Issue no.1 – Short staffed and short changed?

“Have you got itchy feet…?” – Get your fungal cream out and fight to change things together!

In this series we‘ll look at how our work and the conditions of work change. Back in the day only doctors would take blood; in some European countries that is often still the case. Nowadays lower paid HCAs are trained to take blood – in April 2024 the temporary staffing office of the hospital with the slow lifts put out a Band 2 vacancy with required venepuncture experience which makes venepuncture a zero-hours minimum wage task. Certain job roles become very specific. Phlebotomists walk through the hospital all day and take blood, because that’s supposed to be “more efficient”, even if it makes you feel like part of a conveyor belt. New technologies are introduced that are supposed to reduce labour elsewhere. In one of the hospitals, management invested in automated transport platforms (“Attention, automatic transport!”). This would have made a number of waste or linen porters redundant if these platforms weren’t so high-maintenance. Now perhaps only 5 out of 15 of them still work. At the other hospital, management invested in PDAs (basically iPhones) for porters, so that they don’t have to return to the lodge, but can be given one job after the other. They also had to find out that algorithms are actually not always more efficient. It takes a while to know all the short-cuts in that maze.

“What with the staffing shortage and the long shifts, the only pleasure in life that I have left ends with the letter ‘x’… Datix”.

We are interested in the changes at work, because this is where we spend most of our lives. A change can mean more stress or less stress. It can make our job more boring or more interesting. It might lead to job cuts. In the end it is about understanding how our work is organised in order to have more control over it together. People who feel that they lack control become depressed. But understanding is nothing without the power to challenge certain changes or to propose our own, in our and the patients’ interest. We have to live up to this responsibility together. When we look at how work is organised we will also see that we depend on the work of hundreds in order to be able to do our work properly. In the NHS everything seems so divided into thousands of job roles and pay bands. This hides that a nurse can’t do her job without the domestic or housekeeper, the doctor not without the porter or canteen worker. And this reaches way beyond the hospital walls. Remember the supply-chain crisis, when we couldn’t get wet wipes or Tazocin? And what is the ‘community care crisis’, if not a lack of staff, which then means that patients have to stay in hospital longer then they would normally need to.

“This has increased the staffing shortage – and being short-staffed on long days really sucks, your life becomes the equivalent of a sluice room.”

For this issue of Vital Signs we asked colleagues in different jobs to tell us how the staffing shortage affects them. In the public this is mainly discussed as a problem of nurses, but it is actually everyone’s problem. And it is a funny problem, as there isn’t actually a shortage of people who could do the job, but a lack of will to hire more people or to pay more in order to attract them.

Instead of doing a heavy hospital job, people work in bullshit jobs, which might make no sense whatsoever in human and social terms, but which pay the bills and are bearable. Perhaps 40% of jobs in this society can be categorised as bullshit jobs, as work which makes no one’s life any better. If we would organise things together and consciously, we could redistribute loads of work and only work half as much. This would leave more time for creativity and relationships. But where money rules, common sense goes out of the window. Instead we are in a Catch22 situation. How many NHS workers are on long-term sick leave due to stressful working conditions and have appointment after appointment cancelled because the NHS is “overstretched”. Write to us with your own experiences and thoughts.

These are examples from the two big hospitals in Bristol…

Catering worker: “It’s a weird one. We don’t have enough staff to do the washing up in the staff canteen. So we hand out paper plates. At the same time management is not requesting more bank staff. The queues are getting longer, in particular for the morning bacon baps and on a fish-and-chips day”.

Pharmacy worker: “It’s kinda the same as everywhere else. Instead of having people doing specific things, they expect everyone to be doing a bit of everything but not as well. It feels like we’re short staffed from top to bottom, with pharmacy technicians filling in for a shortage of pharmacists and pharmacy assistants filling in where the pharmacy technicians were, to some extent. If there aren’t enough pharmacists or pharmacy technicians on the wards it takes longer for people to get their TTAs. There aren’t enough people in distribution to make sure all the wards get the top ups they need so they have to wait a day for stuff they need, which means patients might have to go the night without the drugs they’re relying on. And then because it seems a bit unmanageable, people tend to leave pretty quick which means they’re constantly relying on overtime to fill the gaps. It seems a bit unsustainable to be honest”.

General porter: “Before we had separate tasks. Now management wants everyone to work everywhere, from ED to general patient transport, from linen to waste. They think that they can cope with staffing shortages better when everyone is more flexible. But now we have situations where we do clinical waste in the morning, because the linen arrives late, and then distribute fresh linen. This can’t be good for infection control, can it.”

Domestics: “When there is a staff shortage you might have to do more tasks during your shift. On a certain ward you might only be supposed to do a green clean, meaning, changing the bin bags. But if they couldn’t find a replacement for your colleague who is off sick you might also have to do the general clean, on top of the other tasks”.

Bank HCA: “The ups and downs of shift availability is extreme and doesn’t seem to correspond with actual demand on the wards. For a while they cancelled loads of shifts and there were not enough shifts available to make ends meet. But you heard that the situation on the wards was not good. A couple of weeks later the Bank office texts you every 5 minutes and offers 50% uplift for allocation on arrival. From the outside it seems very chaotic. I work in both hospitals. In one hospital you have on average 5 to 6, in the other one 8 to 9 patients. That doesn’t sound like a big difference, but it can really decide if you – and the patients! – have a good or a shit day. If you have time to really get to know a patient and connect with them or not”.

Ward nurse: “I don’t know if that is related to staffing shortage, but somehow it probably is. In one of the wards where you have a lot of confused patients they now start a trial of video supervision of patients in their rooms. I don’t think that they will replace 1:1 care for so-called ‘ECO4’ patients (patients who need constant attention), but it will undermine the demand for better staffing levels in the long run. What with the staffing shortage and the long shifts, the only pleasure in life that I have left ends with the letter ‘x’… Datix”.

HCA (or HCSW or NA): “Some years ago they changed the shift-system for HCAs from 8-hour shifts to 12-hour shifts. In that way management hoped to achieve two things: they would save 30 minutes hand-over time per day and they would need less people overall. Some people like the 12-hour shifts, because you have more days off, but with the inflation a lot of people work extra bank-shifts anyway. Sickness levels have gone up since then and a lot of older people left, because they can’t hack the 12-hours. This has increased the staffing shortage – and being short-staffed on long days really sucks, your life becomes the equivalent of a sluice room. Around a similar time they introduced bank shifts, which also meant that instead of overtime, which is paid time and a half, people were now working casual shifts on the same wage.”

Housekeeper: “As a housekeeper you notice when there are not enough nurses or HCAs. And they notice if the housekeeper is off sick and not replaced. This might decide over the question if patients get washed or not and if they get their meals still hot or cold. But it can get even more serious than that. We had so many more patient falls when we were understaffed. They can’t wait for ages if they need the loo. We try to help each other, but there is a human limit”.

Scrub nurse: “A lot of permanent theatre staff left their jobs, these were experienced scrub nurses and operating department practitioners (ODPs). Management had to replace them with agency staff, many of whom had worked as permanent staff here before. I would say up to 30% of theatre staff is employed through agencies, but it is difficult to tell, because we all work together day in, day out. From April 2024 management wants to cut the jobs of many of the agency colleagues. I just fear that we get back into a cycle where surgeons get stressed, because new staff might lack certain knowledge, this then creates a bad atmosphere and people leave – and in the end management has to call the agency back. Currently three quarters of staff in our theatres have been in the job for less than 1 year, so we lack experienced staff. Perhaps we should send a collective letter to management in which we question their decision. Another way in which we notice staff shortage is with the sterilising service from the CSSD. When they are short-staffed, the turnaround of sterile instrument sets can take too long. We already had to cancel surgeries because we didn’t have the right sets.”

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