Hospital bosses have ridiculed a new edict from the NHS which insists every inpatient should be medically assessed each morning and evening by a senior doctor.
They claim the order is “impossible” to fulfil because so many hospitals are struggling to fill medical rotas because of widespread shortages of doctors, which are as high as 25% in some places.
The instruction came earlier this month in a letter to the chief executives and medical directors of hospitals in England from the regulators NHS England and NHS Improvement. It made clear that in a bid to cut the number of patients using beds unnecessarily, hospitals must “ensure every patient has a review at the start and end of the day by a senior clinician to facilitate discharge”.
“This is totally ridiculous – another example of hospitals being asked to do the impossible by the unreasonable,” one NHS trust chief executive, who asked not to be named, told the Observer.
Another warned that getting doctors to review all patients twice daily would leave them with too few medics to staff operations and lead to longer waits for non-urgent procedures.
“It is not doable. It’s another pie in the sky. There just isn’t the clinical workforce to do this without affecting other services and pushing out waiting times which we are also required to meet. Just another request for the impossible,” the chief executive said.
The UK has fewer doctors and nurses than many other comparable countries both in Europe and worldwide. According to the Organisation for Economic Co-operation and Development (OECD), Britain comes 24th in a league table of 34 member countries in terms of the number of doctors per capita. Greece, Austria and Norway have the most; the three countries with the fewest are Turkey, Chile and Mexico. Jeremy Hunt, the health secretary, regularly points out that the NHS in England has more doctors and nurses than when the Conservatives came to power in 2010. That is true, although there are now fewer district nurses, mental health nurses and other types of health professionals.
NHS unions and health thinktanks point out that rises in NHS staff’s workloads have outstripped the increases in overall staff numbers. Hospital bosses say understaffing is now their number one problem, even ahead of lack of money and pressure to meet exacting NHS-wide performance targets. Hunt has recently acknowledged that, and Health Education England, the NHS’s staffing and training agency, last month published a workforce strategy intended to tackle the problem.
The letter, sent on 9 March, also tells hospitals to ensure that they “boost essential services such as diagnostics and pharmacy at the weekends to maximise non-elective patient flow”.
Saffron Cordery, deputy chief executive of NHS Providers, which represents trusts, urged NHS chiefs to “not to pretend” that hospitals, which have come under unprecedented strain in recent weeks, could do everything they wanted to improve patient care.
“There is simply not enough capacity to deliver optimum care all the time, particularly when demand is as high as it currently is. We should not pretend otherwise,” she said. “Requirements cannot be consistently delivered all the time, particularly when some trusts are running medical vacancy rates of 25%.”
