Alastair's Blog

Return to:  Blog | Articles | Videos RSS feed

Frontline First?

Posted on 12 November 2010 | 9:11am

Throughout the last election campaign, the Tories said till they were even bluer in the face than usual that they would protect the NHS from any looming cuts, and that within the public services more generally they would protect the ‘frontline.’ Where this frontline was drawn was never terribly clear, but the general impression given was that mysterious ‘backrooms’ would go, but nice doctors and lovely nurses would stay.

Again helped by the political cover provided by the Lib Dems, the Tories have managed to go back on their word yet again.

Take a look here and here, at the Royal College of Nursing’s Frontline First campaign. It shows that real jobs are being lost, and not just the sort of job losses a government thinks it can get away with – managers and admin for example (as if, incidentally, a hospital can function without them) – but real nursing jobs too.

If I can put on two of my hats now – chairman of fundraising for Leukaemia and Lymphoma Research, and ambassador for the Time to Change campaign on mental illness – what concerns me most is the impact all this has on specialist nurses. The RCN’s report has shown thousands of jobs are at risk and these will undoubtedly include those nurses who stick with a patient for years, not just days. Like the specialist nurses who look after children with leukaemia, and who stay with them throughout, get to know their medical details in real depth, get to know parents and family and friends, act as a vital lifeline when something doesn’t look quite right in the middle of the night and Mum or Dad knows who to get hold of.

Cutting these posts is not only massively damaging to the patient and family; it’s also a false economy. If a mum can call the nurse instead of going to A&E, it saves money. When the care provided by the nurse reduces complications and speeds recovery, it saves money.

Then there’s mental health. Our local paper has recently focused on the closing of two mental health centres. A glance at the interactive map on Frontline First shows the threat to mental health services all round the country. Hover over the East of England and you’ll see the decommissioning of mental wellbeing nurses; go to the West Midlands and 91 staff are at risk in mental health, learning disability and specialist children’s services. Look at Yorkshire and Humber and you’ll see mental health services which are ‘temporarily’ closed. I suppose if you take away the service, there can’t really be a frontline at all. Maybe that’s what they meant.

As the cuts get implemented, Cameron and Clegg will parrot away the line that the frontline is being protected. To the child with leukaemia, that specialist nurse is the bloody frontline. To the mentally ill – a group likely to grow when the full impact of job losses kicks in with the cuts – there is nothing more frontline than the mental health services that are about to be cut.

Of course the RCN is a campaigning body representing its own members and therefore a vested interest. But their members know about the frontline in the NHS because they are on it, and they know that the combination of cuts, reforms and ideological shrinking of the State will have a devastating effect on real people with real problems when the help runs out.

  • Olli Issakainen

    Every effort, of course, must be made to protect the frontline services including the police. Labour has promised to do this.
    But 2011 outlay will be £681bn. 18% will go to pensions, same to health. The share of welfare will be 16%. Education will take 12% of public spending.
    But it is wrong to ringfence the NHS as the health costs will be £122bn. Other departments, which are not protected, will be cut too much.

  • Mark Wright

    Not just that Alastair but many with mental health problems will find it increasingly harder to claim incapacity benefit as this government seeks to reduce this particular benefit. Once an individual has been recast as merely ‘unemployed’ they will fall into the government’s ’12 months and you’ll start getting your benefits cut if you don’t take work’ ‘iniative’.

    Is somebody with mental illness really the most likely to compete and gain employment in the current economic climate? Of course not.

    What’s of more concern is that these people, some of the most vulnerable, will no longer even be officially cast as illl. Where do these people go?

    The holes in the net have just become that much bigger.

  • Teresa

    I share your anger so much Alastair, can a true word ever leave their lips.

  • Sarah Dodds

    Agree with every word.

    And what worries me in addition to all of the above, is where will the people with this fantastic work experience go when they lose thier jobs? Some people here will already know I’m being shown the public sector exit door. I teach (and love !!) the 1-1 tuition scheme that Gove stated yesterday was no longer going to be an entitlement for struggling pupils. (I’ve just had a fantastic morning at work actually, and some of my tutees are making blistering progress. What mixed and jumbled feelings that creates now I know that it is to end). So what do I do to feed my four kids, pay the mortgage, etc? Do I wait around and hope that a teaching post comes up? No, because after 15 years and with no management experience I am too expensive. Schools want NQTS. Or heads. The sodding mistake I have made is to STAY frontline. I wanted to protect my own precious family time. I wanted to stay at the heart of teaching – ie with the kids. So I’m in the quite harrowing process of saying goodbye to the career I adore. In many ways it’s like giving up my identity. “I’m a teacher.” I hate the fact that soon there will be a last day for me to say that. For me, and this may sound melodramatic, it is like a bereavement. And it is made harder by the fact I love what I do, and not to brag, and bloody, bloody good at it. And don’t want to go.

    David Cameron must be proud of the likes of me, because I am in the throws of staring up a childminding business. I’m sure the angst I’m feeling now will lighten as the process unfolds, because it is always something that I quite fancied having a go at. But there is one issue that I can’t resolve and never ever will. As a public sector worker, there is a total disconnect between the people I serve and the money I make. The money is good, but it is not what motivates my day to day choices with my pupils. But starting up on my own, that disconnect is gone. Everything I do will be based around who can pay what and on time. I will have to choose, to interview, select. So I can no longer work according to need, with no strings. How many nurses, teachers, police will have to do the same????? How much compassion, experience, commitment will now be gone from the very people who need it most, the most vulnerable? (I’m comforting myself by knowing that I am undercutting vitually every other person running the same type of business locally, but it is a cold comfort.)

    My story is just one of thousands – it just so happens that I’m one of the first to go, as I predicted. It all just about breaks my heart.
    And the guilt is the worst thing.

  • Anonymous

    Agree entirely. Just to add that it’s not just specialist nurses looking after children. My son died of leukaemia in 2006, aged 34. His care in Barts (and elsewhere in the NHS) was exemplary, but the standouts were the specialist nurses who pulled the whole care process together and were always available on the phone or in the hospital to give expert advice and counselling. They are the front line of the front line.

  • Pam

    You have too much time on your hands Mr Campbell!

    You are beginning to sound like an old record.

    Give it a rest.


  • Richard

    If New Labour had renegotiated the GP’s contractss properly, not giving them weekend and overnight locums at vast expense, and dealt with the drug companies overcharging the NHS systematically, there would be much more in the kitty.

    As you well know, the amount spent on the NHS is continues to be increased in real terms. They never promised that every aspect of teh NHS would have it@s budget preserved, and efficiencies can be made.

    Ask Gerry Robinson.

  • Gillian C.

    So I guess the gist of your post AC is that they, the ConDem Government are “having a go” at our NHS, even though they assured us before the election that it was ring-fenced. Anyway that being acknowledged and I may return to that particular topic later, but now I have to make a small confession. As Poirot would say, “I am three times an imbecile” yes me, I’m an idiot! Some people probably thought that already. But over the last day or so, for me the penny has finally dropped. I’ve been waiting and hoping for Labour MPs to spring into action and make some effort to oppose, not all but some of the more draconian cuts proposed by the CoGov. But they are not going to oppose any of them, are they? In fact, I would suggest the Gov even has their tacit agreement on the scale of the cuts. If that is the case then I would be the first to appauld Labour for putting the country’s long-term interests above party politics. Even our beloved NHS will probably come under further scrutiny and I have to say if it’s done sensibly, I may even go along with it. I’m not turning Tory, in fact according to a recent survey I took part in, I am much more left-wing than I thought I was and also a libertarian. But this country of ours is in a hole of massive proportions that we will all have to tighten our belts, grit our teeth and get on with it. I am concerned about the most vulnerable in society though.

  • Gilliebc

    May I venture to respectfully suggest that you have too much time on your hands. Why even bother with such a negative post. It contributes nothing to the debate whatsoever.

  • Gilliebc

    I’m inclined to agree with your comments Olli. I don’t know if you or indeed anyone else who contributes to this site watched C4’s programme on Thursday evening i.e. “Britain’s Trillion Pound Horror Story” but for me personally it was a big eye-opener. Leaving aside the fact that the programme’s maker/presenter was so obviously very right-wing the facts and figures presented were for me at least a very big wake-up call and I’m slightly to the left of centre politically. But these are statistics that cannot and should not be ignored. One thing I don’t get though is why the Gov is planning to cut spending on the police force, because that prog. clearly showed that spending on all the emergecy services is so very little compared to huge amounts that are spent on other non-essential public sector organisations. It would be utter madness to scale down the police force at a time when these impending cuts are more than likely to be the cause of much civil unrest.

  • Anonymous

    Why did you come to this web site, exactly?

  • Jenny

    Sarah’s predicament shows the short-sightedness of assuming that the NHS exists in a vacuum and is the only (or main) factor affecting our health. Even if the health budget were to be ring-fenced as promised it seems unlikely that the NHS will have enough funding to pick up the pieces of those who have been dropped and damaged by the lack of other essential services, not to mention those who have lost their jobs as a result of the national belt-tightening.

    Sarah’s brilliant work with struggling kids will surely have helped many to overcome dyslexia and other barriers, get to college and university and/or go on to fulfilling careers. We only have to talk to adults with dyslexia to know that the alternative is often truancy, youth offending, unemployment or low-paid jobs, homelessness and prison. Unemployment, homelessness and prison are closely linked to mental health problems – will the NHS step be able to step in?

    Our prisons are full of people with mental health problems. In one survey the Office of National Statistics found that 39 per cent of sentenced males and 75 per cent of female remand prisoners had problems such as anxiety, depression and phobias (compared to 12 per cent of men and 18 per cent of women in the general population). Yet there will soon be fewer prison places – will the NHS be well placed to take up the slack and support people in the community?

    Your recent blog on housing and the responses highlighted some of the links between housing and health (and housing and education, work etc). As I type there are currently two people in our local psychiatric ward who are only there because suitable housing cannot be found for them in the community. In this case community mental health services are ready to step in and support them at home, but they have no home to go to. So, even if NHS services are there they cannot do it all.

    Finally, joblessness. Galen the Greek physician said “Employment is nature’s physician and is essential to human happiness”(thanks to Jonathan Naess, Director of Stand to Reason/the Guardian for this). As Sarah shows, our work is intricately linked with our sense of self and our self-esteem (by the way Sarah – you shouldn’t feel guilty – you will surely still make an impact in the private sector; if nothing else because of your experience, commitment and compassion). Will the NHS be resourced and ready to support all those experiencing the depression and anxiety that can come with the loss of a job? And btw – bereavement is not too melodramatic a word. When our local primary care mental health service is unable to keep up with demand and has three (of a total of six) staff off sick with stress – I doubt it.

    We treat our animals better than this. I was at a business event in North Wales today and one of the keynote speakers was Anna Ryder-Richardson who, you might remember, has morphed from ditsy TV interior designer to passionate environmentalist and zoo owner in West Wales. She told us the story of Steve the gibbon. When she took over her zoo Steve was housed in a small concrete ‘cell’, with no company or stimulation. He was severely traumatised and Anna was advised to have him put down. It took five years but after being provided with a spacious enclosure complete with ‘riverside apartment’, things to do in the form of trees to swing from and friendship from Lucy (a female gibbon) he is now recovered and a proud father.

    It struck me how similar the effects of isolation, poor housing and lack of occupation are on animals as on humans. The depressing thing is that most people in this country would be appalled by the treatment Steve suffered under the previous zoo owners, but many are blind and deaf to the fact that some of the most vulnerable people in our communities – those with physical and mental illnesses – are subjected to 19th century standard housing, hunger, cold, boredom, isolation, bullying, stigma and discrimination.

    I know the phrase is a bit old hat – but maybe we could do with a bit more joined up thinking.

    Alastair – sorry if this is too long. You might want to link to the Guardian story about emotional wellbeing in the workplace –

  • toni

    @Pam. Not for me to suggest of course, but it might be helpful to the coalition for you to go to LibDem Voice – your place to talk – and offer your unqualified support for the changes to tuition fees and housing that are being discussed there.
    Scroll down a bit to find the articles before they’re drowned into oblivion by fast moving other topics, but I think you’ll find yourself outnumbered by the angry and frustrated comments already posted there.

  • taurus42

    Yeah, politics is so boring. Having long held beliefs and committing oneself to life long principle’s; what a drag. I mean, Pam, imagine nurturing and evaluting a system of beliefs, pursuing it, protecting your faith in opposition, holding it to task and question?

    Yeah, just window shop your integrity, you shallow, insipid dangerous loafer, hitch along for the ride, bitching and moaning all the while. No prizes for guessing who’se gonna be in tears when it doesn’t work out.

    Wake up, Pam

  • Maggie

    I work in cheshire on the community, I am frountline and we have had our mileage allowance cut our mufti allowance taken off us and can’t get equipment to do our jobs. The managers say the patients won’t be affected but ask them they will say completly differently.It now cost me to do my job I pay for my uniform to be cleaned and my mileage dosn’t cover the costs of running my car. We have to scratch around begging for equipment we need. all we hear is it costs too much you can’t have it,Then they preach that ground staff will not be affected, They obviously don’t have any idea how we work.

  • Pam

    What debate