How Did a Nurse & Actor (Michael Sheen) Succeed Where "Bland" Politicians Fail?

By rousing an audience with their passion and conviction. In the words of Michael Sheen in a speech that went viral on the internet this week,

" You must stand up for what you believe, but first of all, by God, believe in something."

His blistering criticism of the coalition government’s systematic dismantling of the NHS touched a national nerve. With few exceptions, “bland” politicians struggle to communicate a belief in anything, other than their own aggrandisement.

Last week BBC's Question Time was televised in Telford and, despite politicians’ attempts to ingratiate themselves with the audience by giving immigrants and Islam a good kicking, they just weren’t biting.

Then a nurse spoke, from the heart, with candour and courage. The audience erupted in whoops and cheers (when was the last time a politician generated that kind of reaction?). She gave voice to the one thing everyone cares about, irrespective of political persuasion, our beloved NHS.

The nurse from Telford said she was disgusted with herself for voting for the Tories, “I helped put you in your jobs and now I’m having to fight for a 1% pay rise, I’m facing my unsocial hours pay being scrapped and I’ve lost all my increments, despite there being a signed contract. As far as I’m concerned, You’re [pointing at Tory party chairman Grant Shapps] in breach of contract with NHS nurses”.

Agency and temporary nurses are costing the NHS millions and are reported to provide poorer quality care. NHS bosses say they can’t recruit nurses, but why not? Nurses I’ve spoken to locally who have left the profession say they felt they’d been forced out of their jobs for the crime of highlighting poor patient care.

One senior A&E sister who left the local hospital in the last few years said, “It’s like being in a war zone every day”. There were never enough staff on duty to cope with demand, so nurses and doctors were working under constant stress and burn out levels were high. “Every time you’re forced to deprive a patient of the care you know they need and deserve, it chips away at your soul until eventually there’s nothing left to chip away at and you just stop caring. That’s when most of us realise it’s time to leave the profession”.

A previous colleague of hers, a highly respected A&E consultant, left around the same time, in protest she said at repeated failures of management to recognise that lack of funding was compromising, sometimes fatally, patient care. That consultant, like many others interviewed in a recent BBC Radio 4 documentary, fled to Australia to work in an A&E system that funds proper patient care and allows doctors and nurses to work adequately staffed shifts as well as affording much more work life balance. It’s not rocket science.

Whilst agency and temporary staff may cost the NHS millions in exchange for poor quality care, they have the advantage of being easily disposed of if they become too gobby/principled. No messy employment rights to be circumvented.

A couple of months ago my child was seriously injured in a car crash. The quality of care he received at our local A&E was first class, for which I will be forever grateful. That intense experience of the NHS made me realise just how the government has eroded the structural underpinning of the institution by starving it of the investment it needs to thrive.

I learned that my A&E is under threat of closure, which would mean a journey that already takes over an hour (in excruciating pain), could be extended to over 1.5 hours. I also learned that my local Clinical Commissioning Group (that’s the board who hold the local NHS purse strings) had opted out of meeting national ambulance response targets (the only county in the country to do so) rather than fund the service to operate at a safe level. Medical campaigners warn this will inevitably result in higher mortality rates.

Still, in a move that seems to acknowledge, albeit implicitly, the likelihood of increased mortality, the Trust has just announced it’s investing £1.4m in extending the mortuary. It’s one thing having ambulances backed up nine strong out the door of A&E, it’s another thing entirely to have the DOA’s (dead on arrival) spilling out into the car park. It would kill tourism.

In order to take a temperature check of my local NHS, I went along to a recent hospital board meeting, which opened with the chairman’s award. The recipient, like the three previous recipients, was a manager. I clapped because I don’t doubt his worthiness. At the same time, I’ve been told by a source inside the hospital that front line medics are feeling aggrieved. The winter months put unprecedented pressure on nurses and doctors who are already over worked and underpaid yet they see managers who make financial savings, not those who save lives, disproportionately, in their view, recognised and rewarded.

Next, the chairman invited the gathering to accompany him on a journey. First stop was a heart rending patient story about appalling end of life care. The patient’s wife outlined a catalogue of medical errors, shoddy hygiene, poor patient care and interdisciplinary communication. The patient’s wife said that although it was too late for her husband, who died alone (she was not informed of his deteriorating condition), she asked that doctors and nurses be reminded that the person in the bed could be their father, brother, husband, and to see them, not as just a collection of symptoms, but a human being.

I was moved to tears and thanked the family for their candour and courage afterwards.

The board move on to examining the Clinical Commissioning Groups, "Future Fit" (FF) proposal. This is their vision of our local health care "offer", "going forward" (AKA: cost cutting measures). He says its viability depends on the setting up of Urgent Care Centres (UCCs) throughout the county in order to alleviate some of the pressure on A&E’s. Problem is they’ve only planned 2 prototypes, only one of which seems operational (reports indicate that it's run by a private company) & it seems it’s not taking pressure off A&E. One of the reasons for this, according to the CEO, is that it’s not a proper UCC yet. Staff haven’t been sufficiently trained so it’s all a bit, well, up in the air.

The chair said he was concerned that wasteful models that don’t deliver could cost more than before. Someone said there was no point in building a new hospital if beds there just get clogged up too. There were concerns about the integration of FF with other providers.

The CEO’s body language grew restless. “We’ve been standing on a burning platform for months now. We must make the best set of assumptions and move forward”. Health warning: When it comes to transformative change of any kind, let alone on an NHS scale (which involves people’s lives), “best assumptions” don’t cut it. Decisions need to be based on evidence, including detailed financial modelling. General Motors famously carried out a cost benefit analysis before deciding whether to recall known faulty cars. They concluded that it would be cheaper to pay out when sued over resultant fatalities than to recall & repair the cars. Private corporations are not driven by customer safety, their allegiance is to profits.

The medical director says it’s deliberate that no detailed costings have yet been forthcoming. If that’s true, it’s deeply disturbing. For example, one of the options is to build a new hospital, which would mean diverting vital funds away from patient care and front line staff. It wouldn’t solve the problem of bed blocking (as noted by the board), which means the problems remain but the funds have been recklessly depleted, all because financial modelling wasn’t provided at the outset. Asking people to respond to hypothetical options that may be unfeasible/dangerous seems to me to be a gross waste of time and money (how much does it cost to despatch an army of highly paid clinical commissioners to every consultation and pop up stall around the county only to have to do it all again once they’ve had a chance to think things through a bit better)?

The CCG had asked the board to endorse their shortlist of proposals but they declined on the basis that there wasn’t enough detail.

Next, the CEO told the board that there’s no capacity to transfer patients off the wards, “We’re working 100 miles an hour but the rest of the system is working 10-20 MPH”.

A board member interjected, “When do we say as a board, enough is enough. How do we support colleagues”? He spoke of the burden on A&E staff and the need for shared ownership with other providers (of social care). He said “we need to draw a line in the sand”, critical of his perception that social care & community trusts ration their contribution. This is problematic because the Future Fit model depends on shared ownership and these partners making beds available in the community.

Someone else chipped in, critical of the local authority (LA) who he said is using money provided for the social care pot, to make savings rather than use it to fund vital infrastructure in the community.

Yet more flashes of brilliance only to dissipate into the ether.

The chairs solution? Using Health Care Assistants to plug the nursing gap. “We already use agency nurses but they don’t give the love”. I look around the table. No sharp intakes of breath. The corporate governance director seems unperturbed so I focus my gaze on the director of nursing, who when asked what she thought by the chair said, “I’m happy to consider it if the board is happy to accept the increased risk”. No one objected.

If we accept the narrative that there’s no money for the NHS then it follows that we accept privatisation as inevitable. If we relinquish the principal of public health care for all, we’re signing our NHS over to corporate providers, for whom profit will always come before patients. As Sheen so eloquently put it, “There is never an excuse to not speak up for what you think is right”.