Supplementary memorandum by the Royal
College of Nursing (PS23A)
During the visit of the Health Select Committee
to Carlisle on 30 October 2001, the Royal College of Nursing raised
concerns about the PFI project at Hexham General Hospital and
the proposed reduction in registered and non-registered nursing
staff. At the request of the Committee the RCN is pleased to provide
further details regarding recent developments at Hexham.
Hexham General Hospital is part of Northumbria
Health Care NHS Trust. The PFI deal reached financial closure
in April this year, has a capital value of £30 million and
a planned operational date of April 2003.
The RCN was first advised in September 1999
that the Trust proposed reducing the total number of beds by 22,
from 120 to 98. The reduction was to be spread across a range
of services, and the treatment of patients with spinal injuries
was to be transferred to Middlesbrough in June 2001. One month
later the RCN learned that the Trust would be seeking a significant
reduction in the nursing workforce.
The Trust stated that the reason for reducing
nursing staff was the new hospital design and the planned introduction
of new working practices. The Trust claim that as the new wards
will be a triangular design, a reduction in nursing staff can
be justified, as less time will be spent walking to reach patients.
However, the new design will also result in a significant increase
in the number of single rooms. As a result an increase in the
number of nursing staff may be required to allow appropriate observation
of patients. The critical factor in determining the requirement
for nursing staff should be patient dependency.
There has been some involvement of nursing staff
in discussions concerning the design of the new hospital. However,
it has been clear to staff that the space available for patient
services is fixed, and therefore any nursing influence over the
design of clinical areas will be limited by space allocation.
In August 2001 managers met with 9 G grade Sisters,
to inform them that a new structure would be imposed to replace
their current posts, in a matter of two weeks, with three temporary
H grades and 6 F grades. This process has been completed; individual
grievances concerning this regarding exercise remain outstanding.
On the 24 September 2001 management then called
a meeting with the remaining registered nursing staff to advise
them that they would all need to apply for new posts by 3 October
2001. A formal dispute was lodged following this meeting, on the
basis of management's failure to properly consult with staff regarding
this proposed major organisational change.
Discussions are still ongoing in respect of
the dispute and the Trust management has held a range of meetings
with staff to discuss these issues. However, we are not aware
that any revisions have been made to the proposed reduction in
the nursing workforce, and it would appear that management are
currently not replacing any nursing staff who leave the employ
of the Trust.
The RCN is aware that a £2 million saving
is required before the new hospital opens in two years time. We
understand from our representatives within the Trust that the
forcasted running cost of the new building will be £16.2
million, whereas the running costs of the existing building stand
at £18 million. There is strong feeling on the ground that
the proposal to reduce the number of nursing posts is related
to the desire to achieve the target of lower running costs, and
does not adequately address patient care needs.
The RCN's main concerns are:
Nursing staff numbers may be being
reduced to an inappropriate level.
Changes are being made without adequate
staff consultation, leading to low workforce morale.
Inappropriate re-grading of posts
may be occurring.
These changes are being implemented
in order to achieve a reduction in running costs for the new hospital
without adequate regard to patient care.
While it is hard to directly link these events
to PFI, these concerns have been reflected in other PFI projects,
and support the RCN's position that a comprehensive audit or PFI
schemes needs to be undertaken as a matter of urgency.