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News analysis: Carter’s vision for the future

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RCN general secretary Peter Carter tells Steve Ford of his hopes and plans for the profession’s future.

‘The average nurse in this country earns £24,000. I actually think the average nurse should earn £34,000,’ says RCN general secretary Peter Carter.

As the NHS nears its 60th anniversary in July, he says that successive governments have neglected nursing in terms of financial remuneration.

‘They’ve still not got nurses’ wages up to the level where they should be,’ he says. ‘Governments of all persuasions over the 60 years have not dealt with that and I think that is a great pity because I think the country is still very well served by its nurses,’ he says.
With this in mind, Mr Carter says that the one thing that dominated his first year in office at the college was last year’s pay dispute, which left nurses in England with a staged pay deal.

‘I still think it was unfortunate – you know we would have accepted 2.5% because that’s what the independent pay review body recommended. By staging it was 1.9% and I still think that was regrettable.’

Perhaps not surprisingly, he predicts that the biggest challenge this year will also be pay, as is already being borne out by arguments among unions. RCN Congress, which takes this week in Bournemouth, is due to debate the current 8% three-year pay.

Despite this, Mr Carter remains largely positive about the mood of nurses. ‘Everybody can find someone who feels slightly disaffected but most of the people feel good about patient care and that they are doing something that is worthwhile,’ he says.

Over the last 12 months he says he has visited nurses across the UK and also those serving with the armed forces in Iraq – he has been impressed.

‘I remember going to Carmarthenshire in Wales and at the local hospital there the standard of care was about as high as it gets – I mean that hospital was spotlessly clean, a very old hospital but it was right out of the top draw.’

Speaking of a visit to frontline nurses in Basra, he says: ‘I’m so glad I did it. I saw the work they were doing and it’s incredibly dangerous. Whether you agree with the war or not, the fact is these are nurses who are doing a terrific job under the most trying of circumstances.’

But not everything is rosy, he admits. ‘The current high profile example is Maidstone and Tunbridge Wells, where people felt a sense of almost despondency that the nursing care had been described as so poor,’ Mr Carter says.

‘The nurses there had been left in a very poor position. The position was almost untenable in that trust. And I don’t care who they were – you could have had the 200 best nurses in the country but if you’re left in a position where you are understaffed, you don’t have
the resources.

‘It looked like the result of poor nursing when it was actually the result of extremely poor management,’ he adds. ‘But when that hits the headlines and it goes up and down the country, it’s understandable that people’s initial reaction is what the heck were the nurses doing.’

However, Mr Carter emphasises that the portrayal of nurses in the press is not always fair. He describes an article last year in a national newspaper where a nurse was shown in a filthy uniform. ‘We were later to discover that was not a genuine photograph. It was a genuine photograph of a nurse but the dirt had been electronically superimposed on it. Now that was a very destructive piece of journalism. If you’re going to call it, let’s call it accurately and properly,’ he says.

‘But I need to be clear, we’re not in some la-la land, there are over 600,000 nurses on the register, there’s another 600,000 healthcare support workers, and not everything is always as we would wish it to be.’

However, Mr Carter highlights other, more overarching challenges facing nursing and the NHS that need attention.

He cites the threat to specialist posts in a climate of tight financial management. ‘I think the demise in so many areas of specialist nurses will begin to stack up problems,’ he says.

‘I mean this country has got one of the highest rates of teenage pregnancy in Europe and yet school nurses, nurses practising in health promotion sex education and so on and so forth – many of those posts have gone.

‘Also you hear of diabetic liaison nurses going, tissue viability nurses, stoma care nurses – stoma care nurses are worth their weight in gold. It’s very short-sighted and I think it’ll stack up long-term problems.

Mr Carter also thinks the effects of devolution are causing tension for nurses, with England trailing the rest of the UK on issues such as free prescriptions and car parking, and pay.

‘Northern Ireland, Scotland and Wales implemented the full 2.5%. Our members in the border towns are saying: “Gosh if I worked in a hospital two miles down the road, I’d get the full 2.5%”.

‘People talk about having to pay to park. You’ve got Scottish nurses, Scottish trained and Scottish by birth who might be working now in a hospital 40 miles south of the border and things like car-parking charges are not the same. So it is a problem.’

Mr Carter cites the constant changes to the NHS as another problem. ‘There is a frustration, not just with nurses but with many clinical staff, about what’s seen as the endless rounds of reorganisations and restructuring.

He adds: ‘Constantly nurses say to me: “I don’t understand this – the NHS is now saying they’ve got a £1.9bn surplus but we’re still having freezes on recruitment”.’

However, he hopes the NHS review, currently being carried out by junior health minister Lord Ara Darzi, will bring positive changes.

‘Obviously we will have to wait and see. We would hope it would put down a template so, while we might have to do some initial shuffling, there is a long-term direction of travel that might get some badly needed stability into the health service.’

Mr Carter highlights greater nurse and clinical involvement in management decisions as a key change he would like to see implemented. ‘The thing that I would like to see further encrypted into the way the NHS works is more people from a clinical background involved in the day- to-day running and decision making – whether it be PCTs, trusts or SHAs.’

Asked what government target he would most like to see the back of, Mr Carter highlights the four-hour A&E waiting target.

‘Not that I want to see it abolished, I think it should be re-evaluated because sometimes patients are being moved on to meet the four-hour target when staff know if they could be left another hour something more sensible could be sorted out.

‘I believe that if it’s explained to a member of the public that: “look I’m sorry you’re coming up to four hours but actually you will be sorted out in the next 35 mins”, I think most people would say: “yeah fine”.’

Over the last year Mr Carter has also radically overhauled the RCN. He now believes the college is in a stronger position to tackle the challenges facing the nursing profession. ‘I want to see the college working effectively as a trade union and a royal college with the government and all other healthcare organisations.’

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