I have worked in the NHS, in various jobs, from 1986 until 2006. I started as a physio department porter, then night telephonist, occasional CSSD storesman, domestic assistant in Stoke-on-Trent, and then as a student nurse in Hull. I flunked the Health Promotion section of the Foundation examinations.

I was then a nursing assistant working with the elderly mentally ill until the hospital closed and I was made redundant. The policy was to move patients out of institutional hospitals into the community. My last job in the NHS was as a domestic assistant in North Devon District Hospital.

There are two relatively recent policy changes that have, in my view, messed up the NHS. The first is Margaret Thatcher’s decision to bring ‘the market’ into the NHS. Second, is the system of Nurse Training.

But there is also a third aspect that also messes up the healthcare system: the way it was structured when the NHS was created in the first place. No-one in particular is to blame for this. Our politicians and doctors did not have the skills and knowledge that is available now to construct a timely and responsive sytem that reacts to the clinical and psychological healthcare needs of the patients/clients as they arise.

Margaret Thatcher brings the market into the NHS

Mrs Thatcher’s policy of bringing the market into the NHS was and is disastrous. It changes totally the ethos of the NHS from a vocation of caring and responsibility towards the patient to an ethos of cost-cutting and income generation. The patient is a ‘cost’ to be reduced. The shortage of hospital beds is the result of accountants and administrators cutting what was seen to be ‘excess capacity’. “Oops sorry, there is a flu epidemic this winter, you will have to wait on a hospital trolley in the corridor until a bed becomes available.” Suddenly on-site nurses’ accommodation at hospitals was converted into office space to cope with the explosion in the numbers of administrators and managers.

We now have a situation where there are insufficient numbers of nurses, midwives and doctors, while useless Chief Executives and administrators are sacked or leave with excessive payoffs (anything greater than £0). Why don’t administrators make themselves redundant so more medical staff can be taken on? (Although, it must be said, many managers and administators are qualified doctors and nurses.)

The system of Nurse Training

Traditionally, student nurses were employed by the hospital and were accommodated in a nurses’ home on the hospital site for the full time of their nurse training. There were two classes of nurse. There was the State Enrolled Nurse, which was a two-year course for nurses who wanted to do ‘hands on’ care and did not want to be a Staff Nurse/Ward manager and not involved with management at all. The State Registered Nurse was a three year course for those nurses who wanted to progress through management. In a sense, student nurses were apprentices employed by the hospital. The training was (and still is) half college-based and half practical/hospital-based.

Project 2000 was brought in to professionalise the vocation of nursing, to make it a Nursing diploma and degree course. Instead of being paid a wage and living in subsidised accommodation for the duration of the course, a nurse was awarded a bursary. In March 1993, it was just over £4,000 per annum. But a nursing diploma or degree course is not like any other degree course, with (say) just 15 hours of seminars and lectures to attend each week. It is 35 hours per week of study or – especially if you proceed to the branch programme – a full week on the ward. But after the foundation course one has to find private accommodation (well, I did up in Hull). With rent at £60 per week and a bursary of £80 a week, any student nurse would require a second job to survive. This is scandalous. I do not know if things have improved now. But I doubt it.

The structure of the health system

The people who should be responsible for delivering timely health care, the doctors and nurses, should be the ones who are given the tools and the information to do the job. It is relatively easy to collect and collate data/information on a daily basis, analyse it, and present the relevant information to the relevant decision-makers on a daily basis and, if necessary, updated hourly. (For example, the number of patients entering and leaving a hospital or doctors’ surgery and with what diagnosis.) These flows of people/information in and out of the various levels of the NHS could be displayed on a screen and health trends predicted so the decisionmakers (perhaps the General Medical Council?) could decide on which course of action to take. Train more heart surgeons, more Orthopaedic surgeons, and more GPs.

In other words: eliminate the bureaucracy that is strangling the life out of the NHS.

* Bob Wootton blogs at A Lib Dem Vision.