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The lesson of the Grenfell Tower fire for nurses and nursing

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It’s the photographs that hit you first. They’re everywhere. Hundreds of them. A toddler playing, oblivious of the camera. A mother and her young daughter, smiling. An elderly man stares out at you, a hint of a smile on his face. A series of family photos are printed on one sheet: a happy looking mum, her husband, their young children. The artist, Khadije Saye. A proud mother with her adult daughter. Carefree moments captured for posterity.

Underneath them all, one word: Missing.

Then your attention focuses on the writing, with messages carefully scribed across wall after wall around the site, along with spontaneous memorials. Many are in sad remembrance of lost individuals or for the wider community. Others demand justice, answers or both. Poignantly, many of the thousands of flowers left for the victims have dried out in the burning sun of the hottest summer solstice on record, but their sweet smell still fills the humid air.

Perhaps most moving of all is a simple message written in black ink on a red London Fire Brigade T-shirt. “RED WATCH, G27 NORTH KENSINGTON, 20th FLOOR. WE TRIED… WE’RE SORRY… THANK YOU.” A woman in her mid forties stares into space and quietly weeps. Later, a teenage girl steps back from the wall of heartbreak and almost faints.

“A blackened gravestone, staring balefully down at a community that’s had its heart ripped out”

Still, a week on, many people wander in shocked silence. In the nearby Latymer Community Church, chaplains pray, eyes closed, clasping hands with local residents. A small group of volunteers grab some respite. Half eaten sandwiches are on a table. Elsewhere, hushed, reverential conversations reveal confusion, sadness, the need for ‘something to be done’ to right this horror. Two nurses, wearing blue NHS bibs, walk through the streets, handing out advice leaflets, talking with people, symbolic of a response from local NHS mental health services that has been coordinated, coherent and competent.

The burnt out shell of Grenfell Tower stands behind them all, a blackened gravestone, staring balefully down at a community that’s had its heart ripped out.

The fire that gutted the tower is a truly national tragedy because it tells us everything about Britain today. The circumstances of the victim’s deaths couldn’t have been more terrible. But what almost everyone has grasped is that the victims lost their lives simply because they were poor.

Walk only a few hundred metres from Grenfell Tower and you’re in Royal Crescent, a Grade II listed mid-Victorian street, replete with white, stucco fronted, four story houses. A one bedroom flat here will set you back about £600,000. This is not in another part of the Royal Borough of Kensington and Chelsea [RBKC]. It’s in a different world.

“They had no voice. They certainly had no power”

People living in Grenfell Tower were only important in that some in the council wanted them shifted out to make way for gentrification. Worse than poor, they were mostly immigrants. Otherwise, they were invisible. They had no voice. They certainly had no power.

The charred tower stands as a horrific monument to decades of government indifference. But that indifference became pernicious in 2010. The financial crash gave the Tory led coalition the opportunity to completely realign the British economy. They grasped it with both hands.

‘Austerity’ was the brainchild of George Osborne and David Cameron, who used the financial crash to create a prevailing ideology: the country was bankrupt because of Labour’s overspending and economic mismanagement. Spending had to be reduced. Which meant cutting public services. That the crash was due to the actions of the deregulated banks was wiped from history. That there were different economic options to resolve the crisis, including raising tax revenues, was ridiculed.

There’s been much talk about austerity recently, but what has it actually meant? Public sector wages, in real terms, are now lower than a decade ago. £12 billion of benefits’ cuts were enacted in 2015. Billions of pounds of further cuts hit the poorest and most vulnerable again in April. Yet, this year alone, the chancellor could give away £43 billion in tax cuts and changes to corporation tax, inheritance tax, capital gains tax and the bank levy will lose the government as much as £70 billion in revenue between April 2016 and April 2022.

Since 2010, the NHS has received the lowest spending increases in its history, averaging only 1% per year in real terms. Up to that point, since 1948, the average increase was nearly 4%.

“Health care costs rise more rapidly than costs in the wider economy”

An aging population, new technology and inequality all tend to increase health spending. And health care costs rise more rapidly than costs in the wider economy. For example, the price of drugs will almost certainly increase by more than 4% for most of the next five years. Non healthcare prices are projected by the Treasury to rise at less than 2%.

Crucially, the amount of care being provided is still rising at over 3% annually despite the funding shortfall. This explains why nurses feel they’re working harder than ever. They are.

Police officer posts have been cut by 19,000 (or 14%) in seven years. With prisons’ occupancy at a historic high and deaths in custody at unprecedented levels, prison officer posts have been cut by 30%. Fewer homes were built last year than for 30 years and many schools are reliant on parents’ donations to pay teaching staff.

Local government funding is 40% lower than it was in 2010. £49.5 billion has been slashed from its budget – including a £3 billion cut in housing budgets. Council funding of social care has fallen by 10% since 2010. Overall, more than 1 million public sector jobs have been cut.

Privatisation was unleashed to an unprecedented level, with deregulation following. Increasing levels of inequality have been the consequence.

The government’s declared intention is to shrink state spending to 36% of GDP from 45% in 2010, far lower than any comparable EU country and back to a level not seen since the 1930s.

In 2012, David Cameron proudly boasted his new year’s resolution was to “kill off the health and safety culture for good,” and Tory MPs wanted “a bonfire of regulations” that year while further deregulation, particularly on health and safety, was a key component of the Brexit campaign for people like Boris Johnson and Michael Gove. Well, they got their bonfire.

This has been far more than the dismantling of the welfare state. We’ve seen the vandalisation of civic society in pursuit of a deregulated, free enterprise, low tax ideal that benefits a tiny but extremely powerful minority, who in turn support the government.

“Councillors were proud of years of chronic underspending”

RBKC was a model Tory council, embracing austerity. Insiders who worked there describe how it was always run on a shoestring. Staff were more poorly paid than in other boroughs. Alongside other services, housing suffered. Planning and building control budgets were cut. Councillors were proud of years of chronic underspending. Yet, in 2015, they felt okay about splashing out £5m from its £274m of usable reserves on setting up Opera Holland Park and a further £1.5m on staffing and operating the event.

This is the context in which survivors of the fire faced a response, both from the council and central government, that was arrogant, inept, ineffective and entirely lacking in compassion.

Following on from the magnificent and truly heroic work of the emergency services and NHS staff, it was the local community and people across London that provided the perfect alternative. They gave more than vast sums of money, food and clothing. They provided a visible presence. Above all, there has been a sense of one community, one people, one purpose.

It’s sad but entirely predictable that Theresa May and Nick Paget-Brown, the council’s ‘leader’, would not only completely fail to get this, but also resent any criticism of them, deflecting everything with officious and inane responses that failed to answer the questions put to them, revealing a callous disregard not just for the victims but also their audience’s intelligence. Watch the interview by Emily Maitlis of the BBC with the prime minister. Ms May’s face says it all.

“Public reaction to this tragedy is a final rejection of austerity”

Since then, Tory ministers have mastered the rhetoric of compassion and apology but have none of the feeling. Questions about why there was such an inadequate response in the first place and what they’re doing now to prevent further tragedies are avoided, with callow utterances of, “We must find out the truth,” and “Learn the lessons.” As if they weren’t in power for the last seven years.

One look at Grenfell Tower and we can all see the terrible truth. This is a watershed moment. Public reaction to this tragedy is a final rejection of austerity, the terrible levels of inequality it has created and the way whole swathes of the population have been disregarded because they have no political value.

When even papers like the Daily Mail and Daily Express turn on the government with a ferocity usually reserved for their many and varied political enemies you know the game is up. Theresa May, the Conservatives, their politics, their ideology are finished.

But this heartbreaking tragedy has a stark message for nurses and our health service, especially its leaders.

The ideology of austerity not only damages our services – it inhibits our collective memory. The NHS had its own equivalent of the Grenfell Tower disaster at Mid Staffs Hospital, when hundreds died unnecessarily. There was public outrage, a public inquiry, recommendations and reforms.

“How many people will receive care that is found wanting because of staffing shortages?”

But since then, we have slipped back. We implement cuts without question, shifting our practice to ‘adapt to the changing circumstances’. And our patients suffer as a consequence.

How many poor, vulnerable and powerless people will be prematurely discharged from hospital tomorrow? How many will not receive an adequate package of care in their home? How many people will receive care that is found wanting because of staffing shortages? How many people die, quietly and invisible, each day because the NHS is not there for them? We know, in mental health, that many of the thousands of deaths by suicide are avoidable. How many in other fields of healthcare? And if they don’t die, how much damage is done?

The entire country has been outraged at the response from RBKC and the government but how many chief executives and directors of nursing could honestly say they have never found themselves mouthing platitudes in a similar vein – albeit in circumstances far less extraordinary - to those uttered by Paget-Brown, May and her ministers?

We have become so used to accepting cuts in services, cutting corners, ignoring policies that are designed to keep patients safe, serving the system rather than the patient, that we have cut ourselves off – partly in order to survive – from the plight of those most in need but with the least voice.

The lesson of Grenfell Tower for all of us in nursing is that there is a moral imperative, as well as a professional one, not to enable austerity but to speak up for the most vulnerable and stand alongside them when they need our care. That is compassion. That is the least we owe them.

  • 3 Comments

Readers' comments (3)

  • What a load of rubbish. Grenfell has nothing to do with nursing.

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  • Grenfell has everything to do with Nursing. Grenfell is a resounding echo of what Britain has become today; lacking compassion, sense of responsibility and duty by the leaders and politicians. Anuerin Bevan had warned about this many years ago ( 69years) that the NHS may disappear once Britain loses its conscience, and I fear that time is close!

    How many politicians' spouses or children are or will become nurses?

    Nursing even in the twenty first century is viewed as a job for the poor working class and the underprivileged hence is the softest target. Why is pay capped at 1% and not in line with the consumer price index for several years? Why are posts downgraded but the workload increased in the last few years since this beginning of the Tory government?

    Why is the NHS paying private contractors more than its own employees? Why are nurses leaving in their droves?
    Why are patients not well cared for in hospitals and in the community and dying from the effects of poor care such as dehydration and bedsores etc

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  • The answer is a very simple one, nursing today is more about money than care,many nurses are unfit for the job, grossly obese, barely able to walk, yet tell patients how they should improve their lives!
    I trained as a nurse in the good old days of having a matron who cared, very strict, but very caring and compassionate, knew all her staff and cared for them as much as she did the patients.

    Nursing was a vocation, nurses looked clean and smart, some today are so scruffy, untidy hair, uniforms that fit where they touch and no understanding of what it feels like to be unwell.

    In mental health care nurses are confined to the office writing up patients notes, never having spent five minutes of their day with the patient in question.
    Mentors 'sign off' students who are not up to standard, because failing them reflects on their ability to judge good practice.

    I look back with great sadness at our dirty hospital, sieved food even for those that have teeth, and nurse organising their smoking breaks rather than worrying about patient care.
    We have doctors that come and question newly admitted patients at 3 a.m. when anyone awake can hear all the finite details of the patients problems.
    There is no privacy and dignity, patient attending fro MRI/Ct scans sit half naked in a public corridor,in a gown that barely goes around them .. how very sad!

    I would agree that some nurses work very very hard indeed, but I do feel being a nurse today iso more about getting a visa, or taking any job rather than being on benefits.
    In my current role I interviews students applying for university places and it makes me cringe and the very low understanding they have of what it means to be a nurse and those that make it quite clear it is the only way they can come to the UK.
    Passing a few exams is not what makes a good nurse, we need compassionate folk willing to care for others as they would wish to be cared for!

    Entry levels fro student nurses needs to be raised to ensure we get the right folk for the right job, with hearts bigger than their heads!

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