Ever wondered what it's like to wash a dead body? See a pastor lose their faith? Clean up the vomit of a convicted paedophile? Convince someone post MDMA overdose that calling the police to complain about of the quality of the drugs they bought might not be in their best interests? Being a nurse is a pretty unique job. In what other walk of life would you get a chance to get to know people, on a very intimate level, across an entire spectrum of society? When a nurse says "intimate", it usually means something pretty fucking disgusting.
But it's not just a good job for the prurient satisfaction of the naturally curious. You know that little boost you get when you help an elderly person get a bag of rice from a high-up shelf, or give a seat to a pregnant women on public transport? That's the type of feeling nurses should have every day. But instead, on the whole over the last five years of coalition government we have been stressed about work, stressed about money and worried that things will never improve.
At the beginning of the coalition government, they were looking for cost savings all over the place. Cutting the nurse-training budget seemed like a win-win. You're not actually cutting nurses who are in work – that looks callous – but you save money. A 2013 Royal College of Nursing report showed a 12.7 percent decrease in the number of places for student nurses.
A couple of years later down the line, that policy now looks a bit short sighted. All around me are wards with 20 percent vacancies. Check your local hospitals website, they publish the vacancy data for every clinical area. This is the Tories idea to drive up standards: let's add transparency and embarrass hospitals into having appropriate levels of staff . There's no need to legally force them. After all, they are mostly financially independent Foundation Trusts, so if they want to save money by having fewer nurses, that's their decision, not the government's, right?
UK hospitals were never notorious for having too many nurses before. How many stories have you heard about a trip to hospital where where the patient rang a call buzzer and three nurses arrived, brought them a cup of tea and they all chatted for 40 minutes? 20 percent too few staff is a recipe for disaster. It's the difference between getting a painkiller quickly or not, getting assistance to the bathroom or being incontinent. More seriously, poor staffing levels also means patients that should survive, don't. They deteriorate unnoticed, they pick up more infections, they fall over and break their hips.
The Francis Report into poor care at North Staffordshire NHS trust spelt it out in harrowing detail. At "North Staffs", a busy acute admissions unit and A&E department was seen to be unsafe by it's staff. There were too few nurses and doctors to safely look after the patients, so staff members wrote incident forms, reporting to their managers about their concerns. They found nothing changed. So as time went on, staff stopped writing the reports that no one responded to, or took notice of.
A generalised culture of acceptance of poor standards crept in. By the time the whistle was blown and investigators stepped in, it was estimated that between 400 and 1,200 patients had died needlessly. Healthcare in the UK can be roll of the dice based on which hospital an ambulance takes you to – the average one, or the well below average one.
Since North Staffs, there has been a consensus on the importance of adequate nursing levels to maintain safety, but there is a reluctance to define it on a national level using quotas, as used in Australia or the US state of California. The trouble is, there just aren't enough nurses out there to hire – hence the ridiculous vacancy rates. It feels like a massive scandal, but no one seems to be talking about it. Labour can talk about hiring more nurses, but where they're going to find them isn't explained.
Some nurses have left the profession because it's too demanding, or they are reaching retirement age. There are fewer newly qualified nurses coming through now, and the UK is not exactly the easiest place for foreign workers to get a work visa these days. So NHS trusts are throwing around massive amounts of money trying to recruit staff internationally. Finding prospective employees via recruitment agencies, flying them to the UK, providing food and board, interviewing them, and then accepting all those costs were wasted on the applicants then found not to besuitable for a job. Trying to fill one vacant nursing post these days can cost thousands.
Jeremy Hunt talks hypocritically about an over reliance on agency staff, as if it wasn't his coalition government that created the exact circumstances that necessitated it. Nursing agencies that provide temporary staff on a day rate are making a killing.
So that's the fall out from the last change in government. Now it's the election, and once more everyone's saying how much better they're going to make things. Unfortunately, politicians seems to be playing, er... politics with people's lives again.
The Tories promising "seven day a week" care, for instance, seems logical on the face of it. It's always surprising how quiet a hospital can become at the weekend, compared to weekdays. Surgical theatres are empty at weekends – why not use them to lower the waiting lists? It seems like an obviously smart move, but are there hospital beds available for those extra surgical patients? There are not.
I guess you could build an overflow ward for these weekend patients. The only trouble is that many hospitals don't own their own buildings any more. They became tenants in privately financed hospitals, thanks to the PFI deals brought in under the last Labour government. We have little say in altering them based on changing needs.
Those little niggles aside, to make this policy work, the Tories could bully Consultants into coming into work at the weekend to see patients. Nobody would shed a tear when someone earning £100,000 a year complains they have to work a bank holiday. But making people who earn loads of money work more will probably cost a lot.
This is the thing: There are no shortage of bright ideas about how to improve patient care – honestly they are ten a penny. But are they efficient? The problem is how to fund them. In the absence of a costed plan to really, truly sort out the NHS, we're left with politically expedient choices. The same report by Dr Foster (a health intelligence company) that highlighted poor weekend care, also highlighted poor night time care. Most parts of the hospital close or have less than half the staff on at night. So where is the policy to improve staffing at night? For whatever reason, Jeremy Hunt hasn't mentioned it.
Labour, meanwhile, have pledged an extra £2.5 billion spending to aid "caring" in the NHS. The 2015/16 NHS budget is £115.4 billion, so basically they will spend a couple percentage points higher than the Tories. That's the difference between the party that styles itself as the defenders of the NHS, and the wrecking party they say they're defending it from? 2 percent? A couple of percentage points aren't going to touch the improvements in pay and infrastructure that are needed.
And what will they do with this 2 percent extra money? Labour are promising a GP appointment within 48 hours, made possible by funding 8,000 more GPs. The only problem is that GPs are already fleeing this country in droves, in part because of the stress of working in an overstretched system. Is adding a new target likely to reverse this?
Labour also promise diagnostic tests for cancer completed and reported on within seven days. For this to be achievable, a number of things would need to happen, in very rapid succession. Let's say you see your GP on a Monday with a suspicious lump. On Tuesday the Oncologist would receive the GPs referral, and they would book you a scan urgently. The scan could be done done on Thursday, initial findings completed by a Radiologist on Friday, then over the weekend, six to eight very senior doctors would meet to discuss the results and make a diagnosis.
It seems like a fantastic idea – but once again the politicians don't seem to be taking practicalities into account. It would be great if these scanners weren't already being used at full capacity most of the time. And if the Doctors weren't already working far in excess of their expected work hours. But often they are. In an overstretched system where it can take almost a week to get a GPs appointment, how is that timeline going to be realistic?
But before we write Labour off, they announced they will cap private profits within the NHS at 5 percent. I expect some good accountants would make mincemeat of those caps within weeks, and business will continue as normal. Labour have pledged to halt "the tide of privatisation" of the NHS, but I'm not holding my breath.
It probably isn't surprising that I have been out on strike a couple of times in the last few months. The strikes were officially over a paltry pay deal, but what really drove them was the everyday stresses of doing an important job with inadequate resources.
Unfortunately the strike got called off as soon as momentum was being built. Despite having a mandate to use industrial action to get a meaningful pay increase, the unions seemed happy to get offered 1 percent, cancelled all upcoming strikes, and made it clear to the members that accepting the offer was the best way forward. Which is probably pretty lucky for Ed Milliband, you could almost imagine the cold sweat on his brow as the Daily Mail asked him to condemn striking nurses.
With none of the parties seeming likely to meaningfully improve NHS funding, we will have to continue stumbling from crisis to crisis, as doctors and nurses morale and goodwill continue to plummet. And honestly, if I see one more politician in a hospital with their sleeves rolled up and their tie tucked in, with their "concerned" face on, then I think I'll be the one who vomits.
Jane Stolz is the fake name of a hospital nurse working in the South East.
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