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Opinion

Cast Iron Legacy?

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Suddenly, people are talking about profound political differences as if the years since Margaret Thatcher lost power never happened.

As in life, as in death.

After almost two decades of 49½ shades of grey politics as New Labour, particularly, based its policies on what it thought Essex Man wanted (even following the Tories in forgetting about women), the death of Margaret Thatcher has reignited bitter enmities and vicious divisions overnight.

Suddenly, people are talking about profound political differences as if the years since she lost power had never happened.

Many under the age of 30 must think the world’s turned upside down rather than a frail, elderly woman dying.

The narratives of her achievements and life have made only passing reference to the impact of her policies on the health service, most attention inevitably focusing on the miners’ strike, the Falklands War, the sale of council houses and her economic policies.

Interestingly, the fawning of many apparently ‘independent’ commentators gave way to a more considered view as the memories and opinions of – often ‘ordinary’ – people forced their way into the story.

Yet, even as a more critical analysis has begun, the revolution her governments forced on nursing have not raised a single eyebrow.

 

The wider context was that she almost always operated amid extreme conflict.

 

If Arthur Scargill hadn’t existed in 1984, she’d have had to invent him.

As it was, as president of the National Union of Miners, he served as her perfect bête noir, leading what she called “the enemy within.”

What is forgotten is that she had not long finished a year-long pay dispute with healthworkers.

However, despite some shrill rhetoric, characterising Trevor Clay, the RCN’s leader, as ‘an enemy’ would have earned her short shrift.

She was critical of ‘healthworkers’ as a whole, but that was mainly aimed at porters, domiciliary and admin staff.

Nurses’ ‘angelic’ shine was briefly tarnished but survived.

The eventual – but crushing - defeat of the miners in 1985 and serial legislation that critically curtailed unions’ ability to operate, effectively dealt massive blows to the trade union movement as a whole.

But Thatcher’s governments were always busy. Next up was health service reform.

Privatisation had already been introduced, not just to cut the costs of ancillary services but remove from the workforce the elements that were most likely to oppose any changes or commit to industrial action.

However, while the changes introduced with general management in the mid 1980s were explicitly aimed at curbing the power of the doctors, the main casualty was nursing.

Swathes of senior nursing posts were lost. The little influence nurses had wielded was lost.

Newly recruited general managers came in as an army of occupation, enforcing change, all of them directly accountable to the secretary of state through the new chain of managerial command.

Whether or not change was necessary, nurses’ objections were much more about how it was implemented.

They suddenly had greater responsibility but no authority, expected to be subservient to people with no clinical experience or knowledge.

In the worst cases it was senior nurses giving the orders as if they had no understanding of the patient or nursing implications.

There were consequences.

Increasingly dissatisfied with how they were being managed, nursing shortages, and the inability to provide the care they knew patients required, a stream of nurses freely complained to the national press in ways unimaginable in the 21st century, under either Tory or Labour governments.

Before long, a relative handful of nurses were emblazoned across the nation’s TV screens and front pages, protesting and taking industrial action.

Despite much inflammatory rhetoric from Mrs Thatcher and her pugilistic health secretary, Ken Clarke, the public’s sympathies remained solidly with the nurses.

Although the then health union, COHSE, campaigned for a 2p tax increase solely for NHS funding, the unions were so fazed by the nurses’ action that they tagged in a pay claim.

As a new system of grading was being introduced, the disputes became soured.

I say ‘disputes’ because COHSE had inadvertently stumbled upon a strategy of guerrilla tactics against a government that had ground out victory after victory in what had essentially been trench warfare.

As soon as one group of nurses settled a local issue, another flared up.

Eventually, The Iron Lady had to concede her only ‘industrial’ defeat – although she was nowhere near the announcement when it was made.

Indeed, Clarke sought no fanfare when he casually announced at the Tories 1988 conference that health spending was actually to increase by £1 billion - exactly the amount for which COHSE had campaigned.

The action of that small number of nurses also gained them an average increase of 15% that year.

Still they weren’t finished with her and 120,000 continued their protests by appealing against the grade they were given.

Again, there were consequences.

Her government took stock and prepared for far reaching change.

Clarke introduced a bill for NHS ‘reform’ in the form of an internal market that ultimately paved the way for Labour’s introduction of Foundation Trusts and Andrew Lansley’s unholy mess in the name of the health and social care bill.

Gagging clauses were inserted into contracts. General management tightened its grip.

The landscape changed, not least in the changes to nurse education that saw Project 2000 introduced.

Nursing numbers and overall funding went back into decline, as did training places for students.

Nothing increased the authority of nurses or gave them more influence.

The transient victories of 1988 seemed very distant even by the time Margaret Thatcher left power in 1990.

Like so much of Britain, the NHS was unrecognisable from the time the Grantham revolutionary had become prime minister 11 years earlier.

 

Interestingly, as our only female prime minister, she never had any affinity with nursing nor any of the ‘caring’ professions.

 

Indeed, the insularity and complete polarity of her later years in power could not be better exemplified than when asked the question about whether or not she liked Monty Python.

She not only failed to recognise this as a reference to one of the most successful comedy shows ever on TV at that time.

Her only response was, tellingly, “Is he one of us?” Nurses were never ‘one of us’ and we suffered accordingly.

Which leads us to one last, simple, question no one else has yet asked.

What might have happened had she not gained power in 1979?

She told us Britain was “the sick man of Europe” and this became the accepted orthodoxy, justifying everything she did.

Whatever the problems and political analysis there was always more than the one solution, despite her famous refrain: “There is no alternative.”

Could Britain have embraced a gentler vision that cherished collaboration, compassion and a continued belief there was such a thing as ‘society’ that needed nourishing?

If this had been the case, nursing and the NHS would definitely be very different from how they are now.

There have been much broader changes that have hugely affected us in the healthcare system, such as changed social relationships, and the wider economic conditions (though her monetarist policies played a significant part in worsening those) and technical innovations.

And while far more of our healthcare provision is in the private sector, few could argue that the NHS is a nicer place to work, that, overall, it’s more efficient, that it always provides a better patient experience.

Its relationship with the public is far different, as evidenced by Mid Staffs.

And, yes, we can trace the beginnings of the disaster that was Mid Staffs, directly back to those policies and changes in the mid 1980s, perpetuated by New Labour.

Margaret Thatcher completely destabilised a fragile ecosystem that required nurturing and changing from within.

Evolution rather than revolution.

The sad irony is that every government since hers has adopted the same top to bottom approach – but with the model only becoming increasingly market orientated - to try and right the mess she and her ministers created.

With no form of meaningful organisation to mount any opposition or coherent alternative, nurses feel individualised and helplessly watch it happen.

We really are Thatcher’s children.

 

Chris Hart is nurse consultant and principal lecturer at Kingston and St George, University of London.

Follow Chris on twitter: @Chris898Hart

 

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