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Editorial Graham Scott EDITOR

@NSeditor

It’s time for consensus on the future of the NHS Guidance on the number of nurses needed in A&E departments was issued last week by the National Institute for Health and Care Excellence (NICE). No nurse should have to look after more than four patients – and only two if their conditions are more serious. The guidance is out for consultation, but hospital managers would be well advised to take heed straightaway. For months there have been

ALL THE PARTIES HAVE HAD warnings that this winter was A GO AT IMPROVING THE NHS going to be tough. The issues extend far beyond the nation’s AND NONE HAS SUCCEEDED

emergency departments, of course, but A&E often provides an accurate barometer of the service as a whole. Some nurses have told us that their department is well run and would be staffed adequately for more normal circumstances, but problems elsewhere in the system mean their patients are left hanging around in cubicles or on trolleys. A few extra staff should help, but will only help solve part of the problem. All the NHS reforms over the past 30 years have been introduced on the premise that they will create a service built around meeting patients’ needs. We have been promised that more care will be provided in the community, reducing demand on the acute sector. Access to primary care will improve. Money will follow the patient. None has delivered as intended. In election year none of the main political parties appears to have any appetite for a further round of reforms, with recent debates focusing on funding rather than the system. Staff and patients would not relish any further organisational upheaval either, but the most recent reforms were so badly botched that, like it or not, further changes will be necessary. RCN Wales director Tina Donnelly opined over the weekend that it would be better if politicians sought consensus rather than difference over the NHS, focusing on the long term rather than tomorrow’s headlines. This may sound like wishful thinking, but perhaps is not so fanciful given that all the parties have now had a go at improving the health service and none has succeeded. See news page 7

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