As Dame Donna Kinnair, then Chief Executive Officer and General Secretary asserted on the 1st anniversary of the start of the pandemic, nurses are neither heroes nor angels. She rightly reminded all of us who needed reminding, those of us who were out on the steps clapping or banging saucepans, that they are professionals who are “highly skilled and carrying out a safety-critical job”. Further, in the same interview she says “Old-fashioned stereotypes of nurses as handmaidens of the ward have been rubbished.” (David Doyle, In Your Area, 2021).
I am not a nurse, but even I find the use of the terms “Angels” & “Heroes” deeply demeaning and highly patronising. Dame Donna was being rather optimistic in asserting that the stereotypes have been consigned to the bin. They are still around particularly among those who hold the power and the purse strings.
I am currently an in patient on a mental health unit having had a bad episode of my long term condition – Post Traumatic Stress Disorder. I know most of the staff here well. I have never seen such low morale however nor, indeed, such exhaustion.
Mental Health nurses and Healthcare Assistants are already the poor relations in the NHS family. The oft talked about ‘parity of esteem’ between mental and physical health in reality does not exist. Staff and patients need deeds not words, to quote Emmeline Pankhurst.
During my admission I have witnessed staff having to cope with violently psychotic patients, having to be ultra-vigilant over patients at risk of self harm or suicide, be a listening ear to patients in distress and their worried families, act as security guards, clear up mess, deal with a constant barrage of demands from patients wanting to be accompanied outside so they can smoke – the list is endless.
I am not saying they are all perfect. Every team has bad apples but with staffing levels dangerously unsafe, they need all the staff they can get.
These are specific examples I have witnessed personally:
One morning I was up as usual very early which I like to do before the chaos starts. I noted two patients standing opposite the reception desk being abusive. The two night staff told me they had been doing that incessantly all night without stopping. It had prevented them from having their statutory rest breaks. They are beyond stretched. A medieval rack comes to mind with a wheel cranked by assorted Tories in shifts.
Every single morning of my 12-day stay has started with a palpable feeling of panic as they try to paper over yawning gaps in staffing levels. They shift people round from other wards and rely on bank and agency staff. On this ward according to a senior nurse, they are supposed to have 16 staff in total. Right now they have five. There is no way this degree of staff shortage can guarantee patient or indeed staff safety no matter how dedicated the staff may be.
I have been on both sides of this having been a frequent patient and also run a consultancy where I used my lived experience and what I learned at the NHS Leadership Academy to fight for improvement and patient safety. I understand the pressures staff are under more than most. Patients, particularly those who are detained under a Section of the Mental Health Act, only see staff refusing their requests to be taken outside for a cigarette or to the shops. They can naturally get angry, and this can lead to even more incidents. It’s a particularly vicious circle.
And then there’s the shoddy state of some of the equipment they have to deal with. There are two computers for patients’ use, neither of which work. The washing machines are ancient, the new so-called “safe” bins are not fit for purpose as they block up almost immediately (source – 20 members of staff whom I asked ‘what do you think of the new bins?’ 100% replied ‘rubbish’ and other things not printable here). Yesterday I had to leave early to let cleaners into my flat. I had to leave without my morning meds including pain relief as the computer system had crashed again.
On another ward here on a previous admission the washing machines were so past it, they were shredding people’s clothes so staff were washing clothes by hand for patients. This was not so bad for me as I could go out and use a laundry, however those detained under Section did not have this privilege.
It was a similar story on medical wards. I was on a general medical ward before COVID but post Brexit referendum (just to emphasise that blaming the pandemic for all this is missing the point). Staff shortages were already very obvious.
Half the patients on our bay had dementia. One night there was precisely one Healthcare Assistant on duty responsible for two bays of six beds each and a side room. She had no other help. Our ladies needed to be watched constantly as one of two would try to get out of bed and could potentially injure themselves. With all the will in the world, there was no way this single HCA could keep an eye on all the patients. Nurses are amazing but cannot see through walls.
One lady was very adept at getting out of bed and had an ability to sprint like an Olympic athlete. Three of us who did not have dementia took it in turns to watch these ladies and alert the HCA if there was an escape attempt. This lovely Jamaican lady got out of bed and started sprinting down the corridor at great speed followed by me in my regulation hospital pyjamas.
The next morning the lady told me ‘I feel mucky’. I helped her have a shower as there was no-one available to assist her among the staff. I had never even given my own mother a shower so it was quite an experience
Later I found out that Matt Hancock had been in the hospital that night pretending to do a night shift in Paediatrics for a photo op. There was a sickening picture of him in immaculate freshly pressed scrubs surrounded by nurses with very forced looking smiles. I swear if I had known I would have gone down there and frogmarched him up to our ward so he could see the reality rather than the Potemkin Village.
In essence I don’t just blame the government for this though they are by far the main culprits. I have also seen such waste. When I had a two-year contract with the NHS Horizons team. It would appear to have been a vanity project for one ‘leading lady’ of the NHS.
It involved running events in which NHS ‘leaders’ were encouraged to throw scrunched up paper with a ‘pledge’ on it & then have a paper snowball fight. On another occasion, a very shouty American-style seminar involved creating something (out of pipe cleaners & coloured card etc) we thought the NHS would look like in 20 years. My table was made up of very senior clinicians who looked horrified. I told myself ‘if this descends into Interpretive Dance, I am out of here’. Sure enough, one group got up, plugged in a phone, happy clappy music started and I, along with other introverts, raced to the door to get out.
We also spent a long time being paid to come up with a new ‘strap line’ for the NHS. The result? “Change is Changing”. Change changed so frequently as these Transformistas, as I called them, were like magpies. They’d pick up some shiny new thing from say, the Harvard Business Review, and be all excited to the point of euphoria. By the time said transformation reached the grass roots where the hardest work is done for the lowest pay, the Transformistas had moved to the next shiny thing.
So yes. There needs to be more funding from the government, safe staffing levels, and pay commensurate with the level of responsibility. In addition though, there has to be some kind of independent inquiry into value for money to ensure that such funds that the NHS has are being targeted to the areas of greatest need. This means no more gimmicks, abolition of ego trips and focus on the basics. The basics include an end to antiquated IT systems, an end to staff having to use the torch on their personal phones to check patients’ eyes, no more running out of drip stands, and above all ensuring that staff do not have to forgo their breaks or even the chance to go to the toilet due to the shortages of staff.
I conclude this blog with a quote from the Royal College of Nursing:
‘Strike action is a last resort. But it can be a powerful tool for change. Unfairly low pay in our profession is driving chronic understaffing. It puts patients at risk and leaves nursing staff overworked, underpaid and undervalued.’
If you care for patient safety, you will support this strike. Nurses cannot pour from an empty vessel for much longer. I will be joining picket lines as a patient advocate who supports this strike. Enough is enough.
Fragments from a Half Life 