nurse and UNISON member, reports on the crisis in the NHS and the need for a decent pay settlement.

The predicted and inevitable winter crisis has hit the NHS; we know it's a crisis because even Frank Dobson has said so. A flu outbreak, nowhere near an epidemic, took a large proportion of the blame, rather than an understaffed and underfunded service.

The realities of this crisis have been many and varied. The first areas hit have been accident and emergency departments. More than 30 patients, more than a wardful, have regularly been camped out in A&E waiting for admission to a bed for up to four days. Patients have died in these circumstances with little privacy and dignity. Staff have been unable to deliver adequate care to these patients when they have to cope with those constantly coming through the door. We have seen patients assessed in ambulances because there's no room in the department - is it any wonder A&E nurses want to leave?

The cause of the difficulties in the A&E departments is the shortage of staff and beds. The flu in itself was not a problem so much as the consequences particularly for frail and elderly patients who developed life threatening complications such as pneumonia. A stretched NHS reached breaking point. Intensive care beds ran out in London, at times the nearest bed being as far as Derby and Taunton. Intensivists had to become far more selective about who would receive ITU care, which must have resulted in some patients dying who would otherwise have had a chance.

Specialist interventions such as respiratory support had to be carried out on general wards rather than in high dependency areas where appropriate supervision and monitoring is available. Doctors had to make decisions about taking the risks with these interventions on the ward rather than let patients die. This put more pressure on ward nurses to manage unfamiliar treatments with a ward full of sick patients, and pressures to discharge patients as quickly as possible to make way for the next batch from casualty. Patients' relatives had to be asked to help provide basic care for them - is it any wonder ward nurses have had enough?

Then there is the knock-on effect on other services, most notably the ambulance service. Ambulances sitting outside A&Es waiting for patients to be allowed in are delayed reaching other calls. We have seen St John's ambulance crews used to transfer the critically ill when no paramedic crew was available. One trust used ambulance paramedics to staff its casualty department - as if there is a surplus of them with nothing else to do.

Although the worst pressure has eased for the moment, the service is no better equipped to face the next onslaught. The net effect is a grinding down of staff, who will leave, need more sick time, or at best, lose the commitment that has enabled the service to cope as well as it has. Staff who are burnt out and demoralised can't transfer, because it isn't going to be better anywhere else. There is no option but to get out of the NHS.

That is why this year's pay award is the most important ever, not just in terms of cash, but to show staff they are valued and respected, and that the Government is committed to the NHS. Whatever the final figure, the response will be the thing to watch for - and there are likely to be a lot of unhappy health workers up and down the country.

The Government have said any "inflation busting" pay award will have to be funded from existing budgets, ie. cuts in services. Gordon Brown incorporated only a 2.5% pay rise into his NHS budgets. Dobson may be reluctant to use up to a third of the extra funding allocated this year on pay. He knows the extent of the recruitment and retention crisis so why does he want to spend money on services that there won't be enough staff to be run? Whatever happens, nurses must not be held to ransom over their pay award through cuts in services or more likely, less than equal pay rises for all other health workers. The whole healthcare team is demoralised. If nurses are given special treatment this year, the recruitment and retention problems will spread throughout the service.

The mood and the opportunity is right for health workers to take industrial action if the awards don't meet expectations. But will health unions deliver? The strength of feeling is definitely there, but without co-ordination and leadership from our unions nothing effective can happen. The worry is that some in the unions are so close to the Government that there is a risk they will do nothing more than send a few stickers out to branches rather than taking the kind of high profile lead required.

Staff need to take action, if only to show their frustrations, to give them some power and a voice. I believe it is the only safety valve available to save the NHS, because otherwise more and more staff will take their own industrial action and leave the service altogether.

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