Low uptake of influenza vaccine, a shortage of nurses, unrealistic expectations of patients, an already high occupancy rate for beds, and the unfortunate timing of outbreaks of both influenza and meningitis over the new year holiday brought the NHS to its knees last week.
The Public Health Labora-tory Service warned last year that vaccine uptake in 1996-7 was only 44% among elderly patients and only 12.4% among younger patients at risk. It said that there was a “clear need” to increase uptake, particularly among vulnerable people under 65.
Sir Kenneth Calman, the chief medical officer, wrote to all doctors in August 1998 and launched a “flu awareness week” in October to publicise the new policy of offering vaccinations to everyone over 75 years as well as to other groups at risk. As a result, a third of a million more doses of vaccine were used this year as compared with last year, but the Department of Health does not yet know what the uptake was among particular vulnerable groups.
Despite these preparations, influenza cases, in numbers that were far short of an epidemic, stretched intensive care facilities to the limit and forced many hospitals to postpone elective surgery. One hospital even resorted to using a refrigerated trailer when its mortuary was full.
Doctors said that much more effort will be required before uptake of the vaccine among all vulnerable groups is anywhere near 100
Douglas Fleming, director of the Royal College of General Practitioners’ Birmingham Research Unit, pointed out that many places had been hard hit by influenza even though the national figure of 188 consultations per 100000 population was not unusually high.
The general secretary of the Royal College of Nursing, Christine Hancock, said: “It is nurse shortages that have led to this year’s crisis in the NHS. We cannot provide good patient care when we are short of some 12000 nurses. A good pay rise would boost numbers immediately.” She warned that even a 5% pay rise would not remedy the nursing shortage.
Tim Jones, policy manager at the NHS Confederation, said a survey last week of 267 healthcare trusts with acute beds showed that the most common reason cited for constraints in admitting patients to hospital was pressure on beds (26%), followed by difficulty recruiting and retaining nurses (21%) and staff illness and absenteeism (18%).
“What we saw in the NHS last week was the service re-gearing itself from elective mode to emergency mode. With bed occupancy at around 95% there is no margin at all for emergencies, and the question now being asked is, ‘Do we have enough beds?’ Nurses’ pay is an absolutely key issue but we don’t want to see a massive hike this year.”
Unification of health and social services in the United Kingdom was recommended this week by the Commons health committee to end the confusion over continuing care for elderly and disabled people.
The government is moving in this direction, though not far enough for the committee, which proposed a fully integrated health and social care system.
Whether this should be established within the NHS, local government, or a new, separate organisation has been left open. The report records many shortcomings in the present system. Responsibilities are blurred, professionals face problems, and users suffer because of artificial barriers between health and social services. These barriers lead to uncoordinated hospital discharges–possibly 6000 people over 75 are being kept in hospital longer than necessary.
The Relationship Between Health and Social Services is available from the Stationery Office, price £8.00.