News analysis Londons NHS finds it hard to get the staff

3 Mar 05
The capital's health service offers clinical excellence but many trusts are facing a difficult financial year

04 March 2005

Londoners are used to having the best – the best theatres and clubs; cinemas that host world premieres; world-famous restaurants. But would they say they receive the best NHS services in England? Two reports have cast doubt on whether they do.

Last week's National Audit Office report on tackling cancer said patients' experience of services in London were less positive than elsewhere in England, although survival rates were no worse.

And a King's Fund report, published on March 3, found that job vacancies in the health service across London were twice as high as the national average.

Trends in London's NHS workforce reports a long-term vacancy rate of 5.5% for qualified nurses, midwives and health visitors in London compared with a vacancy rate of 2.6% in the rest of the country.

King's Fund chief executive Niall Dickson said: 'This is not about statistics, it's about Londoners receiving a raw deal.'

It could be argued that the number of large teaching hospitals in the capital, which have a reputation for excellence and cutting-edge practice and often attract the best doctors, offer Londoners the highest-quality care.

Ruth Hutt, one of the report's authors, says staff are attracted to the capital to train at the large teaching hospitals but often leave as they become more senior or wish to get on the housing ladder.

'The exception tends to be consultants, who are attracted by the opportunities for private practice. In nursing we rely heavily on international recruitment but we still have a problem with the senior grades.

'There seems to be a bigger problem for allied health professionals (AHPs), such as dieticians, than for nurses. AHPs tend to be younger and come to London to train but then leave.'

London's hospitals rely heavily on agency and bank staff – nurses volunteering to do overtime – to plug the gaps. This is expensive and might partly explain the expected deficits across the capital's health economies.

An analysis by Public Finance shows strategic health authorities are expecting a deficit of £97m by the end of the financial year.

While agency fees do not figure highly in the explanations for this overspend, staff costs do. Along with their peers in other areas, London's trusts are struggling to cope with the extra costs of new contracts for consultants and GPs, as well as Agenda for Change.

These costs are exacerbated by cost-of-living supplements – under Agenda for Change, for example, staff working in inner London receive a 20% pay top-up.

As one of the capital's finance directors points out: 'I think it's a difficult financial year for everyone, but it is particularly acute in London. We all have to cope with higher staff costs, Patient Choice, increased emergency admissions and payment by results – but our overheads are greater.'

Waiting lists across the capital have fallen since April 2004 but in two areas predicting large deficits they have increased. North West London Strategic Health Authority is predicting an overspend of £47.5m and waiting lists have increased by 677. For South East London SHA, the figures are £18.2m and 286 respectively. However, although South West London is also expecting a deficit – of £20m – its waiting lists have fallen by 671.

Hutt says Londoners may benefit more from the choice agenda than patients elsewhere. 'If you live in southeast London, you have three major teaching hospitals on your doorstep. If you live in Cornwall, you don't have that choice.'

However, the picture is not as good in other areas. Hutt adds: 'In community services, there are problems recruiting district and other nurses. Older people are more reliant on these services and this may create problems for them.'

There is also a shortage of GPs and this is likely to increase, as in some areas 50% of GPs are due to retire in the next five to ten years. This is not good news for the government, which intends to expand the services provided by GPs and other primary care staff.

Hutt says: 'We've got to find a way to attract staff to stay in London and help make the transition to community-based care, or there will be a real problem with capacity in the community.'

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