By Dave Munday, professional officer, Unite the union (in the health sector)
This week (on Monday) the Royal College of Nursing president, Andrea Spyropoulos, said at their national conference that the idea of the 1 year requirement for future student nurses to work as healthcare assistants was “a really stupid idea”. What we then saw was such an interesting insight in to the ‘culture of the NHS’ when first the secretary of state for Health, Jeremy Hunt, and then later prime minister Cameron launched what outsiders would see as attempts to bully their critics silent. For many of us working to support our excellent front line health professionals (and also the huge network of amazing colleagues that work with them to keep the NHS running) it’s sadly of no particular surprise. When you think deeper though it’s intriguing that at the time when Hunt is saying there mustn’t be a culture of bullying and there must be openness and candour, he is perpetrating the exact same bullying but on the national stage.
President Spyropoulos is right to voice her (and her members, who we should remember are hundreds of thousands of nurses) concerns, after all, Hunt has demanded it of her as a nurse. It’s all well and good that they come out with the line of the public want nurses to be expected to actually care for patients. But this again is systematic of a government who argue issues on superficial PR and never scratch the surface of the issue. Let’s scratch that surface just a little (and remind some of the things that Unite in Health have been saying):
• There are legitimate concerns about this plan from frontline nurses and other professionals that it will affect. The organisations that represent their views are rightly raising them.
• Why is it nurses must do this pre-training work and not doctors, physiotherapists, speech and language therapists, healthcare chaplains, paramedics, etc, etc, etc… Also why not managers who work in healthcare, but if we really want to think about people in our society who should show compassion (and have in some cases evidenced that they have very little by the current policies coming from them), Members of Parliament.
• It ignores the large practical and care delivery component that is in modern nurse training (about half the time, 2,300 hours which is one of the biggest amounts of any nurse training in the world). Anyone listening to Hunt’s scratch the surface PR comments would believe that student nurses turn up at the lecture theatre on day one, and then three years later when qualified they finally manage to find their way to the front door of the hospital (as again in Hunt’s world nurses just work in hospitals). Again, I do wonder if one reason for this belief that nurses don’t learn how to nurse people any more with the ‘professionalisation’ of the profession is because at the same time, MPs have become professionalised in the modern career politician employment route.
• How many of the nurses that worked in Mid-Staffs had worked as healthcare assistants (HCAs)? For many of the nurses I speak to have worked as HCAs (I know I did both before and during my nurse training). What’s the evidence that they’ve collected that these people (including me) are better than those that did not?
• Francis also wanted HCAs to be regulated (Hunt’s said no) and receive standardised training (Hunt said yes). So are student nurses in waiting going to have to train to be an HCA first to then be an HCA to then train to be a student nurse?
• Health care assistants are professionals and in a profession themselves. They aren’t just mini-nurses or their handmaidens. Just like nurses aren’t mini-doctors or doctors' handmaidens. Neither are they ‘not posh so can wash’, just like nurses aren’t ‘too posh to wash’!
• The government doesn’t set the rules on nurse training. Why should they? They aren’t experts in the field although politicians often feel they can dictate what they, incorrectly, know to be right. The Nursing and Midwifery Council (NMC) set this and from what I’ve heard from colleagues that have more involvement with them were pretty surprised that the government came out with this.
As a registered nurse (and health visitor), what I want is solutions that have an evidence base that we can show will actually make the care our patients and clients (but also our friends, families and loved ones). In the Francis Enquiry, the spot light was rightly shined on the huge devastating impact that the culture that was created to chase for Foundation Trust status. I and Unite the union believe that with the coalition governments attempts to privatise our NHS that this will be played out across more and more of our health services. I also want and expect a government that will follow its own insistence that nurses (and other health staff) mustn’t be bullied into silence.
On that final point I’d say however, I expect the bullying to continue. It is, and will sadly probably always be, part of my job. I just hope it won’t ever stop me from saying to Hunt, Cameron et al. you’re wrong, when I know it to be the case. In Unite we’ll work with other organisations as well that will stand up and be counted (like the Royal College of Nurses and their President).
Can I also say to the government, if you want to lecture people on conflicts of interest, can you please choose someone with a better track record on conflicts?
You can read Unite the union’s response to the Francis Enquiry, ‘Prevention is better than cure’ here. You can also see Unite’s response to the governments response here.
We’ll be continuing to issue support and guidance on this issue on our website, via facebook and twitter.