Nurses and the right to strike
This week, I would like to focus on the NHS and specifically nursing, given the recent announcement from the Royal College of Nursing (RCN) that, for the first time in 300 years, nurses will strike on 15 and 20 December. As a retired State Registered Nurse and Ward Sister, I am sad that this decision has been taken, and for the record I would never walk out on my patients. We are told by the media that this is a pay dispute; however, having spoken to many nurses, I know that the grievance is not the money per se but the conditions they are expected to work in.
Currently, a nurse can on average expect to earn £30,000 per annum. When I started my training in 1976, I was chuffed to bits to know I was going to earn £1,100 per annum—and out of that, I still had to pay for my accommodation in the nurse’s home. I had wanted to become a nurse since the age of 11. In fact, in my day it wasn’t the easiest of choices, as I watched my school friends either enter the 9-to-5 work market with a decent wage or start at university, where it seemed like a party or holiday to us student nurses, who had to work long shifts and study and take exams.
But it was never about the money; instead it was an honour and achievement just to be accepted to start our training. Nursing schools didn’t just accept anyone back then: we had to go through a rigorous schedule of interviews to even be considered. The NHS had the pick of the best, and those of us who were lucky enough to be employed as student nurses wore our uniforms with pride. The uniforms, which had to be laundered in the hospital laundry, were invisibly embroidered with the slogan ‘Tender Loving Care’ (TLC). TLC and a bit of old-fashioned common sense was all you needed to start being a good nurse.
In 1976, nurses held wrists to take a pulse. We battled to learn how to take a blood pressure using a sphygmomanometer and stethoscope, but we got up close and personal to our patients. We changed beds, did bed baths, provided palliative care, and had PhDs in holding hands. We were looked after off-duty by a Home Warden who was charged with ensuring our safety and keeping us on our best behaviour. On duty, we were looked after, taught and scrutinised by our ward sisters and our nursing tutors from the School of Nursing. Never a day went by that we weren’t reminded that any one of our patients could be our sister, mother, auntie, son, husband, father or one of our own family. We cared for them as though they were one of our own family. We cried if we lost them. Still to this day, I remember many of the patients that I nursed.
We were the doctors’ wingwomen and wingmen (yes, we did have male nurses too, albeit they were rare) and we were also the ‘clearer-uppers’ after them. Many of my old-school colleagues reading this will be nodding in agreement, as I cannot count the number of blood trays I disposed of after they had been used and abandoned on a patient's bed trolley! How many of us remember making toast at 4 am for the weary junior doctor on call? How many of us had a half-hour kip in the linen cupboard during a night shift? We were the observers and the professionals that noticed if someone’s condition needed flagging up. We were at the coalface; we were the bridge between the patient and their doctor. We answered the questions they didn’t understand, and we ensured they were safe. We liaised with family. We didn’t rely on Zoom calls, iPads or monitors to know how our patients were; we observed and talked to them to find that out. How quickly so much has changed.
But has it changed for the better, or do we need to revisit the past to create a safer future? To train as a nurse now requires the study of technology, where screens are watched more than the patient themselves. What would you prefer to rely o: a nurse holding your wrist to detect the rate, rhythm and volume of your pulse, and who is invisibly counting your respirations too, or a cheap gadget that wobbles off the end of your finger which is registering your pulse and blood oxygen? It’s a no-brainer. Has touch been replaced by tech; are nurses being asked to become gadget experts at the cost of basic skills?
Training a nurse in 2022 is completely different to the way many of us old-school nurses trained. It changed for the worse, in my opinion, with the advent of Project 2000. We 1970s nurses were thrown onto the wards to sink or swim after just an eight-week crash course in how to give an injection, making a bed, and bathing someone whilst they were in bed. We called it ‘basic nursing care’, but it was care with dignity. Today, nurses are educated in a university environment before being moved into a clinical setting. This generation of nurses in the UK has to pay for their own studies, and for most of their own training, through student loans that may have to be repaid. The bugbears of the academic environment for long years before they are allowed near patients result in many of them dropping out before they qualify.
Those wishing to pursue a medical course or nurse training from other countries will have their training funded by their home governments. It is a far more attractive offer for a foreign student to come to the UK to train than it is for our own home-grown workforce. They are even encouraged to bring members of their families with them. Are our foreign visitors diluting the opportunities for our British workforce, and where do these students go when they have qualified? Many will promptly return to their own countries, leaving a gap in the workforce at our expense.
UK Column has reported for many months of the cosy relationships between our politicians’ families and philanthropic organisations and British universities who are keen to support and sponsor students from lower-income countries for access to academia here. In my day, nurses were provided with accommodation and transportation to the hospital. We were looked after. If we had overslept and turned up late for the early shift, Sister insistently sent us to the canteen for breakfast before starting shift. A nurse working on an ‘empty tank’ was considered dangerous. Who today would do the same? Today, nurses have to find their own accommodation (it's not always easy to commute at odd hours if you're not close to the hospital) and work long shifts, often having to travel by public transport in the dark. Hospital parking charges have made driving to work a luxury.
The NHS currently has a gaping hole in its finances of £7 billion, and whilst I sympathise with colleagues who are struggling, I equally sympathise with the rail workers, postal workers and anyone else who has a mind to strike for more pay. Nevertheless, I don’t believe the issue with nurses is predominantly pay. I believe that conditions and the coercive measures that our government has imposed on our loyal and valuable staff are the primary cause of long-serving nurses leaving the NHS in their droves. Many are telling UK Column that they can’t sleep at night as they are ordered and instructed to treat patients in a way they don’t feel safe or comfortable with.
Patients are becoming frustrated and angry at the way they are being abandoned in hospitals, and staff are reporting more incidents of what they describe as aggression from patients and their relatives. Some are having to wear body cams in order to record incidents. Shouting at patients, laughing at them, bullying them into chemical-induced submission, parking them in corridors and refusing to believe them is all utterly alien to me—but appears to be common practice. Is this a hospital system or a chain of asylums?
What are well-qualified and experienced nurses meant to do in these circumstances? Those that remain, remain under duress, often finding themselves stuck between the proverbial rock and a hard place. A career with the NHS was often considered a career for life. We joked that it was the only guaranteed job in the world: everyone was born and everyone died, so midwives, morticians and undertakers would never be redundant—or would they? The skills that professional health staff have acquired over time cannot and should not ever be replaced by the quick fix of predictive modelling through AI and robots. Yet that is exactly what our Prime Minister of the moment (actually, he's the King's Prime Minister, not ours) appears to be aiming for. No wonder NHS staff are beginning to feel like turkeys at Christmas.
The President of the Royal College of Nursing and Director of Safety and Learning at NHS Resolution (an arm's-length government body) is Dr Denise Chafer. She has held a number of roles within the RCN, including as Chair of the RCN Midwifery Society and as a Branch Public Relations Officer. She has advised the Government and national bodies, and has supported the Association of Nursing Students. However, I cannot help wonder whether Dr Chafer and her executive team have deliberately misled her 300,000 members, who pay £16.40 per month for the privilege, and whether in fact they have been led like sheep straight to the slaughterhouse.
I recently had the pleasure of interviewing Roy Lilley, policy analyst and expert ‘dinosaur’ (I know he won’t mind me using that term affectionately; neither of us are spring chickens) on all things NHS. His passion matches my own and it was a great meeting of minds. Roy has calculated that to run the NHS costs an eye-watering £360,000 per minute. He also calculated that the NHS sees 7,000 patients every second. Have we become too dependent on what we have always referred to as the jewel in our national crown? Do we expect too much from the ‘service’ that has always been there for us in our darkest of times, and is the only way forward a digitised two-tiered service by stealth—a two-tiered service that will be accepted and welcomed by some, knowing they will be in eternal limbo on a more than 7-million waiting list?
Nurses from our own country aren’t a luxury; they are a right. Would I, or many of my old-school colleagues, want to join the NHS now, to commence student nurse training? Would that sense of vocation still have been there, or would I have been advised to steer away from becoming a nurse? The role of a nurse is unrecognisable from the one I remember signing up to nearly fifty years ago. Roy Lilley, who is nearly a decade older than myself, is eager to catapult me into the age of a brave new NHS, as I appear to be stuck in the Seventies and Eighties.
Can we strike that middle balance where nursing remains a vocation and a revered and respected career, and where simultaneously we can use some of the available technology to aid us in improving the journey of a patient through the NHS? (Note the use of the word ‘some’, not all.) I believe we can. Roy is quick to reassure me that only 2% of the NHS workforce is management; however it appears nurses struggle with middle management and with their role being redefined from the application of practical nursing skills to that of acting as managers of their own ward, or rather their own business unit.
The conditions within the NHS for both patients and staff alike appear to have become both dangerous, unethical, cruel and immoral. Patient safety has become a cottage industry in its own right, whereas in my opinion patient safety is the NHS. We should never be questioning or even debating patient safety, because that is the fundamental cornerstone of medicine. If we do find ourselves needing to debate it, perhaps that is because it has become compromised along the way. We appear to have more patient safety experts labelled as such in the NHS than you can shake a stick at; however no-one can find them in order to have a conversation.
If I have appeared to rant in this section, that was not the intention. Whilst I am watching in horror as I see more and more ‘transitional’ nurses being flown in from non-English-speaking countries and World Health Organisation ‘red countries’, my question remains: is this a pay dispute or a safety protest? Have the members of the RCN been hoodwinked and made to think this industrial action is all about pay? If we really want to save money overnight, my first suggestion would be to stop testing healthy people if you cannot treat them. To suggest that early cancer testing saves lives and money is ridiculous when we have a list of many millions waiting to start treatment.
When that brown jiffy bag with a request for a stool specimen hits your doormat, think again before sending it back. What happens if it shows something worrying? Will you be issued a ticket with a seven-figure waiting number on it? With so many needing urgent treatment now, including the thousands with serious adverse reactions from the Covid-19 injection (my latest Vaccine Damage—Real People series interviewee is Adam Rowland), it seems irresponsible and a total waste of resources to target the well and not the ill. ‘Dying waiting’ will be the next talked-up consequence of Covid-19.
When Theresa May was crowned Prime Minister, she removed the office of Secretary of State for Social Care and decided to load one huge combined portfolio upon the Secretary of State for Health. This has had a hugely negative impact and has taken the focus of attention away from social care. Social care and NHS secondary care go hand in hand; one will not exist without the other.
Investing in social care in order to relieve pressure on NHS is the only sensible route to go. With any blockage in any system, the cure is to identify and clear the blockage rather than just ignore it and hope that it will go away. The flow of patients through the NHS has long been a problem, and was even in my day; however, back then we had something called a convalescent home, a halfway house to transition patients through to their own homes. Being in hospital is exhausting for many patients, so to ensure they arrived back in their own homes in the best condition, we ensured they got a bit of a respite from long stays in hospital.
My message to Health Secretary Steve Barclay and to the Royal College of Nurses is to wake up from your slumbers and manage your expectations. The pay deal being asked for is, in my opinion, unreasonable and totally inappropriate. Stop ‘extracting the Michael’ and come up with a solution. However, even in order to come up with a solution, both of you have to realise and own the problem. Pay is a smokescreen. Conditions and safety is the primary concern. Could I sleep at night in their position, knowing what I know is going on in the NHS? No.
If I was running the NHS, or indeed the RCN, I would be asking for free parking for nurses, accommodation help, canteens with hot food, rest facilities, crèche facilities and the right to question and challenge policies. The top-down model isn’t working; we need to be looking at a bottom-up model. Engage with staff on the work floor, talk to them, and find out what they want and what is really important to them. Often, it is the little things that make the biggest difference.
To my colleagues, I say: don’t allow the RCN to speak for you. To Mr Barclay, I would say: acknowledge family more. A generation or two ago, when families were geographically and emotionally closer, there was never a question of getting an elderly or vulnerable person cared for externally; it was the family that wanted to take that role, and still is in many immigrant communities. But in today’s world of high costs and high stakes, distanced families—separated for a plethora of reasons—require financial help to look after their elderly. Wouldn’t that help with the increasing demand on expensive and scarce beds in care homes?
To those of you still working within the NHS and wishing you weren’t: please do get in touch. Often, just talking about your experiences helps with the sleepless nights. We understand that there are thousands of good, kind and professional staff still within the NHS, many often just ‘putting up and shutting up’ through no fault of their own—but how long will it be before they find themselves replaced by a robot? If the staff don’t feel safe, the patients most certainly are not safe. This is the reason the NHS is in collapse, and this is the real reason our home-grown nurses are leaving.
To those of you who vehemently disagree with me and think it is a good thing for nurses to go on strike: I respect your opinion, but I would remind you that for every nurse on the picket line, there will another one from an agency to take your place, at a higher cost to the taxpayer (that's probably you). Good job we can rely on less experienced foreign nurses and robots to do as they are told, without the language skills, the cultural security or the same ethics to challenge the system that we are declaring unsafe. Bring back Matron, I say; then we'll know who is in charge.
NHS 111 online
No longer will you be encouraged to telephone 111 to access advice and "signposting" from the NHS. NHS Online has now been launched, and those wishing advice will now be encouraged to hit the keyboard. From 24 November, patients will be asked to visit this online page to access help. No more hanging on the phone for hours; you will instead be tearing your hair out trying to navigate what I can only describe as a complex and unhelpful tool—designed to make life easier for the patient, of course.
Flu
Flu has flown back. The NHS appears to be overwhelmed with flu cases. In a July episode of UK Column News, and in my first blog at that time, we highlighted the NHS England board meeting where (at 41 minutes) Professor Stephen Powys warned—as if by gazing into some crystal ball—that if the NHS were hit by high flu numbers, capacity would be a great concern. His crystal ball was modelled on Australia so we must assume that what happens in Australia happens in the UK albeit it a few months later. Clearly the NHS have been planning for a ‘twindemic’ for many months however as predicted we now find ourselves in the middle of a ‘tripledemic’ as declared by NHS England. The ‘tripledemic’ is being classified as ‘Covid’, ‘Flu’ and record demand on emergency services. 344 patients a day were admitted with flu last week more than 10x the number seen at the beginning of December 2021.
With hundreds of beds being taken up by flu patients every day over the last week, the NHS is already struggling. Weekly data, published earlier this year than in recent years, appears to show that 19 out of every 20 adult beds were occupied in NHS hospitals last week. I would question whether hospitals are routinely testing for flu and ask, if so, how? Are PCR tests being used, and if so, what threshold of the number of cycles is being applied in determining a diagnosis?
Clearly, the drive to induce the population to take up the offer of a flu jab is being encouraged vigorously. In fact, why not avail yourself of a Covid bivalent booster at the same time? God gave us two arms for a reason: one for each jab, according to a coordinator at the White House. It is not a practice I endorse.
mRNA
A new jab is on the way, you will all be relieved to hear. This time—as expected—it is an mRNA platform for all strains of flu, an undifferentiated one-size-fits-all jab. Researchers are working on an experimental vaccine which they claim will offer broad protection against all 20 known influenza A and B virus subtypes. The two-dose jab will adopt the same mRNA technology used in the Covid-19 injections developed by Pfizer and Moderna (the two manufacturers that are now doing clinical trials researching the long-term serious adverse reactions to their own jabs). Worryingly, this new jab appears also to share an efficacy and safety profile with their last triumph, in that it is ‘novel’ and it is not expected to end flu nor eradicate it. Rather, by loading a jab with all strains, the manufacturers are seeking to take the guesswork out of developing annual flu shots ahead of season.
So, in effect, it is 20 vaccines in one vial. The aim is to prevent (!) the next ‘pandemic’. Will you play your part and take the jabs? Will you take one for the team, just in case?
mRNA: Rabies
Animals are not exempt from being experimented on with mRNA technology, and rabies jabs are no exception. Rabies is an ancient zoonotic disease which affects the central nervous system, caused by a virus abbreviated as RABV, which affects many species of warm blooded animals. Approximately 59,000 people die of rabies a year, mainly in Africa and Asia. A new study by researchers at Liverna Therapeutics indicates the use of a new mRNA vaccine for rabies. With no current effective therapy available, it is being heralded as a game-changer.
mRNA: Monkeypox
And another excuse to fill us with mRNA technology: let’s not forget ‘monkeypox’, which is not smallpox. The Chinese state-owned company Sinopharm has published a new study detailing a new, monkeypox-specific mRNA vaccine (the current offer is a smallpox vaccine with new marketing). Monkeypox is not generally thought to be a dangerous disease, so one would wonder why anyone would want to use a powerful experimental injection to tackle a disease which most make a smooth recovery from. Perhaps a re-evaluation is called for. In the meantime, the NHS is continuing to offer a second monkeypox jab to anyone eligible.
mRNA found in breast milk
As we have always suspected, a study now shows the presence of mRNA in breast milk. Examination of the breast milk of eleven lactating mothers threw up the finding of lipid nanoparticles from Covid-19 vaccines were in seven of them. The particles were only detected 48 hours following vaccination, so more research is warranted on this, and on the implications for neonatal babies.
MHRA
How could I resist mentioning the MHRA? This week, my coverage of Britain's medicines enabler-regulator takes the form of publishing their latest e-mailed response to my question regarding the proposal to extend the authorisation of a Covid-19 injection, Moderna's Spikevax, to babies. It appears that this will be authorised and then the construction used will shift responsibility to the Joint Committee on Vaccination and Immunisation (JCVI) based on their recommendation. It is unlikely that the JCVI will object; it will most likely continue to follow the European model and recommend the extension of jabbing to the under-fives. How long before this Covid shot gets added to the childhood immunisation schedule by stealth? The full MHRA board meeting Champagne on Ice can be found exclusively on UK Column.
The e-mail beneath was written by an unnamed individual salaried by the British taxpayer.
FOI 22/1056
Dear Debi Evans,
Many thanks for your request 22/1056 under the Freedom of Information Act:
Could you please confirm if you are considering the Moderna Covid-19 vaccine to be included in the child immunisation schedule for babies from the age of 6months as early as Christmas 2022?
In terms of immunisation schedules, these are drawn up by the Joint Committee on Vaccines and Immunisations (JCVI) and are published on the UK-HSA website, there are also useful COVID specific resources that you can refer to. To be clear, a decision on the regulatory approval of a vaccine is within the remit of the MHRA, whereas the JCVI provides the advice to the Government on whether a vaccine should be used / included in the immunisation schedule.
What risk/benefit assessment has been carried out?
We have received an application from the Marketing Authorisation Holder to extend the use of the Moderna COVID-19 vaccine (Spikevax) to children aged 6 months to 5 years. Spikevax is authorised in the European Union for use in people from the age of 6 months. The application uses the European Commission Decision Reliance Procedure (ECDRP) which allows the MHRA to take account of the EC decision. We will conduct our own benefit-risk evaluation and publish our decision in due course.
[...]
Yours sincerely
MHRA Customer Experience Centre
Communications and engagement team
Medicines and Healthcare products Regulatory Agency
MHRA job vacancy funded by Wellcome Trust
A full-time opportunity on a two-year fixed-term contract as Senior Manager, Digital Mental Health is the latest remarkable job vacancy to hit the pharmaceutical market. The MHRA pitches itself as the agency entrusted with enhancing and improving the health of millions of people through the effective regulation of medicines. It proposes to do this by bringing together a fusion of capabilities across both medicines and medical devices to enable licensing and market access, as well as ensuring compliance with regulations and standards. Those of you who read the headers will have noticed that this is a Wellcome Trust-funded project to ensure that their mental health products are regulated in a risk-proportionate manner and evaluated predictably. Regular readers will remember that I have referred to the fusion and funding of Wellcome, the National Institute for Clinical Excellence (NICE) and the MHRA before.
For anyone wishing to apply, you must have a knowledge of medical device regulations, be a strong leader with the ability to empower and motivate others across all organisations, and you must be prepared to schmooze stakeholders.
The salary is close on £70,000 per annum and benefits include 25 days' annual leave, one privilege day (a special paid holiday just for civil servants), and occupational sick pay; access to the Civil Service pension scheme; and flexible working hours to ensure a healthy work-life balance. You can even expect a bike loan to ensure you get to work on time, and the less healthy may be enticed by an interest-free rail season ticket and access to many Civil Service clubs. In the application form, one must be prepared to answer questions on behaviour, experience and technical profiles.
No Gas and Air for mums in labour in Ashford, Kent
Due to ventilation problems (of the building, not of patient equipment), William Harvey Hospital has announced that it will not be able to offer Entonox pain relief to mothers in labour. The Kent Online article on this also appears to suggest that it is unsafe for staff to work in close proximity to Entonox! I have since spoken to midwives who simply laughed at the suggestion, and as a mum of five children—and having nursed many who have used Entonox in other situations, such as Accident & Emergency and fracture clinic—I can honestly say that not once has a concern ever been raised relating to the effects of nitrous oxide on a member of staff.
A sickness without a cure
With no further commentary, I will merely allow readers and listeners to read this Polish six-foot vagina in the theatre foyer story for themselves.
Finally
With strikes looming, flu cases soaring, waiting lists increasing and the NHS in utter collapse, the United Kingdom is looking more disunited by the second. My interview with Roy Lilley will be coming out soon on the UK Column website, but to give you a preview, my final question to him was: “Is the NHS a safe place to be?” With frankness, he replied, “Have faith”. I do have faith—but I have faith in goodness, which appears to be in seriously short supply. I pray I am proved wrong.
Until next week, stay well, stay sane, please do your own research and join your own dots. Above all, be kind. Debi.
