‘I’ve seen everything as a nurse – this is how private care differs from the NHS’
Alison* has worked as a nurse across the North of England for 30 years since qualifying in 1991, spending her career in both the NHS and private healthcare. She has worked in surgical departments, in both operating theatres and recovery and surgical wards. She tells i how, in her experience, private care differs from NHS for both staff and patients…
Itrained in a traditional school of nursing. Uniform rules were strict, we worked fulltime alongside studying. I met sisters who scared me rigid, consultants who demanded students were hidden out of sight on ward rounds and sisters who made us pray in front of patients. When I qualified, I worked for the NHS. The hospital I trained in had a private ward, and no one wanted to work there because it was suggested that only the worst nurses worked in private care.
After relocating for my husband’s job and having children, I started working in a local private hospital in the outpatient clinic. The first comment from a friend I trained with was: “What have you done wrong?”
We didn’t see many patients, and I found that apart from seeing a paediatrician more quickly, there is little benefit to private care for children. Most of the parents there were anxious new parents worried about feeding and allergies. They needed reassurance more than their children needed treatment. I moved on to another private hospital, connected to a large NHS hospital, and worked on the ward as a staff nurse. This private hospital survived on its reputation, and looked for the best staff it could get. The company was very patientfocused, and patient satisfaction was always high. But while profit didn’t come before patient needs, we were aware we were in the business of making money, too.
Talking of money, we had contracts with a local high-level sports team and their members were often admitted, along with a few other high-profile names. There were no non-disclosure agreements, but it was understood that asking for autographs or discussing the patients off the ward was at very least a disciplinary offence, potentially dismissal.
Being connected with an NHS
trust was beneficial as we could use their facilities at a price, and at the same time we could observe the brilliant healthcare in the NHS. The NHS staff assumed that we private staff sat around chatting
Alison* is now retired but is concerned about the future of the NHS with patients all day, and that most of them were having breast augmentations or facelifts, but nothing could be further from the truth. The biggest irritation, whenever I’ve worked in private hospitals, has been listening to people outside the system pontificate about it being the privilege of the rich, and not open to those who are lower paid. It is costly, yes, but the patients I encountered tended to be normal people who had insurance through work, had savings or managed to scrape it together because their pain was too bad to wait for their name to get to the top of the NHS list.
Eventually, the private unit was taken over by the NHS and the decline in staffing, patient care and staff morale was alarming. Staff left in droves and the replacements were nurses who didn’t stay long, and there were lots of agency staff. The high turnover led to patient dissatisfaction. Some time after that, I returned to the NHS properly, to a different hospital, in a trust operating theatre. The team was great, hard working and very patient-oriented and I felt like they had been trained as I had.
So what have I learnt over the past 30-odd years? The NHS is a great institution and should be the envy of the world, but there are too many managers. Non-clinical managers make decisions for clinicians, which can be compromising. I found that a lot was wasted – they didn’t look for the best deal or local provision, they just flicked through catalogues and ordered. There was a lot of over- or under-ordering stock and drugs.
Besides the vast number of clipboard carriers, there is a group who contribute to NHS failings: us, the public
The downside of private care as a nurse is that people assumed we were better paid, when in fact we got a fair bit less. This was balanced by a nice place to work, free parking and private healthcare. Patients who pay also often have high expectations – but I’m here to get you well, not to pander to you. Would I go into an NHS hospital for care? Absolutely! If you have a serious illness, cancer, kidney failure, heart problems or anything like that, there is no better place to be cared for. But, finances allowing, if I needed planned care [scheduled treatment to manage a health problem, rather than emergency care] – I would pick private. It’s the same consultants, but you get a single room which is likely to be clean, comfortable and quiet. I retired after the pandemic due to ill health, and I’m concerned about the future of the NHS. Besides the waste and the vast number of clipboard carriers, there is a group who contribute to its failings: us, the public.
Missing appointments, not completing courses of medications, not following advice, ignoring symptoms, continuing with unhealthy habits and behaviours, going to A&E for issues that could wait, calling ambulances like they’re taxis, sustaining injuries on Saturday but waiting to be seen till Monday so that the weekend isn’t spoiled, having your grandma admitted because you are going on holiday/it’s Christmas/she’s getting difficult to manage. I’ve seen it all. I believe the NHS and private care will continue to work side by side. The private teams take on contracts to reduce waiting lists and in some cases the NHS has stopped some non-essential surgeries, so the only way to get them is privately. While we can all learn from the NHS, I still think the NHS leaders should listen to the leaders and staff in private units and learn from them.
I’ve been lucky to meet talented, brilliant people, patients whose lives have touched me, and I will never forget. It’s changed, though. We would laugh with patients, and hold them when they cried.
But now staff are too busy, there’s too much paperwork to be done, online training, audits, endless documentation. Would I do my nurse training again in 2024?
Not a chance.
As told to Kasia Delgado *Name changed on request