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'Each step has taken me further away from patients'


It is a time of great change for the NHS as we enter the new era of GP commissioning, putting patients at the heart of everything we do and abolishing PCTs.

The changes taking place will establish the importance of our clinicians, the drive for the patient to have a real say in their healthcare and the reduction of costs and middle management.

Twenty five years ago I sat in a classroom with 11 other first-year student nurses eagerly waiting to start our new careers. We may not have thought so at the time, but looking back all of us were young, raw and eager. It is only with the passing of years you are able to appreciate what youth once offered us.

Most of us had some sense of vocation and chose the job at Bishop Auckland District General Hospital because we wanted to care for people. All of us had the assurance only youth can give, that we were going to be brilliant in our chosen calling.

So much has happened since then. Not just to each of us individually but within our world. There have been the momentous events that define our modern world. Mandella walks free from Robin Island, The Wall tumbles with the fall of a political ideology and Europe is reunited, Newcastle United are relegated then promoted (twice).

There has been the end of Thatcherism and the rise and fall of New Labour at the same time as the birth of the computer age. My entire record collection now sits on a machine that is smaller than the fag packet that once sat in the same place in my jacket pocket. Life shaping events come more usually at a personal level. Marriage, family deaths, the birth of children and promotion all add to the forces that have moulded me, as they have all of us.

Equally there has been constant change within the NHS in the years since I sat with my fellow travelers at the start of our nursing journey. District general management, GP fundholding, first-wave trust status, regional health authorities, resource management, the NHS constitution all had their short period of celebrity before being replaced by the next initiative and the government heralds the latest newcomer in this never-ending series.

This white paper, like its predecessors, heralds “the most significant change since 1948” and promises “a once in a generation opportunity to put the patient at the heart of our health services”. This one may, we will see. The years have clearly weathered me with a patina of cynicism and my career has drawn me along a path upon which each step has taken me a little further away from the patients I wanted to serve.

Staff nurse, charge nurse, ward manager were then followed by trust management, arms length bodies and commissioning. The health secretary says I’m out of touch, bureaucratic and a drain on the public purse. Is he right?

So now I’m back in a very similar classroom ready to “return to practice”. I have my placements lined up with a mentor. I’ve got half the reading list out of the library and one of my younger daughter’s many discarded pencil cases on the desk. Just as there was all that time ago I full of questions, all laden with trepidation. Is it so very different now? Am I too old? How out of touch have I really become?

About the author

Martin Machray is a health service communications and engagement manager for NHS Islington. He began his career as a student nurse in the 1980s and was involved in frontline care nursing for a number of years until he moved into senior nursing management. From here he entered strategic and operational management posts, both in hospital environments and in national organisations before assuming his current role.


Readers' comments (2)

  • I think this is really nicely written, I qualified in the 1980s and remember feeling so 'up to date and a nurse of the future'. Martin has described the journey so well. I stepped out of a management post last year and am back in practice, although luckily didn't have to do a return to practice. The patient is not at the heart of many management decisions as far as I can tell, although targets are. Targets have to be measurable, and sure, some things are, but many nursing activities aren't. Social Enterprises don't have patients at their heart, they have government deconstructing the cost of staff.

    I would like to hear more of your progress and comparisons Martin.

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  • I'm a graduate, dual- qualified nurse who returned to mental health nursing in 2006 after a break of 10 years. Like you, I trained in the 80's. No, Martin, you are not too old: age brings reslience and judgement. But there is a huge gulf between those who manage the service and those who deliver it. You will need to shout very loudly and with eloquence and evidence, if you want to be heard. Good luck with the course.

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