Writer and former nurse Christie Watson talks about her experience working in the NHS, how demand has changed in recent years and the importance of public health and integrated care – along with the changes she thinks are necessary.
So the relationship between the NHS and the public is incredibly complicated, as we’ve just heard but I don’t think perceptions have changed as much as people talk about how much they’ve changed. Certainly, in the 20 years that I was nursing the thing that’s changed the most is actually demand for the NHS and the nature of what people come in with, they’re coming in with much more complex, complicated conditions. People are a mixture of all kinds of comorbidities, physical, mental, emotional, social problems all mixed up. So people are often coming into the NHS with greater need.
You can’t look after people in slices anymore. The idea of a not joined up health and social care system just doesn’t work. Public health is so vitally important and all the unseen parts of health that we don’t hear about, for example district nursing or school nursing. We’ll hear a lot about knife crime, but then we won’t hear about the school nurse numbers being cut massively and those are the healthcare professionals that might have the only access to these vulnerable adolescents at a time when they can support their mental health. So it’s about joining the dots really and it’s not that complicated.
So during my time as a nurse, the biggest barrier that I encountered to improving patient care was always time and sadly there are far too many instances where you just don’t have time to deliver the care that patients deserve and the care that you want to give. And that’s very harmful not only for patients but has a massive knock on effect of mental health for nurses, because people go into nursing because they want to deliver good care and I’ve worked many shifts where we haven’t eaten or drunk, even drunk water purposefully because we don’t have time to go to the toilet, as nurses, and that should never be happening and so you’re firefighting constantly, dealing with critical incident after critical incident and then not being able to help the patient who’s been incontinent in bed 5. Knowing that, it’s very, very difficult for the patient, it’s very difficult for the nurse as well.
The changes that need to happen aren’t really cultural, they’re practical. We’re 42,000 nurses short in England right now. Since the bursary has been taken away last year in England, nursing applications have fallen by a third and the idea that a nurse could come out with £60,000 worth of debt and then we’re complaining forever about retention, not just recruitment but retention, nobody’s going to be able to stay in a job that doesn’t pay as well as perhaps other jobs do.
So I think patients now are a very, very complicated mixture of all things. What this means is that everything has a knock-on effect on health. You can’t just take health as one aspect of somebody’s life and ignore housing, education, poverty levels, social care, all the other things. We can’t just look after people in slices. Everything impacts everything else and it’s all about connecting those dots.