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National Health Service

The President : The General Council supports the composite.

Pauline Betteridge (Chartered Society of Physiotherapy) moved Composite Motion 16.

She said: Yet again the NHS has had its debate time cut. Since the Government came into office we have been bombarded by reforms. Many of these involve local stewards working with managers, taking even more time away from their clinical role. Some weeks I could be excused for forgetting I am a physiotherapist.

We all welcome the promise of an extra £13 billion over the next four years, but if we are to implement an agenda for change which totally restructures the pay and conditions of all who are employed in the NHS, and at the same time implement the changes outlined in the NHS Plan, when it is recognised that recruitment and retention of professional staff is a major problem, then the timescale for change has to be realistic. There is currently an identified shortfall of 7,000 staff from the professions allied to medicine.

In the meantime we have to breakdown the barriers between health and social care, form primary care trusts and provide intermediate care. It has long been recognised that not all health care needs to be provided in acute hospitals, but currently the other methods of care are limited.

While we try to implement these changes, just a few of those outlined in the NHS Plan, please remember that the workplace stewards are spending less time with their patients and more time working in partnership, hopefully true partnership. You cannot pay lip-service to partnership and expect it to work. We need to ensure that those employed in the NHS are not further disadvantaged by these changes.

There is an expectation of increased flexibility providing more services 24 hours a day, seven days a week, offering the patient more choice on where and when their treatment is delivered. This will impact on the working lives of those employed in the NHS. Those same employees are being promised hours of work to suit their requirements. These two plans do not marry easily. Like the staff, management at all levels work increasingly longer hours to try to introduce all the changes expected of them. To facilitate successful change there must be support and not the big stick approach. We can all see that the traffic-light system of financing Trusts is meant to encourage Trusts to be more efficient, but some could be set to fail. Let's hope not.

Congress, we call upon the TUC to co-ordinate responses from affiliate unions and take every opportunity to make representation to the Government. I move.

Richard Cannon (Society of Radiographers), seconding the motion, said: President, like yourself, I am a proud resident of Peckham!

Working in the NHS is becoming increasingly stressful. Staff shortages are stretching working conditions to the limit. Patient expectations are increasing and the gap between what the patient expects and what we can deliver is reaching crisis point. We want to win at work but we are finding it difficult to keep up with the game.

Our recent evidence has demonstrated that three-quarters of staff are reporting shortages in recruitment. Some radiotherapy departments are currently experiencing a shortfall of over 30 per cent in some grades. Our members have seen a marked increase in workload over the last year, while at the same time working with less staff. Since 1993 there has been a three-fold increase in the number of staff who report that they have insufficient time to treat their patients satisfactorily. A survey of intensive care units earlier this year has shown that a unit with an excessive workload has a mortality rate twice that of a unit with a lower workload.

We expect, and sometimes demand, that our hospitals provide a 24-hour service. The level of the staffing in some of these essential areas cannot be reduced. This leads to the staffing shortages being reflected in other areas who often have to work with 50 per cent less staff, have no reduction in the workload and no control over the work referred to them. Staff cope with this by working through their breaks and lunches. Two-thirds of staff reported regularly not taking a lunch break, the majority reported unpaid overtime as being a regular feature of their work. This is no way to treat any workforce, it is certainly no way to treat patients. Little or no attention is given to health and safety issues of new equipment, increasing the risk of back and repetitive strain injuries.

What about this 24-hour service? Our members, the radiographers, often work 24-hour duties alone and in remote departments, leaving staff to feel isolated and vulnerable. They can face drunken patients who have waited patiently in waiting rooms, but once alone with the radiographer they become threatening and violent. The examples I have used are from my own profession, but parallels exist in other areas in the NHS. Congress, support this motion.

Anne Picking (UNISON), supporting the composite motion, said: UNISON supports Composite 16. The National Action Plan for the NHS is the biggest shake-up the Health Service has ever had since its inception in 1948. The National Health Service is going to get much-needed investment over the next five years. The Plan sets out how that money should be used to improve health services and UNISON is thoroughly behind it. We were involved in developing the Plan and we have signed up to the principles and the proposals set out in it.

The lead statement of support for the principles of the NHS against those, like the Tories, who would move to privatise the Service - the NHS is the fairest and most effective health system in the world despite all its problems and we need to keep it. The labour and trade union movement created the NHS and it has stood the test of time. It is a principle that we should all be proud of.

There is a major programme of investment in new hospitals and new equipment - UNISON welcomes this. Recent surveys have shown that there is a major backlog of repairs and, as everyone knows, they are crying out for new hospitals. UNISON is opposed to the continued use of PFI for providing these facilities. Let us modernise the NHS, not privatise it.

The Plan includes commitments and some resources to improve cleaning and catering standards. Now, we welcome this focus on what have been neglected areas. I must say, however, that we take criticism of NHS standards from consultants employed by Virgin with a pinch of salt. Richard Branson might run an OK airline, and possibly the lottery, but he hasn't made trains run on time and he has no right to criticise the hospitals.

Support the staff, support the people who work in the NHS, support the people who use the NHS. UNISON strongly supports Composite 16.

Sara McGoldrick (Society of Chiropodists and Podiatrists), supporting the composite motion, said: The recently published 10-year plan for investment in the NHS outlines the Health Service designed around the patient. We welcome the Government's promise to increase staffing levels and pay, to reduce waiting times and improve facilities. Overall it aims to be responsive to the patients and supportive to the staff.

The public's top concern about the NHS is waiting times for treatment. The Congress recognises the commitment for the NHS to utilise the skills of podiatrists and other health care professionals to use their full scope of practice. The skills of a podiatrist can be used to diagnose and treat a wide range of conditions, for example, flat feet, heel pain, toe deformities and gait abnormalities. This will free up the time of consultants and help improve waiting times, making the service more cost effective.

Presently there are too many unnecessary boundaries that exist between the professionals which hold back staff from fulfilling their true potential. An ingrowing toenail is a painful condition. It can get worse in a very short period of time. They are prone to infection and require radical treatment for a satisfactory prognosis. If an immediate referral is made to a podiatrist they can anaesthetize the toe and remove the section of nail, preventing its reoccurrence and the need for repeated antibiotics.

Orthopaedics and dermatology are particular specialities that account for most of the long waits. An initiative by the Walsall Community Health Trust Podiatry Department was to highlight their ability to treat the patients waiting to see the dermatologist for verruca and warts. Monies were made available for community-based verruca clinics to be established. The podiatrist saw the patients more quickly and locally, enabling the dermatologist to extend his role with other conditions referred.

To enable podiatrists and other professions allied to medicine to contribute to reducing waiting times and providing a more cost efficient service doctors, district nurses and other referring agents need to be educated on the scope of our practice. This will ensure that timely and appropriate referrals are received and conditions are diagnosed and treated with minimum expenditure of time and money but maximum satisfaction for the patient. Please support the composite.

Lesley-Anne Baxter (British Orthoptic Society), supporting the composite motion, said: I am an orthoptist, a member of the professions allied to medicine and I deal with defects of vision. Orthoptists welcome in general the new changes in the NHS and have always been happy to extend their roles, but we need continuing professional development to do this.

Throughout this Conference we have heard about education, education, education, but to do this we need the proper financial backing. I know of orthoptists who have had to fund their own educational development or have had to take annual leave to attend courses. In a number of Trusts, finance for courses comes out of the same budget as buying equipment.

I urge you to support this composite, ensuring that staff within the NHS have the necessary training and financial support to extend their roles within the new NHS.

Heather Ballard (Community and District Nursing Association), supporting the composite motion, said: Focusing on the sixth paragraph and the issue of 'virtual beds' where health care is provided in patients' own homes.

In the past, the NHS has been seen as the national hospital service rather than the National Health Service. This, thankfully, is now changing and co-ordination between hospital beds and community solutions is quite rightly seen as the way forward for a modern 21st century Health Service. The CDNA has been engaged in the consultation processes for major issues, such as long-term care of the elderly, palliative care, National Beds Inquiry and, of course, the National Plan. All of these issues have major logistical, financial and policy implications. In many ways they are central to the good health of the NHS.

The CDNA believes that 24-hour community nursing services, whilst not the panacea, is a common thread running through all of these issues, and offers a range of solutions that will make the NHS flexible, patient centred and cost effective.

A recent Department of Health report estimates that at least one in five beds are currently filled by patients who neither want nor have to be in them. This obviously shows scope for further reductions in hospital bed occupancy, though not necessarily hospital beds, but only if community services offer full 24-hour cover. Many patients are in hospital beds because they need 24-hour access to care, not because they require a hospital bed. This is not an efficient use of resources or a fair way to treat patients.

Let me explain. An elderly patient with a chest infection is taken into hospital and may wait several hours until a bed is found. During the next 24 hours of treatment using oxygen, intravenous antibiotics, they may have developed pressure sores, incontinence and become disorientated in these strange and noisy surroundings. They cannot be discharged and the final insult is they get labelled as a ‘bed blocker’. There is an alternative. The same elderly patient with the same chest infection is referred to the district nurse, 24-hour nursing care, support, oxygen therapy, intravenous antibiotics are provided. The patient is in their own home, familiar surroundings. They will eat better, sleep better and consequently the acute condition improves without them ever having to occupy a hospital bed.

The CDNA believes that the solution to many of the NHS's current ills is 24-hour community nursing services. It is not a case of either hospital or community services; the provision and appropriate use of both will benefit our patients. For a co-ordinated health care system to work all parts must be adequately staffed and funded. Provision of 24-hour community nursing services right across the UK will enable the NHS to provide better and more appropriate care to very many patients.

Pam Davies (UNIFI), supporting the composite motion, said: We want funding and paid time off for training for all workers, irrespective of their profession. The lifelong learning agenda sets out the Government's commitment to deliver this strategy and the involvement of the General Council in its delivery underlines the importance of this issue, but the voluntary system in operation in the UK is failing to deliver sufficient quality training to produce a workforce that can not only match but can compete with its competitors.

The bank and building societies' national training organisation's latest research indicates that finance sector employers spend on average only two and a half per cent of their resource budget on training. This equates to only £600 per employee per year, and the average time allocated to train the employee is a measly three days. It is not clear from this research how well spread paid leave is across the finance industry and, indeed, it is likely that many will receive well below the average and very few will receive above the average. One very good employer and many bad employers could account for the results of this survey alone.

Provision in the European Social Chapter allows for paid educational leave and in other EU countries there is a national right to paid leave for education for all workers. The UK National Skills Task Force recommends statutory rights for all 16 to 25 year olds to paid leave so that they can attain level 3 qualifications. Workers are being prevented from undertaking vital re-skilling and continued development in businesses that do not invest in training. Statutory rights would rectify this.

In conclusion, it is vital that the General Council continues to highlight the deficiencies of the voluntary training system in this country. We must campaign and lobby together against the inequalities of the paid educational leave system in this country to ensure that all employers are obligated to train their workforce. We want improved statutory rights for all UK workers in line with our colleagues in Europe. Please support.

Bill Stewart (Association of University Teachers), supporting the composite motion, said: The AUT's contribution to this composite is contained in paragraph 8, which highlights an inconsistency in Government policy. On the one hand the Government is seeking to increase the number of doctors and nurses, but on the other teaching hospitals and universities with pre-clinical departments are facing significant budget deficits and some have proposed job losses as a consequence. So what is happening is that at one end of the training spectrum experienced staff are being offered, or in some cases persuaded, to take early retirement simply to balance the books of an institution, and at the other end there is a greater number of students and, therefore, a greater demand on teaching and other training resources.

Other speakers have referred to joined-up government and here is another clear example of joined-up government - not.

With respect to potential job losses the situation in London's teaching hospitals is particularly worrying. King's College has just announced that up to 300 job losses are likely throughout the College but with particular emphasis on the Medical School. At Queen Mary and Westfield College management are seeking to reduce the medical staff budget by £4 million, and at Imperial College 60 academic and 60 support staff posts are under threat.

So, Congress, the message that should be sent to Government - and not in joined-up writing but in block capitals - is that the relevant ministers should get their collective act together and make available sufficient resources to deal with all aspects of providing the kind of National Health Service that we would all wish to see.

* Composite Motion 16 was CARRIED

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