Dear Martin,

When I trained as a mental health nurse, I thought that I could make a difference. On the whole, the six years I have worked for the trust have been positive. But the working conditions have now, I feel, become intolerable, and I ask that you accept the following letter of resignation.

There are many things nursing staff wish they didn’t have to deal with — staff shortages, aggressive and inappropriately placed patients, a lack of control and restraint teams, broken facilities, illicit substances — but we do deal with them, on a daily basis, and mostly without complaining. Why? Perhaps because we care. Many times I have considered joining the stampede of staff leaving psychiatric nursing and thought better, but the proverbial straw that breaks the camel’s back has finally arrived in the form of NHS Professionals (NHSP).

When NHSP was set up in 2000, it was supposed to offer nurses and other NHS staff a better deal and save money, but instead it has created an extra layer of bureaucracy which has resulted in the recent problem of an estimated £5 million in late payments.

The problems with NHSP are twofold: the suitability of some of the staff provided and efficiency.

For psychiatric patients in particular, continuity of care is paramount. They will not discuss their feelings with staff they have never met before, and become unsettled by constantly changing faces. Our trust has long relied on agency staff to supplement regular nurse numbers and provide cover due to sickness/holidays. We used to book regular staff directly from agencies, ensuring both continuity of care for the patients and ward safety. A phone call would usually produce results with the minimum loss of time from already stretched patient care.

Now, all bookings must now go through NHSP. Wards must first fill in and fax detailed booking forms, or, if at short notice, phone for a reference number first and then fax the request. And if, as is usually the case, NHSP cannot meet the requests and the shift is imminent, they will offer the shift to other agencies. If staff are found at such short notice, NHS Professionals will allocate a shift reference number, ensuring that they are credited with supplying cover regardless of which agency provides the staff.

All this is supposed to help us deliver care more efficiently, but in reality it is a bureaucratic nightmare. Some of the agency staff are excellent. Some are not. Incidents of staff falling asleep while on one-to-one observations are worryingly frequent. A patient recently approached staff and asked if the agency member could be replaced as his snoring was keeping her awake. Yet we can no longer request the staff who we know will do the job well because NHSP doesn’t allow us to be selective. “It’s not procedure,” they say.

On each shift hours are spent introducing agency staff to the patients and explaining procedures. This is not an effective or efficient way to run a hospital. Nor are many agency staff control-and-restraint trained. So wards rarely have a team that can deal safely with a violent patient. Patients joke that they can get away with anything when they realise that a shift is staffed mainly by agency, and they do: in one incident recently a patient who was being escorted by agency staff on a supervised excursion brought a gun back. It was discovered only when other patients revealed that they had been threatened.

NHS Professionals is not the solution to a problem; it is the cause of yet another one. I feel that the trust would best serve its patients and staff by admitting that the staffing situation has become intolerable. There are not enough staff on any of the acute psychiatric wards, and it would be preferable for the ward to close than to continue papering over the cracks with NHS Professionals.

I cannot continue to work in an environment where I feel constantly at risk. I cannot continue to work feeling totally undervalued and unsupported by hospital/trust management. I cannot continue to come into work not knowing whom I will be working with nor whether they will be a help or a hindrance. I cannot continue to cope with being unable to provide the good nursing care that I was trained to give.

I quit.

DEAR SUE

Martin Barkley,
Hampshire Partnership Trust

There is a serious shortage of trained nurses employed by Hampshire Partnership Trust in the Department of Psychiatry. In the summer of 2004 around half of the posts were vacant, but more than ten new staff have now been recruited. The Trust signed up to use NHS Professionals at the beginning of 2004 to improve the quality, reliability and cost-effectiveness of temporary staffing. We recognise that this staff shortage is the most serious operational problem that we have to resolve. We have put in place several initiatives to improve recruitment and retention of staff.

Esme Crabtree,
communications and media relations manager,
NHS Professionals

NHS Professionals does not owe £5 million to commercial agencies. There were payment problems but these have been resolved and will not recur. Where possible, NHS Professionals offers long-term bookings for mental health nurses so that patients remain in the care of the same individuals. We encourage trusts to name staff who they feel are most appropriate for their needs.

All NHS Professionals staff undergo qualification and CRB checks, along with any mandatory training or update requirements.

Is bureaucracy killing the NHS?
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