NHS “Reforms”

Today the nurses have given a resounding “thumbs down” to Andrew Lansley’s so called reforms. He says that he is listening, but is he hearing?

I feel very sorry for the nurses of today, and am so glad that my nursing career was before politicians and bureaucrats started interfering with a service which ran well until they decided that health care was a business rather than a service.

When I was working in hospital we didn’t have fancy titles, which no one understood, we had Matron in overall control, aided by her deputies. There was a Sister on every ward, which I don’t think they have now, and her deputy was the Staff nurse. All of these were in regular contact with the patients and were easily recognised by their distinctive uniforms.

Obviously all these senior nurses had administrative duties to keep the the hospital running smoothly, but nothing like the mountains of office work that today’s nurses have to cope with. The Matron, or one of her deputies, had time to visit every ward every day, and the Sisters had time to spend on the ward.

The Sister or the Staff nurse, did the medicine rounds, served the meals and supervised and mentored the student nurses, so they knew everything which was happening on the wards, and they knew if patients were not eating or drinking. They were available for patients to ask questions or voice their problems.

I know that today’s nurses are educated to high technical standards now, they do procedures which were formerly done by senior medical students and junior housemen, but has this been at the expense of nursing care? Who has the expertise and time to do the ordinary nursing care now?

When we spent more time on the wards during our training we were there not only as an extra pairs of hands, but we gained confidence in those procedures as we progressed up the ladder towards our final exams. We each had a record of achievements book which had to be filled in by the Sister at the end of each placement.

Sister not only kept the nursing staff and domestic staff under control, but also the patients and their relatives! The relatives accepted that, unless their relative was on the seriously ill list, they should not telephone at other than the given times and they queued up after visiting time to discuss problems with the Sister. I think the general public had more respect for authority then and were able to see that if they interrupted nursing staff at inconvenient times it was their own relatives who were being deprived of the nurses’ time.

Maybe there would be less time spent ticking boxes and form filling if, as a society, we had not become so obsessed with “our rights” and ready to employ the “ambulance chasing” lawyers. This too takes time from caring for patients. It also makes senior staff wary of giving student nurses the opportunity to practise their skills, and in a practical subject you only really become proficient when you actually do the procedure, however thorough the theoretical teaching.

I don’t know when it was decided that health care was to be treated as a marketable commodity rather than a service, but until the 70s the hospitals and the GPs worked together to provide the best service they could and there was no feeling of anyone commissioning any part of the service, or putting a price tag on it. The GPs requested the hospital service they considered necessary and the hospital provided it. When the patient was ready for discharge the GP took over and arranged the domicillary care. It was qute seamless. We didn’t have PCTs or commissioning bodies!

I am not in the profession now and can only judge things by my own experiences as a patient and what I hear or read from those still working in the NHS,  but I hear very few in favour of Andrew Lansley’s reforms other than those with a vested interest in the private sector. The enthusiasm with which the private sector embraces them makes my cynical mind very suspicious!