My wife came home from work last night ‘too tired to chew’. She’s a nurse, and she’d just completed a ‘double’ shift – leaving home at 6am and getting home at 9.15pm after a solid shift of almost 14 hours on a ward full of ‘dependent’ patients.
She came in, and I asked if she wanted me to warm something up for her to eat. ‘No, I’m too tired to chew‘, she said – and it wasn’t humour. She then warmed up some instant porridge that she could eat with minimal effort before having a quick bath and then going straight to bed. She’s on another ‘double’ today, so she couldn’t do anything else before sleeping in order to be ready.
It hadn’t even been an unusually busy shift – just ‘par for the course’ on a ward that has about 8 patients for every qualified nurse, and almost all of them with conditions that make them ‘high-dependency’, needing help with even the most basic functions.
Earlier today, in a speech to the Nuffield Trust, Health Secretary Jeremy Hunt criticised NHS hospitals for ‘coasting’. In his considered opinion,
too much of the NHS is focused on doing just that [‘not coming last’]. Not on achieving world class levels of excellence – the gold medals of healthcare – but meeting minimum standards, the equivalent of ‘not coming last.
and
The weeds of failure grow more quickly in a garden of mediocrity.
Hunt was comparing the NHS to Olympic athletes. Since it was unthinkable, he was saying, that an Olympic athlete would train with the aim of ‘not to win, but to not come last’, we should also expect NHS hospitals to aim for not only excellence but constant improvement.
The thing that strikes me most about the whole, fatuous speech – and it really shouldn’t, because it’s entirely normal in the way this government treats the targets of its measures – is the blatant skewing of any semblance of truth or sense, but stated as if it’s the most unarguable, self-evident thing in the world.
Elite Olympic athletes are singled out, given support, funded – everything is set up to give them the best possible chance to shine for personal and national glory. The best training facilities are provided. And when the government wants a greater chance of success, funding is increased – often massively.
How far would Olympic athletes get in pursuit of excellence if they were underfunded? If their fellow team-members progressively disappeared and their coaches were removed? If they were forced to compete not just in their chosen specialism, but to stretch themselves to cover 2, or 3, or more related events – if every sprinter, for example, was forced to become a decathlete?
The NHS is under sustained, multi-fronted attack by a party whose ideology simply cannot tolerate the existence of healthcare free to all at the point of need. Only politics prevents the Tories from immediately abolishing the NHS. As former Tory minister Michael Portillo put it:
They did not believe they could win an election if they told you what they were going to do.
So the attack has to be multi-faceted, progressive and ‘kept under the radar‘ as much as possible – and it involves a constant ‘drip, drip’ of poison in the ears of the British public to erode support and affection for the NHS, with occasional intensification to prepare the ground for a new phase of the assault.
You see, the Tories want Olympic glory – so they’re prepared to pay for it. They don’t want an NHS free to all – so they’re not.
Elite athletes work hard – but everything is set up to give them the best chance of success, and they are lauded and feted in front of the country. The NHS, by contrast, is starved of funds (no matter how the government tries to twist the figures), under-staffed – and vilified by craven government ministers whenever it’s politically convenient or possible to do so.
Hunt spoke of a need for ‘continuous improvement’ and said that it’s just not good enough to be ‘good enough’. He even dared to use Mid Staffs as an example of what happens when hospitals settle for ‘mediocrity’ – even though the real story of Mid Staffs is one of gargantuan efforts on the part of health staff preventing an increase in the death rates in spite of desperate under-staffing and cuts.
The daily reality of the NHS is one of constant, untrumpeted hard work that routinely goes ‘above and beyond the call of duty’ – in spite of being treated as a punchbag by politicians who’ve never known hardship. Or hard work, in many cases, for that matter.
Nurses and other healthworkers give their best on a daily basis – without glory, without high financial rewards and without the support that they should expect as a right from those at the top, and usually without even recognition or thanks.
Here are some examples that are known to me personally – and which deserve a wider audience, just like the millions of other such acts of dedication that I don’t know about:
- a ward manager who was asked by the the hospital’s senior matron to release a nurse from her ward to help out another ward that was struggling. The manager knew that her own ward was already overstretched – so after a 10-hour shift she went up to the other ward and worked another 4 hours to help out. Unpaid.
- a healthcare support worker who, at the end of a 13.5 hour shift, stayed another hour rather than leave a distraught, bereaved relative before her family could arrive to grieve with her.
- a nurse phoning her ward at 3.20 in the morning, in spite of only finishing a late shift the previous evening, to make sure a patient’s belongings had been brought up from Accident & Emergency.
- a nurse working on a ward where the patient to nurse ratio is regularly 12:1 – double the recommended level, but battling hard to keep things from collapsing altogether.
- a nurse (my wife) who regularly cries quietly into her late-night cup of tea over the death or fear of a patient with whom she’s ‘connected’ in order to provide some human contact and comfort, even though she knew they were terminally ill.
- and it’s not just nurses and healthcare assistants. 2 doctors – SHAs or ‘senior house officers’ who regularly stay back 3 or 4 hours after the end of their shifts, to make sure that everything is done that needs to be done.
I think you should hear from a couple of those people in their own words. First, our HCSW who phoned the ward in the middle of the night:
Something so trivial yet it worried the hell out of me, I couldn’t sleep thinking that he won’t have anything in the morning and his bag may get lost. Lol. I had actually took it up with him, DOH! but when your busy, your heads trying to think of a billion things to do. I’m a HCSW..I’ve been kicked, punched, verbally abused and bitten, yet nothing is done about it, just recorded and that’s it! I sometimes wonder why on earth I do this job, but the simple fact is I love it. I love interacting with the patients, caring for them no matter how vunrable they are. Sitting with a dying patient and comforting them through their final hours and most of all saving someone’s life. These are the most rewarding things about my job.
And our nurse who faces caring for twice as many patients as she should be:
it is virtually impossible to provide the sort of care that everyone should be able to expect. I have to prioritise on a daily basis and I very rarely go home feeling that I have done a good job. I never leave work on time, my breaks are unpaid (except for a 10 minute tea break) and as I don’t get time to take more than a sandwich on the run break, I am giving the Trust my time every day for nothing.
The reason I carry on working is that I consider myself to be a good nurse, and I try to make a difference to some-one’s life every day. However, I can’t begin to tell you how angry it makes me to see the demonisation of the NHS and nurses in particular as if we are the main reason why the NHS doesn’t always perform as well as it should. There are few jobs where people would put up with the conditions that we have to work in under a constant barrage of criticism. The danger as I see it is that people will be put off going into nursing – I know many colleagues who have left to go into other jobs where they don’t go home at night worrying about the dear old chap in bed 1 who may not be there when you go in for your next shift.
(If you want more examples of the real story of the NHS, I’ve written two ‘day in the life of an NHS nurse’ posts, which were two of the most-read posts on this blog last year – you can read them here and here.)
The weasel words and self-serving distortions of Jeremy Hunt and his ilk are on our TV screens and in our news media every day. The words of the people he denigrates and undermines are not. But there’s no doubt about which should be listened to and trusted.
Hunt and his party are seeking every way possible to kill the NHS in a ‘death by a thousand cuts’. Whether it’s downgrading Lewisham because of problems at another Trust, or propagating a death-myth and then putting Mid Staffs into administration even though the Trust has stuck to a plan agreed with Monitor and the Department of Health – or making an utterly spurious comparison between athletes and the NHS as justification for whatever he’s planning next – it’s clear that the Tories’ aim is the end of the NHS as we know it.
The NHS is not ‘coasting’. It’s sinking.
Holed beneath the water-line by by a hundred Torypedoes – as the Tories then mock, deride and impede the heroic efforts of those who are trying to bale out the water, keep our national flagship afloat, and to keep things ‘good enough‘ against all the odds.
And those efforts are heroic. Olympic athletes achieve great things – but they do it for their own glory and fulfilment.
The real heroes are the hundreds of thousands who give their time and hard work – at great emotional cost and for little reward or recognition – because they care.
We fund and fete our athletes to give them the best chance of success. If Mr Hunt wants more from the NHS, he needs to put his money where his mealy mouth is and stop trying to cut the legs out from under the heroes who really matter.
(If you want to do something to help defeat the Tories ideological and greed-based attack on the NHS, please take a look here and consider making a small donation to the fight)
As a former NHS nurse, I can totally identify with everything you have written. Hunt’s weasel words indeed – the man and his colleagues are a true force for evil – unqualified, incompetent, ambitious, uncompassionate, dangerous, destructive – they deserve our contempt.
Couldn’t agree more!
Well done for exposing the actual reality of our NHS today.
The staff are heroic. Lions being led by the Donkey Politicians such as the current and previous Secretaries of State for Health, not to mention the rest of this most untrustworthy and dissembling Cabinet in living memory.
When I read Hunt’s words this morning “The weeds of failure grow more quickly in a garden of mediocrity.” I thought it was the most apt self description yet of the current government. The only change I would make though, to properly describe this bunch of over privileged, under brained posh boys, would be to delete mediocrity and insert incompetency. “No more top down reorganisation of the NHS” was the promise. The biggest top down reorganisation in its history is the reality.
With just three weeks to go before the new reforms take place the Regulations being put in place on 1 April have had to be withdrawn at the last minute because they were being slipped through under the radar and imposing draconian restrictions on the new Clinical Commissioning Groups to force them to competitively tender NHS services to the private sector and to virtually remove the ability of local doctors to what was in the best interests of their patients locally.
The liars denied it ,they refused to admit it, but eventually because they were exposed by more than 1,000 doctors, many other health professionals and 250,000 members of the public they were eventually forced to back down and had to withdraw the Regulations which are now be rewritten as we speak.
More lies, more deception, more incompetence. And yet the likes of Hunt have the brass neck and no shame in continuing to vilify the NHS workers, the vast majority of whom, are dedicated, hard-working, conscientious, honest, trustworthy and reliable way above and beyond their their contracts of employment.
In the meantime George Osborne fights in Europe to protect the incompetent Bankers to try and ensure that they can continue to receive their uncapped bonuses each year and fixes their tax to give the highest paid in Barclays a tax rebate of £250,000 a year on their annual income of £5.5 million.
Perhaps their biggest lie of all was “We are all in this together” Vilified NHS workers, unemployed, disabled, low waged, part time workers, anyone claiming benefits for any reason must all suffer, but not the Bankers. In this new version of our democracy you can only reach the conclusion that under a Tory Government Maggie Thatcher was right – there really is no such thing as Society. No “Big Society”, another lie and cruel deception. And if this circus of clowns is allowed to continue down the same road, the NHS is at serious risk of being fractured beyond repair. We must not let this happen and do our best to support skwalker1964 to enable the continued exposure of the lies and to detail the hypocrisy that underpins this government’s continuous and relentless attacks on our NHS.
Fantastic comments – you should write a blog!
Well said Charles, I can’t add anything more You have said it all
Agree the NHS is full of staff in various groups who do a difficult, sometimes harrowing job that most people wouldn’t touch with a bargepole (but are generally grateful for when they need the help themselves). These sorts of jobs can be physically and emotionally draining and worthy of far more support than is generally offered.
If anyone is still in doubt about your analysis of what has been and is being done to the people of mid staffs, I would point out:
1) it’s external consistency ie a lack of excess deaths would account for a lack of large numbers of shocking revelations emerging from the many coroner’s inquests, GMC/GNC investigations and the notes review ordered by Alan Johnson, the secretary of state at the time and
2) it is entirely in keeping with the analysis in the BMJ in 2010 by Richard Lilford (Prof Epidemiology) & another, backed up by an editorial by Nick Black (Prof of Health Service Research) – references BMJ 2010; 340: 2016 … and 2066. The main article is very good on the phenomenon of spotlighting organisations.
A further oddity has occurred to me. I may have the timings wrong here but after the original story broke in April 2009, the board more or less resigned and was replaced by a series of interims working part time. This was followed some months later by Sir Stephen Moss taking over as Chairman (he was already on the board for a few months) and Antony Sumara arriving as CEO. Over this period and the following year there were numerous exec and middle management changes, mostly occasioned by short term attachments. The first year of Mr Sumara’s tenure was spent tightening up procedures, removing (a very few) bad apples, getting rid of the “floor” model much loved by Jan Harry (previous director of nursing, generally unpopular with the nurses) and re-instating speciality wards with ward sisters; and moving into apology mode. This latter policy was designed to engage Cure the NHS, and thought to be an essential pre-requsite to recovery (unfortunately this mode also extended to the many visiting regulators who were having a field day proving they had muscle but who were, as a result of this policy, unchallenged – this may have been a mistake). Sensibly, as things seemed to be moving on and ward nurse numbers were improved, Mr Sumara announced that a review of “where we go from here” would be undertaken. Professor Warlock (apologies to him if I’ve got that wrong) from somewhere East (Cambridge?) came for a few months and reported (I think the professor was approved or even appointed by the DoH). This was a written report and he also talked to various groups about his conclusions. This essentially was that the people of Mid Staffs had a right to expect acute services including A&E, maternity and paediatrics. He suggested majoring on/investing in/expanding diagnostic work and divided specialities up into those to provide in-house, those to collaborate with other centres to provide and those to “buy-in” (some specialities, obviously, were already in the correct category). There was considerable debate over some of the designations though he emphasised that some movement would be possible as public confidence improved. This was a well balanced and sensible way forward (cliche alert) which had enthusiastic staff support.
It disappeared without trace
and shortly afterwards, Mr Sumara began his year-long vigil at the inquiry on the Mid Staffs Trust table and while improvements on the ground continued, a lack of strategy was apparent. Who was responsible for burying this sensible outcome? Was it the “wrong” answer? Was Mr Sumara prevaricating or distracted? Were the department of health hatching a more wide-reaching policy which this would not fit into? I don’t think we will ever know (unless the professor himself can shed some light).
I keep on saying this.If you ask your friends and relatives what their experiences of the NHS are,it may be very different from what the media and the politicians are saying[I cant think whether labour are defending NHS workers].I have very good experiences of the NHS,and lots of people I know do as well.
What the NHS and the nurses,doctors and other personnel do-save life,alleviate suffering,get people through awful times in their lives-is more profound than any other section of workers.And yet the tory slime machine tars them all and insults and maligns them.
The sickening thing is that the press/media is offering no defense.They are as disgusting and sickening as the slimeball,inexperienced incompetent politicians [what does hunt know of anything?He’s a politician.Knows nothing]
What is worse,actually,is that the media is being listened to,the politicians think they can say[and do] anything and are being listened to,and the public are quiesent and allowing this dishonour.
Yes. Most of the media collaborate with the Tories to try to warp public opinion – the Telegraph is particularly guilty when it comes to the NHS, but others aren’t far behind.
A look at Andy Burnham’s recent statements should leave no doubt as to Labour’s commitment to the NHS – the people who work in it and the people who rely on it.
Bit new to this blogging business. Was my piece last but one in the wrong blog? (I now realise that the first paragraph belongs best in this blog, the second in another, the third in yet another. Sorry!
Don’t worry – all together is good! 🙂
Thanks – that’s OK then. Did I mention that the PM Mr Cameron fought the Stafford seat in 1997 and lost (to David Kidney, Lab). A source close to me (cliche alert) was at the count. Apparently he arrived confidently but by 3 am was in the corner, dejected. Was that his only experience of public failure since leaving Eton? Is he likely to forgive the people of Stafford?
Ha. I doubt that’s insignificant. I’ll look up more details…
Maybe you’ve seen the announcement about the final GMC hearings (http://www.telegraph.co.uk/health/heal-our-hospitals/9919493/Three-senior-doctors-face-GMC-over-Stafford-Hospital-scandal.html). 3 competent doctors who had additional management responsibilities and who carried them out in a similar way to equivalent individuals in most other Trusts (foundation or otherwise). The GMC will be under huge pressure to hang them out to dry. Likewise Mr Hutchinson the general/gut surgeon – in his case he had no management responsibility. He had some cases with bad outcome (as the President of the RCOG said when asked about Wendy Savage “I wouldn’t want my worst 5 cases looked at either, nor would any doctor”). But what about his workload? I have a feeling it was stupidly high – but the people judging him will simply say he should have refused to do it. The problem for him was perhaps a dire emergency on Christmas eve when there was no other option than do his best with gum boots full of blood when the rest of the population was sleeping, in anticipation of a jolly time the next day. The transcripts of all of these cases may well be worth following (is that possible?)
Mrs Harry is another matter. She presided over Nursing for a considerable period, including the ethos and staffing levels/”skill mix” and did it from a Board Level (ie powerful full time executive) position. She may have more explaining to do – and this may be illuminating. As for the idea that Helen Moss has “got off” with no case to answer – this may relate (rightly) to the fact that she took over in 2008 – into a very difficult situation – and you won’t find anyone in the Trust that thinks she was anything other than a sensible person who did her best (and she wasn’t sacked – it was suggested that she get another job as Cure the NHS kept demanding her resignation).
It’s worth pointing out that the 4 managers mentioned here are having their management roles examined because they happen to be professionals with relevant professional bodies (who can stretch their remit to non-clinical duties if they desire). Whatever the outcome, you can bet your bottom dollar that there are hundreds of professional who have done their bit for clinical management who are sweating away thinking “there, but for the grace of god go I”.
There is, of course, no such accountability (if that’s what you’re keen on; Robert Francis didn’t think it would address the issues and he spent 18 months thinking about it) – for pure general managers or, perhaps more importantly, government politicians (who, one could argue, have a far greater hand in all this than the foot soldiers, however senior).
“The weeds of failure grow more quickly in a garden of mediocrity.” ??
Jesus Christ! The gall of that weaselly little get!
Yes. My post is basically a wordy way of saying the same thing! 🙂
Lol skwalker, I was so caught up in the article and the rage it stirred in me, I totally forgot my usually good manners! Truly, the more I learn what this old world has become, the more I wonder if we will ever be able to fix it all. I’m on board for anything that will, but it all seems to have, rapidly, gone to hell in a handbasket!
You are a brilliant writer, thanks for the site, keeps me sane, some days I feel as if I’m living in that matrix with Neo. 😉
Thank you! I do think I’d look dashing in a long, black coat and shades.. 😀
If you can do that twirling in mid-air thing too, then you’re exactly the fellow we need in the corridors of Westminster. 😉
Reblogged this on kickingthecat.
Having just read your remarks about your wife being too tired to chew after coming home from her double shift, I can’t tell you how much that resonates with me. I can feel her fatigue – in fact I can still feel it from my own shifts over the weekend. I worked two 12 1/2 hour shifts on Saturday and Sunday on my 24 bedded acute medical ward. On Saturday the other staff nurse rostered to work with me was off sick and so for the first 2 hours I was the only staff nurse looking after those 24 patients. Eventually management found me an agency nurse which was some help but I still didn’t manage to stop for a drink or anything to eat until 5 pm having started my shift at 07.30 and the the break was only for 10 minutes. I couldn’t stay longer because I knew how much work there was still left to do.
The second day was a little better with the rostered nurse from our own ward but the work load was just as overwhelming. What saddens me is that this is becoming a common occurrence and patients and visitors often remark about how busy we are and that we should have more staff, but this never filters through to those controlling the purse strings.
There are no weeds growing on our ward – they would have been trampled by nurses’ feet long ago!!
Thanks for the update – one nurse to 12 patients is insanity, let alone one to 24!
Does the government think we are all completely stupid? They keep telling us the NHS is “failing” then you read nurses stories like this, and I saw for myself when my mum was in hospital recently, nurses running from ward to ward, not enough time to even walk sedately (never mind get a break!) due to being badly outnumbered by wall-to-wall patients.
We, the people, can see with our own eyes it is the incessant government cutbacks that is failing the NHS and we wouldn’t be anywhere as near well cared for without the dedication of hungry, worn-out, worked-out hospital staff to whom we owe a huge debt of gratitude.
So here’s a plan for job creation for the government: forget giving away billions of our money in “ring-fenced” foreign aid to foreign despots and their Swiss bank accounts, and plough it back into OUR NHS in order to hire the thousands of additional medical staff it needs so it won’t “fail”.
How easy was that?
Now I realise this does not fit in with their agenda of deliberately trashing the NHS so they can privatise it both to their own enrichment and that of their wealthy buddies (and likely all have their very own Swiss bank accounts) but they really should think twice about it because we are at the end of our teathers with them and there are more of us than them.
Oh dear, now I’m incensed again. Skwalk, throw on your coat, shades and off to Westminster with you!
There is an irony here – one of the reasons given for closing services is that centralising them will make the whole process more efficient so then there will be enough nurses (etc) – happiness all round!
WRONG!
• Either all the patients have to travel (hassle, expense, sometimes danger to them; ditto for relatives) and be looked after distantly – thus the same knackered nurses are simply needed elsewhere (and further to travel for some of them too – so even more knackered) – with consequently the same staff ratio
OR the patients (ie the poorer and more impoverished) just don’t get there, releasing some staff time that ought to have been devoted to their care (ie the desired outcomes are not achieved)
• Where has all the investment gone then? Firstly NHS inflation goes ahead of general inflation (new developments, ageing population etc), secondly there was an infrastructure/IT/repair defect from decades of neglect – the solution to which was to go to PFI – the most expensive possible solution – for a good dollop of it, thirdly there was a general waste on mad or fatuous projects, fourthly the costs of the (wholly unnecessary) internal market and other bits of managementy madness, fifthly unnecessary pay structure changes designed to take advantage of the laziness of all the heath worker groups but cost a lot because in fact most were doing far more than the government thought (especially GPs) – we were not amazed …….. so you can see there was not a lot left for items to produce tangible front-line benefits like more nurses! (Targets, perverse incentives …. none of this helped either)
One weeps for the opportunity lost.
The magnitude of which has resulted in the desperate scenario, currently being played out, whereby the government is playing a game of “creative destruction” in the hope that what will emerge is a fantastic Health Sector that is not their responsibility.
You will have noticed, however, that the staff try to keep the show on the road for the patients whatever mad-cap tomfoolery the government is up to, thus providing them with no incentive to stop.
As for the nurses who have featured in this/these blogs – these are people who’s boots most politicians are not fit to lick. I hope and pray that the satisfaction of a job well done for the public will keep them going because, don’t be fooled, as I have explained, even if Mr Hunt gets rid of 50-60 hospitals, it won’t get any easier on the ground for the staff in the remaining institutions (and it will certainly get harder for many of their patients).
What I have never understood is – given that the public value their health above almost everything else (when push come to shove), why not simply work out what is feasible and required and where (given good access for the vast majority and sensible arrangements for the rest), work out what you need to do that and then pay for it? That is what ORDINARY people want and are happy to pay for by progressive taxation. The irony is that if they did that, it would be high quality, equitable and very likely cheaper than the dog’s breakfast we have now.
Goodnight!
NEWS. CQC report out today from their visits just before Francis2 reported. There are no concerns about care in the Trust – and believe me the big team sent in tried hard enough to find something. The government can react in 2 ways. EITHER push on with plans to airbrush Mid Staffs out of existence for ever to the considerable discomfort of the people who live there OR use what is clearly a considerable achievement under unbelievable pressure to help the rest of the NHS improve in the way Robert Francis thinks may be important. Quite a good place to draw the battle lines if the government shows a lack of intelligence and sensitivity.
Thanks for the pointer! I travelled down to Staffs briefly today (would’ve loved to visit the hospital but had to be back north for a deadline) for a very interesting discussion. For now, will just say that there is more in the pipeline from me and from others to continue the fight – and the CQC report will be useful ammunition.