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The war you don't realise you're fighting

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In this mixed up, muddled up, shook up world in which we find ourselves, I keep thinking it can’t get worse. We’ve had Donald Trump fretting over the size of his inauguration crowd, comparing himself to Barak Obama – well, boys will be boys - then his obsession with size went into overdrive as millions of women took to the streets to protest his presidency.

He lied about having the biggest election victory since Ronald Reagan, made up a terrorist attack on Sweden and rambled through a 90 minutes press conference as if he’d missed his medication. Then the president supported his Attorney General, the chief law officer in the United States, who lied on oath to Congress about having contact with Russians, only weeks after having to fire his national security advisor for lying about – yes, you guessed it, contact with the Russians.

Just for good measure, Trump then accused Barak Obama of tapping his phone during the election campaign. Investigations of his claim have turned up no evidence.

Maybe the craziest thing about Trump is that his chief strategist, Steve Bannon, declared at a recent conference that his aim was “the deconstruction of the administrative state”, and several of Trump’s cabinet were brought in because they held the same views. Yes, that’s the administrative state, or government, they’re now running. At least Trump can offer up the excuse he’s taking orders from the Russians.

Theresa May has no such get out of jail free card. She, of course, promised to govern for “all the people.” But, clearly, her relationship with the truth occasionally also gets strained. Maybe, rather than listen to what she says, we should watch what she does.

“Underfunding has the NHS, schools and prisons in crisis”

Austerity measures are in overdrive. Underfunding has the NHS, schools and prisons in crisis. Even previous Tory sweethearts, the police, are not immune. A new report highlights how funding cuts mean some forces have insufficient detectives to catch criminals, which is a novel way to solve the prisons’ crisis.

Maybe the government will fix overcrowded classrooms by having schoolchildren take up jobs once done by immigrant workers. Or replacing the 2000 European doctors the BMA estimates may leave because of Brexit.

The CQC recently declared economic pressures and ever increasing demand mean the health service “stands on a burning platform” of an outdated model of acute care, no longer able to deliver services needed by patients, with 81% of non specialist trusts deemed inadequate or requiring improvement for safety. We face the worst nursing shortages for decades and the government cut student bursaries.

Of course, benefits cuts continue. The Institute of Fiscal Studies has shown changes arising from tax and benefit ‘reforms’ will hit the very poorest the hardest, with losses of up to 8% of net incomes, or over £1,000 per year. Higher earners will see small gains, with the wealthiest and huge corporations benefitting the most.

“George Freeman said PIP benefits should only go to “really disabled people” rather than those with mental health problems”

The government sneaked out news it was overturning two tribunal rulings on Personal Independence Payments, including one that found people with extreme anxiety should be given the same status as those who are blind. George Freeman, the Tory MP who heads May’s policy unit, said PIP benefits should only go to “really disabled people” rather than those with mental health problems while his boss said, “This is not a cut.”

A modest commitment to take 3000 child refugees has been capped at 350 while May sanctioned a sweetheart deal with Surrey Council so they wouldn’t ballot residents about putting up their council tax. A British born Muslim teacher on a school trip was hauled off a plane in front of his pupils and denied entry to the United States, despite having valid visa documentation. So much for Boris Johnson’s fatuous boast Britain had secured a deal with Trump.

And after the Lords gifted May the chance to change her mind and guarantee EU immigrants the right to stay, the prime minister’s response was a resounding “No.” She sees that as being like walking into a casino and giving all her money away without even putting a bet on. Perhaps when she said she wanted to reach out to those “just about managing” she meant “just about managing to screw the rest of us into the ground.”

Yet, while Trump’s lying goes beyond absurd, there’s nothing new in “fake news.” Politicians everywhere ‘spin’. And it’s not just them. The hacking scandal was about media dishonesty and too many journalists have lost themselves in a race to the bottom, trivialising major issues and pursing ‘infotainment’, with irritants like accuracy and objectivity becoming increasingly irrelevant.

Trump and Bannon’s frenetic assault on the truth is a strategy: to create chaos, confusion, anxiety and undermine any criticism of their behaviour. Despite their immense power, they’re systematically trying to undermine the rule of law. Criticised for lying? Accuse good journalists of lying. Thwarted by the courts? Threaten ‘bad’ judges. Create more chaos.

And May has, in a far more modest manner, been engaged in the same thing, for example failing to speak out when judges who ruled against her were labeled “enemies of the people”.

“Forget how the NHS is currently managed. Forget how difficult it often feels to be a nurse.”

She’s denying the elected Scottish government the opportunity to hold another referendum in the face of Brexit, the Scots having voted to remain. She wants to make them wait until the UK has left, hoping if they’re already out of Europe the Scots will be less likely to vote for independence.

But this isn’t about ‘good’ and ‘bad’. It’s about ideas. And the Tories’ ideas have been in the ascendant for a long time. More socially inclusive, tolerant, liberal alternatives about economics, communities and immigration and what sort of society we want to live in - and which work - have been abandoned in recent years. Which is why nursing and the NHS are so important.

Forget how the NHS is currently managed. Forget how difficult it often feels to be a nurse. The underlying principles of both have huge political significance for the UK as it tries to determine its fate, post the biggest political decision made since the war. Nurses and nursing values are intrinsically linked to the NHS. Indeed, there would never have been an NHS without a small number of highly influential nurses, but that’s another story

So, politically, is it game over? Trump and May would have you think so. But only 37% of the British electorate wanted Brexit, let alone Theresa May’s version of it. That’s no mandate for a divorce from Europe without a deal or abandoning the EU’s ideals of internationalism. Hillary Clinton polled almost 3 million more votes than Trump, despite Russian hackers’ best efforts to influence the election in his favour.

Nurses marched in protest against stopping bursaries in January while March saw another huge demonstration in support of the NHS. Ms May comfortably ignores those. With Labour in chaos, she rides wave after wave of media exposure of the problems facing the NHS. There was no new money for it in the budget and only a relatively meagre increase for social care, given the scale of the problem we face.

“Regular lobbying of Tory MPs would help them recognise the reality of the power nurses have in the electoral process”

But her government’s collapse following the outcry over national insurance contributions shows its weakness. Properly organised, systematic and regular lobbying of Tory MPs would help them recognise the reality of the power nurses have in the electoral process, particularly in marginal constituencies and even more so in those which had a majority of Remain voters. Nothing sharpens MP’s minds more than the thought they might have to start claiming the benefits they’ve been busy cutting.

This needs coordination and the obvious way to do this is through the RCN and Unison. The latter’s problem is they’ve lost so much traction with nurses. Partly, this reflects its relationship with Labour. But its generalist nature also leaves nurses marginalised.

Unison’s nurse activists could push for a far greater profile for their health group and creating nurses’ sections as generalist unions, like NUPE, did in the 1930s (in part giving those influential nurses a platform to create the circumstances that led to the creation of the NHS).

The RCN is currently the only coherent voice of nurses but has to be far better supported as it balances its role as a professional association and trade union. It needs a strong trade union alongside it. But if that isn’t going to happen, it must rethink its industrial relations strategy. Its old model of exerting political influence behind the scenes and building strong relationships with civil servants and ministers is even further undermined by this administration.

“Revolution starts in the head and in the heart”

The type of resistance required, however, will only come in the workplace and the key change required is for nurses to regain the belief they can exert agency - the power to not only influence but change their circumstances. It’s that which gives people hope. And nurses need hope right now. Not for miracle cures or even that things will soon improve. Indeed, a dose of reality about the scale of the challenge is necessary. But the hope that comes when people initiate positive change themselves.

In part, success in doing that is essential to nurses developing the confidence to be different. But that change can only occur when nurses start to think differently. Revolution starts in the head and in the heart. Not on the streets. But this isn’t about a ‘fight’ in the mould of the 1970s and ‘80s.

This is going to be about building alliances, finding ways to collaborate. For example, senior nurses and managers can unite around a vital demand that Theresa May agrees to existing EU residents stay in the UK, providing stability for the NHS and our health and social care system. But they also need to get out on the wards and in the community, supporting those at risk. And all nurses should support this. It can also help the country, as there are few more positive cases for immigration in the face of a rising tide of racist abuse and attacks than the NHS.

Mrs May has to be pressured from within the NHS to at least restore the levels of funding it received during the Blair-Brown years, highlighting the irony that most of Europe, including Greece, spend more on health than the UK.

The Chief Nurse has said she’ll support nursing directors maintain safe levels of registered nurses but she’ll also have to support sufficient funding for those posts.

Yet funding is not everything. Every nurse is important. Nurses should be able to confidently assert this about themselves and see that view reflected in managerial policies. Only then will the NHS be able to say every patient is important. An enabling political culture within the health service, genuinely bringing together operational management and nursing would make nursing more effective, while empowering nurses to act, to do the things they know can improve patient care without extra investment. It could even produce savings.

“Compassionate management is key”

This means reconceptualising nursing, recreating the sense of its wider community, acknowledging nurses as collective and individual agents of change. It can only come about by developing systems designed to devolve managerial responsibility and give nurses greater autonomy and authority. They should be assisted to organise themselves more effectively and build their own resilience - not to do more and more, as some proponents of what threatens to become the latest buzzword for nursing mean – but to have strategies and structures that support them as they work in increasingly difficult conditions.

It means helping nurses acquire analytic and problem solving skills and using clinical supervision. Compassionate management is key. Managers have to learn they must model what they expect to see from their nurses and align themselves far more to the nursing agenda, bridging the chasm between that and their trust’s ‘business’ agenda.

Rather than paying lip service to such concepts, improving the relationship between managed and managers really is crucial. Nurses are often the ready made solution to improvements in our healthcare system: successful change starts with them. Equally, nurses have to start thinking and acting differently, becoming far more assertive, identifying themselves as a collective force and articulating their needs and concerns as groups. This is not about establishing an independent republic of nursing within the NHS but nurses participating as genuine equals – and accepting the responsibility that goes with that.

Compassion and the emotional labour that underpins it, openness, co-operation and solidarity - the way nurses support one another in their work, no matter how hard it is – are the principles that underpin nursing when it is at its best. These are essential values that contribute to what people most admire in the NHS. They are also the characteristics that underpin the kind of internationalism and public mindedness that are needed to counteract the narrow minded nativism of the likes of Trump, May, Farage and Le Pen and the cultural and economic war they are waging.

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