Trying to survive in an ailing system

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THEY serve the sick and injured of our community with patience, resilience and good humour. But the challenges faced by our health workers are becoming increasingly difficult to tolerate.

Despite our reliance upon these dedicated professionals, front-line staff in the NHS are now facing a daily barrage of insults, threats and physical attacks at the hands of abusive or violent patients and visitors.

And while the majority of doctors, nurses and support staff at our hospitals and in our communities love their jobs and strive to provide the best care possible, many complain that there is not enough staff to provide a good standard of care.

Long hours add to the feelings of low morale and, while the new Agenda for Change wage-structure aimed to address concerns about low pay, for many, the reforms have not gone far enough or been implemented quickly enough.

In the Lothians alone, the NHS employs more than 28,800 people, including more than 10,300 nursing and midwifery staff.

Andrew McGregor, 26, is engaged and lives in Edinburgh. He earns around 24,000 a year as an A&E nurse at St John's in Livingston.

Andrew talks of a job made more difficult by bureaucracy, staff issues and constant stress.

"Recently, from midnight to midnight we had 140 people through our doors - that was with seven staff on day shift and four on night shift," he explains. "When I left there was a five-and-a-half-hour waiting time.

"I phoned around for help but no-one could be spared and there's an agency ban - there's no money to pay for them.

"But only a third of the patients were admitted. Most were minor injuries or people that could have been dealt with elsewhere."

Andrew trained for three years at university, leaving with a student loan to pay back from his 1400-a-month salary which includes extra payments for night and weekend work.

"I work a 12-and-a-half-hour shift - it's very stressful," he says. "There are seven trained nurses for a day shift - we need more nurses, more doctors and definitely fewer managers. I've never seen morale so low. People want to do the best they can, but go home feeling drained, sometimes feeling they weren't able to do their best for those patients."

Caring and compassionate, he wants to improve his own skills to help save lives, but is hindered by seemingly petty bureaucracy and cash restraints.

"I'd like to be a nurse practitioner in A&E but the money isn't there for the training. You end up looking at funding your own training and even then your qualifications might not be recognised," he says.

"I know someone who did a life support course with the RAF reserves before going to Iraq.

"Then the division wouldn't recognise that qualification - it was okay for Iraq but not for St John's!

"It's frustrating because we all love our jobs and just want to look after patients the best we can."

Midwives have a similar story to tell of having to juggle patients, working long shifts without the chance to take their breaks.

Carrie McIntosh, 35, former NHS midwife at Simpsons, is now an independent midwife. She earned 18,000 as a newly qualified midwife until leaving in December 2005.

"I was in a large unit with too many women and too few midwives," says Carrie, below. "Ideally you want to stay with one woman throughout her labour, instead you're dashing between them - I'd be looking after four women at a time.

"On one shift there was a post-natal lady who had just given birth and should have been in a high dependency unit but wasn't because they were full, another in the middle of being induced and two women at different stages of labour - all being tended by one midwife.

"A woman in labour shouldn't be left alone. It's not good for the midwife either; she's stressed, leaping in and out of rooms, and just too busy. You were continuously having to search for basic things. A lot of my colleagues who have left have gone to completely different jobs, to do 9-to-5 where they don't have the stress and the responsibility for the life of a mother and a baby for rubbish money."

Midwife Natasha McDonald, 34, quit the NHS in September.

"In hospital you're run off your feet, you're qualified so are expected to make decisions. Everyone's busy," says Natasha, who is now independent.

"I got used to having to look after a couple of people at any one time. There'd be, say, two post-natal women, someone being induced and someone who is already in labour... it's a constant juggling act.

"You're running between rooms, popping in here for just five minutes to check the baby's heart rate and check on the labour, the women think they can't cope and they'll ask for an epidural.

"It's a long day - 12-hour shifts. Some days might involve three births, others none. You're supposed to get two half-hour breaks, often you get one half hour. There's a general attitude: 'You chose to work in the NHS, so just get on with it'. People don't complain."

Derek*, 41, lives in Edinburgh but chooses to work as an agency theatre recovery nurse in Belfast.

"I came back from Canada in January and put out feelers for work," he says. "People at the Western General were saying there had been staff cuts in the areas I wanted to work, intensive care and high dependency.

"I heard they were sending staff by taxi between one hospital to another. Robbing Peter to pay Paul and giving money to taxis on the way - it doesn't make sense.

"I heard that intensive care runners - people who fetch items for the staff so they didn't have to leave their patient - had gone, if you needed something you had to ask around and find someone to get it or even leave your patient. I wouldn't be happy having to do that."

Derek recalls working in colorectal surgery after it moved from St John's to the Western.

"The workload increased two fold but there was no extra staff in recovery, no more theatre staff," he says. "It was not uncommon to do a 20-hour shift, get 11 hours' sleep then go in the next day for a ten-hour shift. The health service can't operate like a biscuit factory. Everyone says 'oh nurses, they're angels', actually nurses just want to be treated like professionals."

Theresa Fyffe, director of the RCN Scotland, agrees. "Nursing is a hugely exciting, fulfilling and challenging profession," she says.

"Nurses across the Lothians are developing their roles and leading improvements in services in ways that meet the complex needs of individuals and communities.

"NHS Lothian makes positive efforts to involve staff in decisions about their working conditions and the services that they provide. However, the pressures faced by nurses and their colleagues in delivering modern healthcare services are also significant.

"They continue to provide high-quality care but do not always feel this is fully recognised at a national level by decision-makers."

Of course, hospitals need more than nurses and doctors to function.

John*, 42, is a porter at the Western General. Married with two children, he earns around 180 a week.

"We're the people in the health service who never get any praise," he says. "We're the guys that do double shifts to earn a decent wage - in a seven-and-a-half-hour shift, I'll walk 16 miles, usually shoving something - a bed, a wheelchair, a food trolley, a cage of laundry or a bucket of clinical waste.

"People say, 'I wouldn't do your job for any money' - most are on around 11,000 a year.

"We care very deeply about the NHS and we want it to be good. None of us could do this job if we didn't.

"There's a huge turnover of staff. You hear people say 'we're going to recruit more nurses', you never hear them say 'we're going to take on more ancillary staff'.

"NHS Lothian has a target sickness rate of four-and-a-half per cent. We're running at closer to 12 per cent - people are knackered.

"There are too many managers, and there's too much change. The amount of money that gets spent on changing things that they've mucked up is incredible."

*Some names have been withheld to protect identities.

Assaults on NHS staff triple in five years

THE number of assaults reported by NHS Lothian staff has tripled in five years.

Health workers are being attacked five times a day in surgeries, hospitals and while working in the community.

There were 1797 assaults on health workers in the last financial year compared with 634 five years ago. The majority of the attacks (1284) were on those working in the community, mainly in GP surgeries and patients' homes.

NHS Lothian figures revealed that despite the overall rise, attacks on hospital workers have almost halved from a high point three years ago. But threats and verbal abuse are on the increase.

Healthy 16m bonus for doctors in Lothians

DOCTORS in Edinburgh and the Lothians earned 16 million in bonuses by offering patients extra services in 2005.

The average city surgery received 166,600 in bonus payments - 30,000 more than the Scottish average.

The cash can be used as bonus payments for staff or it can be ploughed back into providing additional services the following year.

The payments are linked to extra services which health centres opt to provide for their patients, such as health screening and special clinics.

Far more pharmacists

THE number of pharmacists employed in Lothian has risen by 25 per cent in five years. In September there were 320 pharmacists working in the Lothians compared with 257 five years ago.