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

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

Recruitment Genius: Senior Digital Marketing Consultant

£28000 - £45000 per annum: Recruitment Genius: A Senior Digital Marketing Cons...

Recruitment Genius: Assistant Stores Keeper

£16640 - £18500 per annum: Recruitment Genius: An Assistant Stores Keeper is r...

Recruitment Genius: Claims Administrator

£16000 - £18500 per annum: Recruitment Genius: This is an excellent opportunit...

Recruitment Genius: Software Developer - C# / ASP.NET / SQL

£17000 - £30000 per annum: Recruitment Genius: Developer required to join a bu...

Day In a Page

Read Next
Prince William and his wife Catherine, Duchess of Cambridge show their newly-born daughter, their second child, to the media outside the Lindo Wing at St Mary's Hospital in central London, on 2 May 2015.  

The Only Way is Ethics: The birth of a royal baby will not top the news for long

Will Gore
Mosul falls: Talk of Iraq retaking the town, held by IS since June, is unconvincing  

Isis on the run? The US portrayal is very far from the truth

Patrick Cockburn
'It was first time I had ever tasted chocolate. I kept a piece, and when Amsterdam was liberated, I gave it to the first Allied soldier I saw'

Bread from heaven

Dutch survivors thank RAF for World War II drop that saved millions
Britain will be 'run for the wealthy and powerful' if Tories retain power - Labour

How 'the Axe' helped Labour

UK will be 'run for the wealthy and powerful' if Tories retain power
Rare and exclusive video shows the horrific price paid by activists for challenging the rule of jihadist extremists in Syria

The price to be paid for challenging the rule of extremists

A revolution now 'consuming its own children'
Welcome to the world of Megagames

Welcome to the world of Megagames

300 players take part in Watch the Skies! board game in London
'Nymphomaniac' actress reveals what it was really like to star in one of the most explicit films ever

Charlotte Gainsbourg on 'Nymphomaniac'

Starring in one of the most explicit films ever
Robert Fisk in Abu Dhabi: The Emirates' out-of-sight migrant workers helping to build the dream projects of its rulers

Robert Fisk in Abu Dhabi

The Emirates' out-of-sight migrant workers helping to build the dream projects of its rulers
Vince Cable interview: Charging fees for employment tribunals was 'a very bad move'

Vince Cable exclusive interview

Charging fees for employment tribunals was 'a very bad move'
Iwan Rheon interview: Game of Thrones star returns to his Welsh roots to record debut album

Iwan Rheon is returning to his Welsh roots

Rheon is best known for his role as the Bastard of Bolton. It's gruelling playing a sadistic torturer, he tells Craig McLean, but it hasn't stopped him recording an album of Welsh psychedelia
Russell Brand's interview with Ed Miliband has got everyone talking about The Trews

Everyone is talking about The Trews

Russell Brand's 'true news' videos attract millions of viewers. But today's 'Milibrand' interview introduced his resolutely amateurish style to a whole new crowd
Morne Hardenberg interview: Cameraman for BBC's upcoming show Shark on filming the ocean's most dangerous predator

It's time for my close-up

Meet the man who films great whites for a living
Increasing numbers of homeless people in America keep their mobile phones on the streets

Homeless people keep mobile phones

A homeless person with a smartphone is a common sight in the US. And that's creating a network where the 'hobo' community can share information - and fight stigma - like never before
'Queer saint' Peter Watson left his mark on British culture by bankrolling artworld giants

'Queer saint' who bankrolled artworld giants

British culture owes a huge debt to Peter Watson, says Michael Prodger
Pushkin Prizes: Unusual exchange programme aims to bring countries together through culture

Pushkin Prizes brings countries together

Ten Scottish schoolchildren and their Russian peers attended a creative writing workshop in the Highlands this week
14 best kids' hoodies

14 best kids' hoodies

Don't get caught out by that wind on the beach. Zip them up in a lightweight top to see them through summer to autumn
Robert Fisk in Abu Dhabi: The acceptable face of the Emirates

The acceptable face of the Emirates

Has Abu Dhabi found a way to blend petrodollars with principles, asks Robert Fisk