The Blog

The NHS and Nursing - The Constant Revolution

Like many nurses, I left the NHS because I found it practically impossible to be able to deliver a good standard of care due to what I call the 'constant revolution' within the health service.

It was with great sadness that I read Ann Clwyd MP's account of the circumstances of her husband's death. Like many, I felt upset and disappointed that someone had suffered in this way. It 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 pressurised 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 and the fact that we need to be reminded of this today is a shocking indictment of the current state of the NHS.

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 challenging part is delivering effective psychological care and support to both the patient and their loved ones. It requires a level of skill and experience that cannot be underestimated, and there is only one opportunity to get it right.

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 are learnt not by sitting in a classroom, but by observing more experienced practitioners. When I first qualified as a nurse nearly 20 years ago, I worked with an inspirational senior sister who shaped the way in which I practised. On many occasions she would pull me into difficult meetings with families so that I could learn from her directly. Above all, she was an exceptional manager - she not only managed a difficult clinical environment but also the patient's journey through her department. Central to her care was the primacy of the patient.

Back then, nurses had autonomy to manage their departments and be actively involved in running the hospital. There were no targets and very few managers: nurses' decisions focused on ensuring that the patient received the best care possible. I remember caring for a young girl who had been in a terrible accident and required full intensive care treatment. I got to know the family well and, when her condition deteriorated, they asked me to stay with them. We didn't worry about European Time Directives or policies - 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. This family's needs were no different to the hundreds of others that I looked after: they just wanted someone to be kind, provide information and support; someone to listen, cry and, at times, laugh with them.

Like many nurses, I left the NHS because I found it practically impossible to be able to deliver a good standard of care due to what I call the 'constant revolution' within the health service. The pressure on successive governments to improve the institutional behemoth that is the NHS has led to the implementation of performance measures, but in my view, this has had a detrimental effect on care quality. There are far too many non-clinical managers and the focus has swung from patient care to key performance indicators, targets and budgets. Education, skills development and clinical time have also suffered.

Successive governments have tampered with and tweaked the NHS to the point that practitioners, sick of constant change, become disillusioned and unhappy. At the same time, an increasing number of patients are accessing the NHS's limited and finite resources. Problems arise as this general malaise spreads throughout the profession: nurses who are unhappy and overworked cannot deliver as additional strains are put on them and their relationship with patients. It is ironic that, as a lawyer, I spend more time dealing with 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 long-term care.

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 why this has occurred are a consequence of this 'constant revolution'. However, I disagree with recent commentary that nurses simply don't care any more. The majority of nurses care profoundly about their patients, but they operate in increasingly 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.