Let Clinical Staff fix the NHS

Nurses Day on 12 May is an opportunity to put the dedication and strength of nursing staff in the spotlight. It is also time to say;

“Let Clinical professionals together, fix the NHS”.     

A 20-point plan by ReMEDI Rx  www.remedi-rx.com


  1. Double the nurse (and doctor and midwife and physiotherapist’s) staff levels.
  2. Whilst this is taking place (and it might take some years), appoint good nurses and doctors from abroad but check, (and coach if necessary) and then examine; (a), their clinical skills, (GMC or NMC), (b), their communication skills, (GMC or NMC + ReMEDI Rx), (c), their English knowledge (IELTS, 7.5 out of 9) and (d) their clinical English vocabulary (GMC or NMC + ReMEDI Rx).
  3. Increase nurses’ pay up to twice the current salary and make it relevant to the number of year’s training and number of year’s postgraduate training (for example, midwifery, theatre courses, anaesthetic courses, ITU or A+E training should all add a financial increment).
  4. The widespread problem of staff shortages in hard to recruit posts (such as A+E consultants, or midwifery, or operating theatres) must be managed better. It is unacceptable to continue to run emergency areas where life and limb may be lost with insufficient members of unqualified staff. The incentives could include; further senior training which might lead to a higher qualification for the recipient, or promotion, or a managerial role overseeing their area of expertise. Or pay their professional indemnity premiums or simply a financial bonus.
  5. In theory, nurses work 37.5 hours per week but more often than not, work extra unpaid, un-social and disruptive hours, just to keep the NHS going. This should stop now. ReMEDI Rx believes that trained staff establishments must be calculated by ward or department clinical leads, (not by non-clinical managers).
  6. We suggest that with improved staffing levels and realistic levels of pay, that clinical staff would be prepared to work a 40-hour week or even 42.5 hpw.
  7. Return to apprenticeship style training for nurses and remove WTR restrictions on doctor’s work ensuring (in both instances), better patient care and better clinical communication.
  8. Make a post graduate 4th year, following nurse training, mandatory at the hospital where a nurse has trained to guarantee the student a job immediately after he/she has qualified and to guarantee the hospital a filled post. This idea could be copied for medical students planning to move into their first house jobs.
  9. Having clinical vacancies anywhere in a hospital and having to resort to bank staff and locums, should become a ‘hanging offence’ for the hospital’s finance manager/director
  10. Ensure medical students spend extra time on the wards during their training and under the eagle eyes of the ward sister/charge nurse. Nurses and doctors alike must be familiar with hourly measured fluid intake and output and the once routine ‘bowel movement’ question, which is now too often not asked.
  11. Bring back ONE old style hospital matron with a deputy and an assistant as back up. Part of this job would be to ensure that all nurses from abroad speak good clinical English and have good communication skills.
  12. Appoint a senior consultant to work in parallel with the Matron and to be the hospital’s lead on all medical staff. Part of this job would be to bring back the old style “Firms” and ensure that all doctors from abroad speak good clinical English and have good communication skills.
  13. In our experience, many non clinical managers and CEOs have been noted to chase their own non-clinical agendas, even against the advice of medical and nursing staff, so we feel this point is pivotal to ‘Fixing the NHS’ and suggest that with immediate effect, all non-clinical managers and CEOs are removed, (with a 3-month notice period and no major pay-offs). The money saved from this exercise will fund points 1, 2 and 3 above.
  14. Address the Health Care Assistant (HCA) issue. HCAs provide care in a health setting. but, and this is a big BUT, unlike a nurse, doctor, midwife or physiotherapist’s training, assessments, examinations and subsequent qualifications, HCAs are not formally trained nor are they qualified. How often is it do you think, that untrained and unqualified staff are being appointed instead of qualified staff because they are cheaper? What a false economy when things go wrong.Patients of today are quite rightly going to be asking whether there are enough qualified staff on their wards to give them the quality care they expect and deserve.
  15. There is an urgent need to introduce formal HCA training, along the lines of the previous Enrolled Nurse (EN) 2-year training.
  16. Senior clinical staff (nurses and doctors) should use their collective best endeavours to ensure that bed usage does not exceed 85%. This is important from an infection point of view as well as a logistical point of view.
  17. Patients should never be discharged during the night (yes it currently does happen).
  18. Bottlenecks must be routinely de-congested or unblocked. [For example, operating theatre time is very costly and the theatre sessions must be optimised. It is a false economy to skimp on the number of (low-paid) theatre porters, only to have the (highly paid) operating team waiting for the patient’s arrival].
  19. ReMEDI Rx believes that where nurses and doctors have the time, space, support and encouragement to use their skills and knowledge properly, then the best possible patient care will follow, and this is, after all, what a good NHS is all about.
  20. Every NHS problem has a solution and it will be the clinical staff who will fix the NHS.