My first feature in the debut edition of PRN Magazine, a new online title dedicated to the nursing profession.
I was approached by the founder to cover medical politics and nursing, and this feature, ‘Fallen angels?‘, examines the link between reforms by the Coalition government and falling morale.
A damning report in December revealed increasing levels of stress, anxiety, mental and physical health problems, and falling morale among the nursing profession. Benedict Cooper investigates this worrying trend. Benedict is an investigative journalist and writes regularly for the New Statesman.
Illustrations by Rosie Irvine
“A perfect storm is developing”, reads the brochure for the ‘Protecting the frontline against burnout’ conference, which took place in March. “Amid rising demand for services and reduced resources,” it continues, “workload is the ‘tip of the iceberg’ in terms of stressors”.
It’s an uncomfortable truth which, sadly, will come as no great surprise to thousands of nurses in Britain. Studies consistently show a rising tide of work-related stress and anxiety, absenteeism both short and long term, recruitment problems, an increasing reliance on costly agency staff, and a steady decline in morale.
So what’s going on? What has happened to a workforce once considered the guardian angels of Britain, and what is causing stress to rise, and morale to fall, in the new health service?
Back in December, Nursing Times asked 700 nurses about their own experiences of working life in the wards. The results of the survey made for difficult reading. A depressing majority, 78%, said that they felt more pressure at work than 12 months before; 63% said they had suffered from physical or mental health problems in the last year as a result of work-related stress, and over a half said morale in the wards was falling.
Perhaps even more upsetting, were the anonymous comments left by the nurses responding.
“l am nearly on my knees with the level of work l have,” said one. “l am beyond exhausted and have gone off with stress today”.
Morale was at an “all-time low”, said another respondent. They continued: “I am seriously considering leaving the profession I once loved. I feel that I am compromising patient care and safety”.
It was a sobering reminder of what’s happened to a profession and a workforce at the sharp end of a system under reform. A profession, which Nottingham-based community mental health nurse Ben Clements, speaking to PRN Magazine, says has lost the special status it once held.
He says: “There’s a long tradition in the health service that nurses were seen as the angels, and it’s remarkable how we’ve moved from that state of affairs to the one we have now. Nurses feel ground down and dispirited”.
Despite solemn pre-election assurances from government that there would be no major restructure of the health service in England, and a continued rhetoric since that conditions are improving and staffing levels are increasing, the reality is simply nowhere near.
One of the first actions of the coalition government was to announce a two-year pay freeze for all NHS workers in England. Just under four years of biting austerity later, in March last year, and staff were told, once again, that even the 1% increase they were asking for wasn’t going to happen. Overriding the advice of the Pay Review Body (PRB), the government said the cash just wasn’t there.
It was the final straw for many. It takes a lot for nurses to strike – the last time it happened was 33 years ago – yet in September a Unison ballot went through, two-to-one in favour of action. It was a momentous step, one that unions warn is likely to be repeated if the government continues its defiance at the negotiating table.
But it’s not just the pay-freeze that’s causing stress to rise; a new culture of healthcare is emerging. One in which private providers are increasingly appropriating the delivery of care and influencing health policy in the process. Around a half of all new contracts have gone to private providers since the Health and Social Care Act changed the rules in 2012, forcing trusts to release all services for competitive tendering.
This morphing of the public service into a marketplace ripe for corporations, which Dr Clare Gerada, chair of the NHS London Clinical Board for Transforming Primary Care, describes as an “overwhelming force of industrialisation on the NHS”, is having unquantifiable effects on the psyche if its workers.
And it is this, says Clements, which is a key factor in the declining morale we’re seeing.
He explains: “With so many private providers taking care contracts for profits, without any public ethos, it gives nurses the feeling that their work is no longer something of social value; that they’re just working for a corporation”.
GP and health campaigner Dr Bob Gill says that this fundamental conflict of ethos is the “undeclared civil war within the NHS”. He says: “The people appointed to run the trusts and the markets often come from business, banking and accountancy; they’re people with a commercial ethos and they’re overseeing the clinical staff who believe in the NHS.
Not only does working for a private company not sit well with some nurses, the fact that the profession is becoming more and more fractured over time is leading to an increasing inconsistency between the types of contract, and on which terms and conditions, nurses are employed.
Kathryn Anderson, a lead nurse in pain management at London’s Royal Free Hospital and National Health Action Party member, says that for this and various reasons, there is a vicious circle forming.
She says: “The whole feeling on the wards is very much one of stress; the more stress we feel the more likely we are to make mistakes. There is extra pressure on us when you think about the financial situation; people feel insecure, that they can’t say anything, that they have to keep their head down and their noses clean”.
Amid a chaotic four years of top-down reform, a number of contradictions have emerged. One of the most potent of these – and a major source of anxiety in the wards – is the increasing reliance on temporary and agency staff. With most staff stuck on a pay freeze or below-inflation rises, witnessing the hiring of agency staff, at the cost of up to £1,800 per day is galling to say the least.
And one of the key factors not to be overlooked is the role of the media. Of a seemingly continuous war of attrition raging against the NHS from certain sectors of the press, undoubtedly one of the victims has been staff morale.
Headlines such as ‘Forget hacking hacks, let’s jail some callous Mid Staffs NHS staff’, and ‘Our sick NHS needs a dose of conscience’, present a crude picture of what’s going on in the health service, and says Paul Evans, director of campaign and research group NHS Support Federation, creates a dangerously skewed view of the reality of nurses’ lives.
He says: “Nurses are not angels, they are committed professionals trying to do a hard job under pressure; but negative press changes the way the public perceives that. Hospitals are working at high occupancy rates, far beyond what they’re staffed for a lot of the time, and most of the time they deal with that incredibly well.
“But that’s not the way it’s reported; it’s made out that nurses don’t care. This contradiction is very frustrating for nurses”.
Outraged campaigners are fighting to reverse privatisation, increase pay to nurses, reduce the pressure on them in their jobs, and fight the negative press that dogs them. It’s a hard fight, especially with an election around the corner; for the sake of the angels trying to watch over us, it’s more important than ever.