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Creating new alliances: What nurses need to do to survive

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In the fourth of a series of blogs about how contemporary events in politics are affecting nursing and the work nurses do, Chris Hart looks at how nurses need to develop new alliances in the face of a growing crisis.

The NHS is in crisis. Shortages of skilled nurses mean surgeons can’t operate on patients. Nurses are unable to deliver the quality of care their patients require. Newspapers and TV can’t get enough of it. Initially, it’s doctors hogging the headlines. Labour’s shadow health secretary is running rings around his government opponent. Before long, aggrieved nurses pressure the government further, publicly talking about the human stories behind the headlines and statistics. Then news leaks that the government is planning to cut nurses’ unsocial hours payments.

Industrial action by nurses determined to fight for their patients’ interest erupts in a small number of hospitals but, with demonstrations across the country, is enough to keep nursing the focus of the nation’s media for the next 12 months, with the government – until this point, apparently invincible – forced to give nurses an average 15.6% pay rise and increase health spending by nearly £2 billion.

“Nurses are reduced to caring angels, often anguished but rarely angry”

But that was 1987. Thirty years later, that narrative reads like a fantasy. Now, documentaries about the NHS fill the schedules. But nurses are reduced to caring angels, often anguished but rarely angry, compassionate but hardly ever critical of the government policies and organisational politics that make their jobs ever more difficult.

As in 1987, we have a female premier. But Theresa May’s style could not be more different from Ms Thatcher’s. Indeed, since Ms May’s cosy up with the Fabricator-In-Chief, she has virtually disappeared from the domestic scene, apart from the occasional foray out to deny there are problems with the NHS or railroad parliament on Brexit.

Yet Ms May’s approach to social and economic policy is closer to Thatcher’s than might appear at first glance. Ironically, given Thatcher’s reputation for being anti European, it is Ms May who has decided to shred her predecessor’s legacy, the Single Market, for “the will of the People”, while her policies are damaging the NHS far more than the Iron Lady ever thought possible. With no resistance.

“May’s policies are damaging the NHS far more than the Iron Lady ever thought possible”

There’s definitely no Robin Cook – Labour’s shadow health secretary in 1987 – to forensically dissect the Tories’ health strategy. Yet while Labour’s current failure to hold Jeremy Hunt to account is bad enough, its actions on Brexit are inexplicable. Jeremy Corbyn recently took a leaf out of Donald Trump’s book, taking to Twitter - and making a twit of himself. “The real fight starts now”, he tweeted about Brexit. This, after Labour’s half hearted campaign to remain and its proposed amendments to safeguard the role of parliament in scrutenising the process of leaving the EU were all defeated.

Despite this, Corbyn still instructed his Party to ensure a Bill was passed that most MPs from all sides believe will significantly weaken the country - all to prop up an increasingly despotic looking Tory government. His tweet reads like a punch drunk fighter making one last bombastic rallying cry on his way to hospital after getting knocked out in the first round. It might be his political obituary.

We should forget the debate about Corbyn’s personal authenticity. Or his politics, much of which should resonate with many in this country. Labour is rapidly sliding toward historical irrelevance, with little likelihood of gaining power again. But we desperately need some semblance of effective parliamentary opposition. It’s because of his inability to connect with anyone outside his political base and, far more importantly, his inability to organise or lead, which should see Corbyn resign as leader if he has any integrity.

“We desperately need some semblance of effective parliamentary opposition”

The irony is that, had he represented the majority from the outset – only 37% of the eligible British electorate voted to leave the EU and no one voted to leave the single market, as that wasn’t on the ballot – and stand up for the real interests of the UK and our heritage as Europeans and part of an international community, it might be the Tory party tearing itself apart instead of Labour. Defending the NHS and the tens of thousands of immigrants working in it would have been infinitely easier.

As it is, nurses are victims of a new ‘consensus’ that isolates and stifles any opposition in the name of “the People”. However, stifling debate within the NHS has been going on since the early ‘90s. It coincided with a steady decline in nurses’ influence, autonomy and authority, even as clinical and managerial responsibility increased. To break free of this, new alliances have to be built, even between apparent rivals. Most importantly, nurse leaders, the nurses they lead and nursing unions must connect far more effectively.

Increasingly, nurse managers have been removed from the task of managing people. As in 1987, many are unpopular with the staff they manage but most are trying to do almost impossible jobs to the best of their ability. Their roles have been subverted. They administer ‘systems’ which seem to control everyone while being beyond any individual’s control. Checklists, targets, strategic objectives are all that matter. We live in a perverse world where, the more it’s said, the more you know it doesn’t happen. So we’re told, “It’s all about quality and a good patient experience” while further cuts make that far less likely.

“Increasingly, nurse managers have been removed from the task of managing people”

And, with news the NHS is facing a deficit of £850 million this financial year, nursing needs rescuing if nurses are to improve things for patients.

Asked by The Health Service Journal how Trusts can provide safe staffing and balance the books, Jeremy Hunt said enigmatically – and unhelpfully – Trusts need to look beyond that binary choice. To what? Planting money trees?

Currently, many nurses feel disempowered, ignored, underpaid and undervalued, working in a system rigged against them – yes, mirroring, to an extent, many of the attitudes of those who voted Leave and for Trump. But a nurse that regularly goes home exhausted, feels resentful at how they’ve been treated, is overwhelmed, anxious about whether or not they can get through the next shift cannot function properly, cannot work effectively.

In 2017, when things are really tough and nurses feel particularly stressed their resistance is quiet, hidden, and usually solitary. It’s embodied in doing the things they think will cover their backs but no more, and absenting ourselves, whether by leaving altogether, sickness absence or disengagement from the process of being managed. That causes much bigger problems, as was seen at Mid Staffs, creating the risk of disengaging from the patient as well.

“Nurses need to rethink their entire approach to politics at every level”

This has to change if nursing is not to be overwhelmed by the tsunami that follows the political earthquake of 2016. Nurses need to rethink their entire approach to politics at every level. And that starts in the workplace.

Managers and nurse leaders have a choice to make. Either carry on administering a system that is gradually picking the bones out of an underfunded NHS, effectively ‘following orders’, or start to say the things in public forums they mutter in private, about the impact government policy is having on patients and nursing, articulating the real, everyday experience of nurses and potential, practical solutions. That is true leadership.

This would facilitate a new dialogue, within a changed mindset. There needs to be a recognition that nurse managers and leaders can’t do everything - and, indeed, shouldn’t be doing everything demanded of them if it’s detrimental to the interests of nurses and patients. But for frontline nurses, blaming “them”, those “out there”, is now an opt out that’s unaffordable.

New systems are needed that facilitate nurses – and nursing unions need to step up and be a part of this – being given the information to allow them to discuss what’s happening and why, participate in key decision making, and work with managers in addressing the problems we face. There’s a huge weight of evidence that shows this works. Nurses should no longer be scapegoated, seen as a problem or peripheral to the solutions of a service being stretched to breaking point.

Compassion for patients starts with compassion from manager and leaders for the nurses they manage. That means being with them, in all their hardship, to help them change things. And for nurses, if that door is opened, walking through it and using the opportunity.

The days of industrial conflict ended 30 years ago and there’s no going back, even if anyone wanted to. Now nursing, weakened but also very different, needs new alliances and to coalesce around issues important to the common good. Nurse managers and leaders joining with nursing unions to call upon Ms May to ensure EU immigrants will have the right to stay here post Brexit – while also calling for an increase in NHS funding - would be an immediate and imperative start, not just for the good of the NHS, but the good of the country and the values that are important to us.

Chris Hart is a Senior Lecturer at Kingston University and St George’s University of London, and Independent Nurse Consultant

 

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