Liane Jones: Patronising Patricia, the cyborg matron for the brave new NHS

Ministers are largely insulated from pressures faced in hospitals

Share

Before Patricia Hewitt entered the hall at the Royal College of Nursing conference, one of her advisers warned that there might be a spot of bother. There had been a few pointers - the coffin propped outside the conference hall door, the nurse grimly tolling a bell and proclaiming "NHS, rest in peace". Inside, Hewitt could see for herself the banners and placards, and read the same message on several hundred T-shirts - "Keep Nurses Working - Keep Patients Safe".

Nurses are no longer just angry with Hewitt and the Government. They are furious. Galled. Outraged. No one who heard their reaction to her speech could doubt that they were venting genuine emotion. At different points, they gasped in shock, murmured angrily, heckled, slow hand-clapped and booed.

The fuse for this explosion was lit last autumn with the announcement of job cuts as part of NHS reforms. Across the UK, hospitals are closing, departments are being merged and jobs are being cut. The RCN estimates that 13,000 NHS posts have gone since October. Some of these changes are due to financial crisis management, with hospital trusts under orders to balance the books. Others (as Hewitt was keen to point out) are part of a positive programme to provide more health care at the local level, via surgeries, clinics and mobile teams.

Hewitt went crisply in to face the nurses, on a mission to explain. She gave them facts (no winter bed crisis, waiting times at their lowest-ever levels). She gave them plenty of figures: 200,000 more staff working in the NHS than in 1997 and 87,000 of them nurses. She even gave the nurses encouraging advice. Having difficulties with workloads and staffing? Why not try reorganising rotas!

Soon after this, the heckling and booing reached such a pitch that Hewitt left the stage. The RCN's president, Sylvia Denton, said she had never seen such a display of fury in the quarter of a century she has been going to the conference.

But why are the nurses so angry just now? Much of what Hewitt said is undeniable - the Government is employing more nurses. Under Agenda for Change, which restructured pay scales within the NHS, most nurses have recently received decent pay rises. And comparisons with European nations suggest that reforming away from hospital-centred to local-level care would be good for the NHS.

Hewitt certainly seemed to think the nurses hadn't grasped the big picture. Before she made her escape, she complained that she was there to listen but what could she do if the audience wouldn't listen to her? And back she went to the Department of Health, where, one gets the impression, she will be shaking her head with her advisers over the impossibility of getting the nurses to take the long view.

And that's where Patricia Hewitt is wrong. Nurses do understand the point of changing the NHS. What's more, they are already implementing Hewitt's reforms. These "challenges", as the Prime Minister likes to call them, are not like the World Cup, trailed and promoted for years but not due to begin till next month. They have already started, and it is nurses who have been boxing and coxing to manage them. They are way ahead of the Government in adapting to new realities.

Every time a nursing post is cut or becomes part-time, or is downgraded to that of a health care assistant, the rest of the nursing team adapts to cope. When a ward cuts back on agency nurses, the permanent staff stretch their hours and change their rotas to fill the gap. They do extra hours on either end of their shift without pay. The RCN estimates it at 6.5 hours a week, per nurse, or to put it another way: nearly a full day for free.

This commitment is something that Hewitt doesn't understand. Nor does the Prime Minister, and nor - crucially - do the consultants who advise on our public services. Cabinet ministers are almost completely insulated from the pressures that nurses face. Consultants, who charge like wounded rhinos for every minute of thinking time, have failed to grasp the extent to which the NHS runs on goodwill.

That is why the new pay contracts for GPs and hospital consultants have cost much more than anticipated. Noticing that some GPs did an unexpected amount of preventative and liaison work, the policy consultants and DoH advisers offered handsome payments to all GPs to do likewise, calculating that it would be cost-effective by relieving other parts of the NHS.

But they hugely underestimated the number of GPs already doing the work without reward, so the salary bill rocketed, with little extra work being done. When new pay scales came in for hospital consultants, again the wonks found they had underestimated how many qualified for the higher rates.

Lucky GPs and consultants, then, finally to be rewarded for their labours. By comparison, the nurses' pay rise was far more modest - they still lag some way behind teachers, for instance. But I don't believe wages are at the heart of it. Fifteen years ago, I spent a year following a group of nurses at a time of reform in the NHS: care in the community was being introduced, and nurses were retraining and gaining more autonomy. There were some drastically differing experiences, but all had one thing in common - they wanted to provide the highest standard of care and they hated the fact that, despite all their flexibility and effort, the funding just wasn't there to let them do it.

Many of them have left nursing now. Fifteen years on, things have changed and in many instances have improved, but once again nurses are taking the strain and seeing patient care suffer. That is why, when Hewitt lectured them about staffing numbers, they heckled her with the slogan on their T-shirts. Hewitt must now be wondering if she'll be hearing "Keep Nurses Working - Keep Patients Safe" chanted on picket lines.

Could another minister with a less patronising style have connected with the audience? Perhaps. Hewitt's perfectly enunciated homilies certainly stoked their rage. There she stood with her unshakeable sense of rightness, her special firewall against destabilising human factors, a veritable cyborg matron for the brave new NHS. No wonder, having done so much of it themselves, the nurses wanted to make her sweat.

Liane Jones is author of 'Nurses: A Year in Their Lives'

React Now

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
iJobs Job Widget
iJobs General

C# Developer (Genetic Algorithms, .NET 4.5, TDD, SQL, AI)

£40000 - £60000 per annum + Benefits + Bonus: Harrington Starr: C# Developer (...

C# Full Stack Developer (.NET 4.0, ASP.NET, MVC, Ajax, WCF,SQL)

£55000 - £65000 per annum + Benefits + Bonus: Harrington Starr: C# Full Stack ...

AIFMD Business Analyst / Consultant - Investment Management

£450 - £600 per day: Harrington Starr: AIFMD Business Analyst / Consultant - I...

Business Analyst Solvency II SME (Pillar 1, 2 & 3) Insurance

£450 - £600 per day: Harrington Starr: Business Analyst Solvency II SME (Pilla...

Day In a Page

Read Next
Jihadist militants leading away captured Iraqi soldiers in Tikrit, Iraq, in June  

Middle East crisis: We know all too much about the cruelty of Isis – but all too little about who they are

Robert Fisk
India's philosopher, environmental activist, author and eco feminist Vandana Shiva arrives to give a press conference focused on genetically modified seeds on October 10, 2012  

Meet Vandana Shiva: The deserving heir to Mahatma Ghandi's legacy

Peter Popham
Middle East crisis: We know all too much about the cruelty of Isis – but all too little about who they are

We know all too much about the cruelty of Isis – but all too little about who they are

Now Obama has seen the next US reporter to be threatened with beheading, will he blink, asks Robert Fisk
Neanderthals lived alongside humans for centuries, latest study shows

Final resting place of our Neanderthal neighbours revealed

Bones dated to 40,000 years ago show species may have died out in Belgium species co-existed
Scottish independence: The new Scots who hold fate of the UK in their hands

The new Scots who hold fate of the UK in their hands

Scotland’s immigrants are as passionate about the future of their adopted nation as anyone else
Culture Minister Ed Vaizey: ‘lack of ethnic minority and black faces on TV is weird’

'Lack of ethnic minority and black faces on TV is weird'

Culture Minister Ed Vaizey calls for immediate action to address the problem
7 best quadcopters and drones

Flying fun: 7 best quadcopters and drones

From state of the art devices with stabilised cameras to mini gadgets that can soar around the home, we take some flying objects for a spin
Andy Murray: I quit while I’m ahead too often

Andy Murray: I quit while I’m ahead too often

British No 1 knows his consistency as well as his fitness needs working on as he prepares for the US Open after a ‘very, very up and down’ year
Ferguson: In the heartlands of America, a descent into madness

A descent into madness in America's heartlands

David Usborne arrived in Ferguson, Missouri to be greeted by a scene more redolent of Gaza and Afghanistan
BBC’s filming of raid at Sir Cliff’s home ‘may be result of corruption’

BBC faces corruption allegation over its Sir Cliff police raid coverage

Reporter’s relationship with police under scrutiny as DG is summoned by MPs to explain extensive live broadcast of swoop on singer’s home
Lauded therapist Harley Mille still in limbo as battle to stay in Britain drags on

Lauded therapist still in limbo as battle to stay in Britain drags on

Australian Harley Miller is as frustrated by court delays as she is with the idiosyncrasies of immigration law
Lewis Fry Richardson's weather forecasts changed the world. But could his predictions of war do the same?

Lewis Fry Richardson's weather forecasts changed the world...

But could his predictions of war do the same?
Kate Bush asks fans not to take photos at her London gigs: 'I want to have contact with the audience, not iPhones'

'I want to have contact with the audience, not iPhones'

Kate Bush asks fans not to take photos at her London gigs
Under-35s have rated gardening in their top five favourite leisure activities, but why?

Young at hort

Under-35s have rated gardening in their top five favourite leisure activities. But why are so many people are swapping sweaty clubs for leafy shrubs?
Tim Vine, winner of the Funniest Joke of the Fringe award: 'making a quip as funny as possible is an art'

Beyond a joke

Tim Vine, winner of the Funniest Joke of the Fringe award, has nigh-on 200 in his act. So how are they conceived?
The late Peter O'Toole shines in 'Katherine of Alexandria' despite illness

The late Peter O'Toole shines in 'Katherine of Alexandria' despite illness

Sadly though, the Lawrence of Arabia star is not around to lend his own critique
Wicken Fen in Cambridgeshire: The joy of camping in a wetland nature reserve and sleeping under the stars

A wild night out

Wicken Fen in Cambridgeshire offers a rare chance to camp in a wetland nature reserve