Let doctors and nurses get on with their jobs

Mar 13 2008 by Steffan Rhys, Western Mail

The NHS has been ripped apart, the patient needs to be put back in the centre of attention and devolution offers real hope, says Eirlys Warrington, the recently retired chairwoman of the Royal College of Nursing. Steffan Rhys’s report is the last in the Western Mail’s series on the 60th year of the NHS

PRIME Minister Gordon Brown said in his New Year’s speech that 2008 was “the year in which we demonstrate beyond a doubt that the NHS is as vital for our next 60 years as it was for our last”.

It was an extension of some rhetoric from the previous year, when Mr Brown announced that much more needed to be done to empower the service’s staff, putting them in charge of developing ideas and long-since deteriorated patient care.

Only this way, said Mr Brown, can lasting change be achieved.

It is, of course, what many within the health service have been saying for years. Indeed, Eirlys Warrington, the recently retired chair-woman of the Royal College of Nursing, pinpoints the moment that control was taken away from hospital staff as the worst single development in the NHS’s history.

In the early 1980s, Margaret Thatcher’s Government began blaming inefficient management and structures within the NHS for the cash problems.

The result was the Griffiths Report of 1983, which stressed the need for modern management processes, with the appointment of general managers in the NHS with whom responsibility should lie and doctors becoming more involved in costs and resource management.

“Lord Griffiths thought hospitals would be better run like supermarkets, that there should be accountants and businessmen who, for my money, didn’t know what hospitals, nurses and doctors did,” says Mrs Warrington.

“When they looked at saving money one of the first things they franchised out was the cleaning, which had previously been done by hospital cleaners.

“Cleaning standards went down because these were outside cleaners with no real pride in the hospital.

“The Griffiths Report is the low point of my 40-year career in the NHS.”

In a continued theme of annoyance with bureaucratic outside interference in her treasured service, Mrs Warrington also reserves some scorn for Salmon Report of 1967, which set up a new structure for nursing when it recommended a new hospital nursing structure under the direction of a chief nursing officer.

This report, says Mrs Warrington, killed off the matron, an enduring image of early 20th century British hospitals and recently the subject of a call by Tory leader David Cameron for their return.

“But it’s no good having the matron return unless she has the authority and autonomy of the matron of old, for whom you would have to jump when she asked,” says Mrs Warrington.

“Matrons ran the hospital with the medical director and there was no bureaucracy from outside. And hospitals were exceptionally clean.”

Mrs Warrington began her nurse training at the Macclesfield Infirmary in 1960, working on a pre-Abortion Act ante-natal ward before moving to the North Staffordshire Royal Infirmary.

In 1970 she moved to the Royal Gwent Hospital in Newport, spending two years as a night sister, and went on to work in acute psychiatry at the city’s St Cadoc’s Hospital where she worked with patients suffering from anorexia.

From 1983 until her retirement 20 years later, the mother of two (one child is a nurse, the other a doctor) worked as a clinical nurse specialist in the field of HIV and Aids in South-East Wales.

The NHS was still a fledgling service when she first became a part of it but her early years nevertheless saw some fundamental changes in addition to the Abortion Act of 1967.

One of the biggest decisions in NHS history was taken in 1961, when the contraceptive pill was made available and free on the service and the first liver transplant was successfully completed just two years later.

The previously unheard of concept of part-time nursing was introduced in response to a nationwide shortage of nursing staff and a 1965 media campaign encouraging qualified nurses to work the hours they could.

But since its noble inception, Mrs Warrington, 66, says the NHS is a service that has drastically deteriorated.

“It is such a wonderful service that has been ripped apart,” she says.

“The NHS is one of the diamonds in the crown of Great Britain. It never used to be about targets and someone needs to get rid of them and let doctors and nurses get on with their jobs.

“Where has our social conscience gone? Aneurin Bevan had the conscience to set us down this road but that is no longer evident today.

“The patient needs to be put back in the absolute centre of what we do. When I started, every lecture I ever went to started with the patient but now they appear to be at the bottom of the list, the last ones that anyone thinks about.

“It was Florence Nightingale that said, ‘Let no hospital harm the patient’, but some of the decisions that have been taken – like the franchising out of hospital cleaning – have not been good for patients.

“You don’t know what you are going to come out of hospital with now.”

Despite the deterioration, botched operations, exhausted nurses and MRSA, there have been recognised improvements since 1997, when Labour came to power, though in many areas – like cancer survival and hospital infections – the NHS, which has a budget of more than £4.4bn in Wales and more than £100bn across the UK, still lags behind other equivalent health systems in Europe.

But, says Mrs Warrington, in its 60th year the NHS’s salvation may yet come in unexpected form: devolution.

“[Health Minister] Edwina Hart has only been in the job for a matter of months but is already making tremendous progress,” she says.

“She has the ear of nurses and doctors, she listens to them and finds out what the issues are. She has the support of the British Medical Association and the Royal College of Nursing in Wales.

“Devolution has been good for the NHS within Wales. The RCN has been able to influence healthcare within Wales, something we were never able to do when decisions were made in London.”