Select Committee on Health Minutes of Evidence

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.

November 2001

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