Confessions of a Coalition NHS Nurse

An NHS nurse, with over 25 years on the job, shares her experiences under the Coalition government, and her predictions for the future, over tea.

The NHS as an institution should make the U.K extremely proud. The ideas behind it, the people involved in making it run, and the work it does for the health of our country, are all facets of its beauty. The NHS in recent years has been lambasted. Reforms made in 2013 cost 1.4bn, with a large proportion of this spent on making more than 20,000 management and administration staff redundant from health authorities, Primary Care Trusts and the Department of Heath. PCT’s and strategic health authorities are phased out as the National Board and clinical commissioning groups now control NHS funding, replacing PCT’s and strategic health authorities. As funding changes hands, costs in the NHS are rising at a higher rate than inflation due to an aging population, costs of new treatments, and lifestyle factors. Coalition reforms were designed to encourage greater involvement from the private sector and charities. Out of every £20 spent in the NHS, £1 goes to non-NHS providers.


Complaints including MRSA scares, stories of malpractice and direct criticism of nurses care of patients, crop up in the papers more than ever before. It’s easy for this criticism to be directed towards nurses, administrators and doctors as we interact with them directly, but, as in any job, those at the top dictate their behaviour. After Cameron’s promise to ‘cut the deficit, not the NHS’, multiple NHS cuts and changes have been implemented, to the gain of private companies. As a short case study of this cause and effect, there’s MRSA. It’s spread and panic took place after the top-down decision to privatise cleaning staff. Privatised staff were less motivated due to low pay, long hours and lack of kinship with the greater NHS network. The timing of MRSA fears hints to a causal link.


The people that make up the NHS should be cherished as the thankless lifesavers they are. However, newspaper stories about nurses lacking bedside manner or sufficient care, have grown in frequency. The papers seem quick to forget that these nurses are overworked, underpaid, and undervalued. They are also without a voice. Unlike any other institution, NHS workers are forbidden from speaking out against certain policies. Surely these are the people it’s most important to hear from, people experienced in the intimate workings of NHS protocol? I spoke to a community nurse, whose name and hospital must remain private due to the law, about the changes she’s noticed having worked on the frontline of the NHS for 25 years.


‘In the last year, it’s changed quite dramatically.’

Up until 2013, N says many of the changes were manageable, and some positive, such as new equipment. Recently, however, there have been several major changes, to the detriment of NHS staff and patients.


Staff on the whole are not being replaced.’ When N changed to part-time care she noticed that no one was hired to replace her at the end of the week. ‘If someone goes on maternity leave, bank staff are not used to replace him or her’. These types of cuts are subtle and generally not discussed. To lower NHS spending to the level the government requires, without firing people or not replacing equipment, insidious tactics appear to be the least harmful. However, they are damaging hospitals, by increasing the workload for the rest of the staff. N notices this increased workload effecting NHS workers psychologically; she has seen increasing instances of work related stress. The Coalition’s decision to set lower targets for NHS spending forces hospitals to make these tough, short term, and often harmful, choices.


‘Out of a working day of 8 hours, I spend 3 hours on the computer.’ This is something, which N, as a more experienced nurse, has little experience of. Many nurses are in a similar situation, as experienced staff are in high demand, and are often older and less adept with computers. In addition, ‘very little’ training is provided, and the system itself is lengthy. N will write what she’s done for the patient in their notes, then give the same information for the GP’s on EMIS, and then write it out again for the NHS system. I asked if there was a way to sync these systems, given the £400m spent on IT and property after NHS reform. N resignedly replied, ‘apparently not’. N feels the information inputted also doesn’t give a ‘true picture’. Busy nurses often write the bare minimum to save some minutes, as the whole practice ‘wastes vast amounts of time’.


Claiming sick time has become ‘very aggressive and quite scary’. Sick time is now on a continuum, rather than resetting each year. ‘If you have more than 2 days on the sick you have to present yourself to your manager’ says N, and the employee will also receive a letter, which N describes as ‘threatening’. The letter mentions how the person in question is ‘letting their colleagues down’, which ‘puts people under a lot of pressure’. Instances involving cancer, or work related stress, are, according to N, the main exceptions to this. Particularly as work related stress has increased dramatically. This is partially specific to N’s hospital, but doesn’t bode well for nurses elsewhere.


The work has become harder. Not physically, mentally.’ N cites this as the main reason for a lot of senior staff leaving her hospital. ‘Until a year ago a good district nurse would not leave their job. It’s a good job: It’s autonomous, you make your own decisions, you’re with your patients till they die…you get to know people’. However, in the last 6 months, 3 senior district nurses have left N’s district for the private sector. Data inputting shortens the day with patients, and staff shortages add to the workload. 

‘Rather than planning and preparing for care, you’re doing far more crisis intervention. You’re now waiting for the problems to happen in order to solve them’

N is unaware of any counseling in place to counter this stress, and sees new car rules as a cause of undue anxiety. N, as a community nurse, drives roughly 30miles a day in town traffic. The amount of money per mile she’s paid has been decreased, and the £70 maintenance assistance, that used to be rewarded to those with their own car, has been scrapped. If a nurse gets a knock while driving, no matter where, at work, they’re now liable to pay the 1st £200 of damages. This used to be covered by the insurance company. N supposes ‘the NHS are looking for cheaper leasing companies’, which cover less. All these factors add towards stress, impacting efficiency. N was not notified about any of these changes before they were put in place.


‘They’re doing it by stealth, rather than in your face.’

‘our terms and conditions have changed slowly over the last 2 years’. Before reform, terms and conditions were set in stone, and unions had to be consulted before changing them. ‘Now you go in to work and another one has changed’ N has noticed. A nurse in a particular pay band used to be automatically put in a job of the same band when returning to work, but now it’s policy to automatically go down a band. N says this was put in place, with no announcement to staff, where she works.


With NHS staff being kept in the dark, and unable to speak out about the changes, the public are unable to access the necessary information that shows stress levels, redundancies, and inefficient systems. Instead, the NHS is either declared unworkable, opening the door to private enterprise encouraged by the Conservatives, or those who work for the NHS are blamed, leading to further difficulty for NHS employees.


The public are unaware of changes that NHS staff worry about. The scrapping of the Liverpool Care Pathway – a document compiled telling nurses and doctors how to keep an incurably ill person comfortable without treating them, allowing them to die peacefully – has ‘put care back 50 years’ according to N and many NHS workers. My grandfather was given this treatment, instead of facing a long stretch of discomfort before the inevitable, and I was grateful that this allowed him control over the end of his life. Without the LCP, nurses won’t have a reference for specific drug mixtures that keep dying people comfortable in their last weeks. My grandmother, who died after the change, wasn’t afforded the control, peace, and painless goodbye, that my grandfather was lucky to have. Many newspapers painted the LCP as euthanasia and therefore dangerous, and without NHS workers, or their unions, allowed to speak out, many people didn’t complain about it being discarded due to ignorance over what it was.

N identifies as a socialist, and is a huge supporter of the NHS as an institution. I asked her what she thought the NHS would look like in 50years.

N morosely concludes that if they go along this path, it will be a private enterprise’. N believes paperwork is not going to change the instances of infection…it’s just gathering statistics for the government, so push top NHS employees into private. NHS workers get less time with patients, and it all ‘makes the private sector look better’. As the private sector looks better, the public sector continues to lose resources and staff. Conservatives and Labour intend to stick to the current budget following the next election. Though Ed Milliband has critiscised NHS privatization, and claimed Labour will add more staff, where the funding for this change will come from remains unclear. Only the Greens intend spending to be ‘maintained at the average in the EU’, by introducing an NHS tax. Today's repot by the King Fund declared NHS reform a waste of billions - 

'Services are stretched to the limit. With financial problems also endemic among hospitals and staff morale a significant cause for concern, the situation is now critical' - John Appleby, Chief Economist on Kings Fund January 2015 Report

Reading the report, I find my conversation with N aligned with it eerily well. I only hope this is a wake up call for NHS reform, rather than a swan song.