The NHS and nursing - the constant revolution

8 January 2013

It was with great sadness that I read the numerous news reports of Ann Clwyd MP recounting the circumstances of her husband’s death. Like many, I was left feeling upset and disappointed that someone had suffered in this way. Ann’s story made me reflect on the reasons why I left a successful nursing career to re-train as a lawyer.  Is there a general lack of caring within the nursing profession? Or is the system just creating robots, too busy and over-pressured to go the extra mile?

Jeremy Hunt MP was recently quoted as saying, “Patients must never be treated as numbers but as human beings at their frailest and most vulnerable.” This was fundamental to my role as a nurse 3 years ago and the fact that Jeremy Hunt MP needs to remind us of this today in 2013 is a shocking indictment of the NHS’ current situation.

In my experience, caring for the physical needs of the dying – a duty that often falls to nurses - is not complicated. Nurses are required to deliver basic care by keeping patients comfortable, hydrated and most importantly, free from pain and discomfort. The complicated and challenging part of caring for someone who is dying is delivering effective psychological care and support to both them and their loved ones. Getting this right requires a level of skill and experience that cannot be underestimated, and there is only one opportunity to get it right. When it goes wrong, families are often left feeling disappointed and, understandably, they never forget the experience. 

Unfortunately, nursing is not an exact science and skills are passed from one generation of the profession to the next by observation, mentorship and experience-based learning.  These skills cannot be learned by sitting in a classroom but are learnt by observing more experienced practitioners and practice. 

When I first qualified as a nurse nearly 20 years ago, I remember working with an inspirational senior sister who shaped the way in which I practised. There were many occasions when she would pull me into difficult meetings with families so that I could learn from her experience and the way in which she dealt with people.  Above all, she was an exceptional manager – she not only managed a difficult and challenging clinical environment but she also managed the patient’s journey through her department.  She had the respect of the medical staff and they certainly did what they were told! She always seemed to know how to appropriately engage with people - whether displaying empathy and kindness or, on occasion, toughness and authority. The one thing that was central to her care, and what she instilled in me, was that the patient always came first and their needs always outweighed absolutely everything else. She was actively involved in the care of every single patient on her ward and she spoke to every single relative to make sure they were OK and we were doing our job properly! 

Things were very different then: nurses had autonomy and could manage their departments and were actively involved in the running of the hospital. There were no targets and very few managers: nurses were able to make decisions focused on ensuring that the patient received the best care possible.  For example, I remember caring for a young girl who had been in a terrible accident and she required full intensive care treatment.  I had got to know the family well and, when her condition deteriorated and she was dying, they asked if I could stay with them. We didn’t worry about European Time Directives or policies and I was simply allowed to work extra hours and be with them until she died during the night.  I ensured that she had a peaceful, pain-free death, and I know that the family appreciated the extra effort we all put in to make their journey as easy as possible. The needs of this family were no different to the hundreds of others that I looked after: they just wanted someone to be kind, provide them with information, support, reassurance and someone who would listen, cry and at times laugh with them. I went on to become a senior charge nurse and later a senior nurse manager, but I never forgot those basic lessons that I had been taught and I would hope that I passed these onto the many hundreds of nurses I later trained and supervised. 

I don’t agree with some of the recent commentary that nurses do not care anymore.  I left the NHS because, like many nurses, I found it practically impossible to be able to deliver a good standard of care due to what I refer to as the ‘constant revolution’ within the NHS. The pressure on successive governments to improve an institutional behemoth like the NHS has led to the implementation of performance measures, but in my view, this had a detrimental effect on care quality.  When I left, I felt battle-tired and I knew that I could not continue as I was unable to give the care that I wanted.  It was my experience that there were far too many non-clinical managers and the focus had swung from patient care to key performance indicators (KPIs), targets and budgets. Education, skills development and clinical time also suffer. For me the tipping point came when one day I looked at my diary and realised that I was spending more time in meetings with managers discussing KPI figures, budgets and change management than I was on the shop floor. I knew at that point it was time to go and to move on.

The whole of the NHS has dramatically changed and continues to change at a rapid pace.  Successive governments have tampered and tweaked to the point that practitioners are so sick of constant change that they become disillusioned, unhappy and generally fed up. On top of this is an increase in the number of patients accessing the NHS making it impossible to manage with limited and finite resources. Problems arise as this general malaise continues to grow and spread throughout the profession. In order to give good nursing care a nurse needs to give something of themselves, and the relationship between a nurse and their patient is special and based on personal trust. It is common sense that nurses who are unhappy in their work, over worked and pressured are not able to deliver as additional strains are put on them and their relationship with patients.

People often ask me if I like being a clinical negligence lawyer and if I find suing the NHS difficult. Personally, I think that clinical negligence cases help regulate the professions. Bringing cases highlights things going wrong and how they can be improved.  By the time I speak with clients, a lot of them have been through the complaints process but have been left feeling that little will change and so they take the brave option to pursue a claim.  In general, clients want answers to questions, an apology and an assurance the same mistakes will not happen again.

There is an irony in that, as a lawyer, I spend more time dealing with the day-to-day care issues , than ,as a nurse.  For example, I instruct and supervise care packages being set up, instruct therapists, obtain medical opinions, find accommodation and plan the long-term care that people will need.  I am fortunate to work within an exceptional team of people that have clearly been drawn to this area of law because they have the ability and skills to emphasise with their clients and to fight for their rights and entitlements. I am very proud of the fact that I am now in a position to help people by forcing the NHS to give them information and provide for their future. 

Some argue that the standard of nursing care within the NHS has diminished and patient care has suffered.  If this is true then the reasons as to why this has occurred are complicated and I suggest, a consequence of the constant revolution that I describe. Of course, as in any profession, there are some bad nurses and it is through regulation and bringing clinical negligence cases that will weed these out.  The majority of nurses continue to offer an exceptional service in the most difficult and challenging circumstances. I wish Ann Clwyd every success in her campaign to improve the standards of patient care but I fear she has an incredibly difficult battle ahead of her. 

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