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Wednesday, 25 March 2015

Nursing Counts - and deserves recognition

In the run-up to this year's General Election, the Royal College of Nursing (RCN) is asking parliamentary candidates to support its manifesto, Nursing Counts, and to commit to supporting the following priorities:

1.    Improve patient care by ensuring safe staffing levels; giving nurses access to training and; listening to the concerns of staff.
2.    Value nursing by paying a fair wage; stopping the downbanding of nursing experience and; investing in nursing so that future generations aspire to become nurses.
3.    Invest in health and care by guaranteeing no more cuts in the nursing workforce; increasing resources for the community and; implementing workforce planning that reflects the needs of patients. 


It's not a difficult manifesto to sign up to, and the RCN's priorities effectively amount to a request for politicians to give the nursing profession the respect it so obviously deserves. Who does not want fair pay for nurses? Who would argue against creating a sustainable NHS, equipped to meet the needs of patients?

As someone who spent 16 years working in the NHS, some of it at Monklands Hospital, I am more than aware of the importance of the NHS, the efforts of those who work within it and the regrettable effect that government decisions can often have. I am a former UNISON representative (health sector) and have been involved in a number of health campaigns in recent years - crossing swords with Patricia Hewitt and Andy Burnham over their misguided pro-private sector agenda. I am a believer in empowering health professionals rather than in burdening them with centrally-driven political objectives (remember Labour's NHS targets, many of which were utterly ludicrous?).

It shouldn't surprise anyone who knows me that I'm happy to endorse the Nursing Counts priorities, but it might be useful to deal with each of them in turn:


1.    "Improve patient care by ensuring safe staffing levels; giving nurses access to training and; listening to the concerns of staff."

This is absolutely vital. it's so simple and so obvious - yet I know the reality to be very different.

Staffing levels are often unsafe - I say this on the basis of experience. I worked in acute mental health for many years and often situations arose which may have been preventable if staffing levels had been more adequate to the need. If we are to move towards a patient care system that is truly responsive to patient need then we need to have the staff in place - as well as the flexibility to adjust to changing clinical priorities.

Access to training is vital - but it needs to be access to the right training. Again, if we are to respond to patient need, clinical staff need to be able to access the kind of training that will allow them to be more effective at delivering the right care. Nurses have a set number of study days per year, and often this is self-directed study - there are obvious advantages to this. However, non-qualified staff are often overlooked in regards to personal training needs and this needs to be rectified.

Listening to the concerns of staff - as a former UNISON rep this is something I used to actively do. Some of this I would feed back through the relevant channels to hospital managers - who clearly had little interest in acting on those concerns. There need to be better processes for staff to express their concerns, and a more transparent system for them to see if and how their ideas are taken forward.

I'd personally add that far more has to be done to prioritise the concerns of nurses, whose views are so often relegated to being of secondary importance behind those of consultants and the medical profession as a whole. I'd like to find ways of ensuring that nurses have a louder voice; the NHS has given disporportionate significance to the BMA's agenda for too long. And not only nurses, but other allied professionals who are so often overlooked - when David Cameron talked up the benefits of having those with health expertise commissioning NHS services, he predictable was referring predomiantly to doctors (each Clinical Commissioning Group has one registered nurse on it, but the balance of power is clearly skewed towards GPs). Any culture that reinforces the patriarchy of a single profession needs to be radically changed.

2.    "Value nursing by paying a fair wage; stopping the downbanding of nursing experience and; investing in nursing so that future generations aspire to become nurses. "

It's a scandal, isn't it? There have been headlines comparing MPs pay to nurses' pay - but you don't need to go that far to see how little nurses are paid for what they do. Simple comparisons with jobs in the banking sector, the civil service, the police and the armed forces show that nurses are earning less - and these are often unqualified professions.

Unfortunately we live in a society where people are valued largely by how much money they're able to make - as reflected in the financial industries. The next government has to think seriously about how it values the work our nurses do, and I agree that asking for a "fair wage" - i.e. in line with police, armed forces and the civil service is not unreasonable. It's a question not of affordability but of justice. Can we afford not to pay nurses a fair wage?

A fair wage, to my mind, means taking into account the unsociable hours that nurses work - any proposal to cut the current unsocial payments for nurses would amount to a significant reduction in income and should be strongly resisted.

3.    "Invest in health and care by guaranteeing no more cuts in the nursing workforce; increasing resources for the community and; implementing workforce planning that reflects the needs of patients."

It is difficult for a constituency MP to guarantee no further cuts in the nursing workforce. What I can promise is that, if elected, I would not support any such cuts and that I would vote against it (whoever forms the government). We need to be actively finding ways to increase not only staffing numbers but ensuring the right skill mix - the South Staffordshire experience confirmed that some hospitals are not only poorly staffed but left junior staff in positions of responsibility they were ill-equipped to deal with.

I agree that we need to invest more heavily in community resources, as part of moving towards a health system that is preventative rather than reactive. This has to be part of a longer-term plan, which should be evidence-based and focused on addressing local health needs

The aim of every politicians with a genuine interest in health should be the facilitation of an NHS that reflects - and addresses - the needs of patients. Services should be as specialised as necessary and as local as possible. 

I applaud the RCN's initiative and am quite happy to support its manifesto aims, but it's reasonable to point out that health is a devolved matter in Scotland and that many of the decisions affecting how the Scottish NHS (which has always been seperate, founded under a different act of Parliament) works are taken in Holyrood. However, I would seek to work with MPs and MSPs of all parties to ensure that the next five years see advances in our NHS rather than cuts to service provision, and to facilitate a change in culture in which nurses are empowered rather than undermined.
 
Nurses deserve recognition, respect and a fair deal. That's common sense. 



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