There was a time when the general secretary of the Royal College of Nursing saying that morale among the profession was “plummeting year on year” amid “dire financial circumstances”, would have made for shocking reading. In 2015, it’s a sickeningly familiar cry for help.
After five years of squeezed funding, a total legislative overhaul of the English system and an unprecedented rise in both marketisation and fragmentation, the profession has been left reeling in uncertainty and strain.
And with the most unpredictable election in a generation just days away, an end to these troubling times seems a long way off. The NHS has been right at the forefront of the debate, and many fine words have been spoken about the service, on all sides. But is it all just words? Benedict Cooper investigates.
The NHS, so reads the Conservative Party manifesto, is a “profound expression of our values as a nation”. The party in government, it continues, has “cleared out bureaucracy, generating savings which we have invested in care for patients”.
Has this self-appraisal been reflected in the experience of staff on the wards? Martin Jackson, a charge nurse at Barnsley Hospital, says absolutely not.
He says: “There’s been a massive increase in the strain on nurses over the last few years; it’s changed so much. The patients we are getting on the wards are a lot more poorly now and take a lot more intervention. The right level should be six to seven patients per nurse, but you’re often getting 12 patients, two nurses running a 24-bed ward with support staff”.
The government’s reforms of the health service have sparked anger, frustration and mistrust from medical staff, partly because of the solemn promises made by the Conservative party before the last election that many feel disguised its true intentions.
But what is being pledged this time around, and will the Conservative Party be trusted again? The party’s manifesto promises it will plug the £8bn funding gap, work towards a seven-day week for GP access by 2020.
The Liberal Democrats, active supporters of the Health and Social Care Act, echo their coalition partner’s pledge of £8bn extra a year by 2020, pump more money into mental health services, and build towards the big prize – integrated care.
Labour pledges to repeal the Health and Social Care Act, and raise an extra £2.5bn a year for the service, to pay for 20,000 more midwives, 3,000 more midwives and another 8,000 GPs.
But for the most radical suggestions you have to look away from the mainstream. The Green Party, whose sole MP in the last parliament Caroline Lucas led the introduction of the NHS Reinstatement Bill, would put “an end to the privatisation of services”, inject an immediate £12bn extra a year to the service – increasing to £20bn a year by 2020 – and provide free social care for older people.
And the reason for these more drastic measures, is the series of alarming warnings that have come from the people in the know; warnings about chronic under-funding, missed accident & emergency targets, unprecedented strain on staff and increasing risk to patients. The argument over what’s causing the added burdens will rage and rage, but Jackson says that it’s chiefly down to a lack of funding and a business-like attitude among top brass.
He explains: “Managers’ and directors’ priorities seem to be to reduce costs and close wards and then they are forced to open escalation wards; this puts even more pressure on staff. They are very high pressure situations, much worse than normal wards, and that can be the trigger for some nurses to decide the health service is not for them”.
It’s what Lisa Clarke, a nurse specialising in immunology and allergy, describes as a “sword of Damocles, that could drop at any moment”.
“Trusts are losing staff,” she says, “and they’re not being replaced. We have to do time and motion studies to justify our existence”.
Hugh Workman, a nurse based in north Bristol, says that something else has gradually changed over time, an intangible ethos which he says is being lost.
He says: “The pay has always been low in the NHS and it’s always been a struggle; but the reason people tolerated it was because of the high morale among staff. There was almost a family environment in hospitals before. That’s been taken away; the market has ripped the heart and soul out of the service. Now it just seems to be about people coming in and making money.
Whether or not this can be recovered is unclear, but, Workman says, something needs to change drastically if NHS staff are going to feel valued again.
“You can either revive that spirit,” he says, “or start paying people properly. As soon as you take away that moral economy people think differently about each other”.
So is there an alternative? Many in the service feel that above all the priority is to make sure the Conservative Party does not get back into power, for fear of more cuts and an escalation of market forces. Labour’s record on the NHS isn’t entirely clean, particularly when it comes to the introduction of private finance in hospital building, but its pledge to repeal the Health and Social Care Act has won many healthcare professionals.
But is it enough? Would simply scrapping the Act reverse the tide, and can the spirit that Workman describes be brought back? The National Health Action Party (NHAP) was formed in 2012, a new political entity made up of medical professionals appalled by the reforms they were seeing.
For Karen Howe, a former nurse now an NHAP candidate in Stafford, after such a huge change in the ethos of the service, it’s too late for tinkering.
She says: “We don’t want short-term pledges for the election; the NHS doesn’t work like that. We have to secure the future of the NHS with proper strategic planning. There’s been a chronic lack of foresight and strategic planning for NHS workforce of the future and now we’re seeing all these things play out.
“It’s fine that the main parties are saying they would invest in the NHS, but it’ll take two years for that to have any effect. It’s a question of what’s going to fill the gap now”.
One of the main priorities, Howe says, is to reverse the business culture that has thrived in the health service since the last election and stop the false economies in staffing.
She explains: “Competition and markets are taking money away from where it should be spent, which is in patient care and supporting nurses. We’re spending huge amounts on hiring locums and agency staff, and having experts replaced by health care assistants”.
Statements about the shocking health of the service have caught the public’s attention, and made the NHS a key election battle. But the key question is whether this translates into real action by the new government. Karen Howe says whoever is in charge of the service, to take the pressure off the nursing profession, recruitment and training must be a top priority.
She says: “We need more experts and skilled nurses that are properly trained; that’s where the investment should be. The more you mess with that the more pressure there is on nurses; a workforce with more skilled workers is more efficient”.
And the RCN has published its own wish-list for the service, with the three key priorities being to return to safe staffing levels, improve pay conditions for nurses, and spend the money needed to improve long-term recruitment, training and retention.
After a tumultuous five years, it’s understandable that nurses are mistrustful of election pledges. The outcome of this week’s election is anybody’s guess, but what is certain is that this is a crucial and potentially make-or-break time for the NHS, and the nursing profession.
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