NHS at 70
A nurse’s view from the medical front line
Iwas sent for my first placement as a student nurse to a hospital in Hackney Road, which pre-dated the hipster bars and regeneration and was known as Murder Mile, back when there were several murder miles in London. It was before the strict age of infection control, and we student nurses would wear our uniform to travel to work without worrying about bringing in all the dirt and diseases of east London.
Besides, the hospital was a place for the great unwashed anyway. Within the first week, I had nits, scabies and impetigo. A child bit me, drawing blood, and I was sent to occupational health for a hepatitis booster. A baby, while I changed his nappy, exploded diarrhoea all over my face, in my eyes, and I went back to occupational health. These were the hazards of nursing. It was on this ward that I first heard the term FLK.
A three-year-old child was admitted with exacerbation of asthma, but was found to be “failure to thrive” (small for his age). His face was sparrow-like, his eyes were squashed together, he had a square head and long, thin arms that seemed to belong to someone taller. He bounced in and out of the children’s ward for months with an exacerbation of asthma. “We need to get the doctors to do metabolic bloods. And send him for genetic testing. He’s an FLK.”
The nurse I worked with had the calf muscles of an Olympic athlete and wore a bum bag from which she produced all sorts: scissors, arterial forceps, green, red and black biros, surgical tape, a pen torch, a tongue depressor, hand cream, a plastic vial of saline, a Mars Bar. I’d been asking questions non-stop since I started the placement, undeterred by the wave of infectious diseases (foot and mouth disease and scarlet fever were still to come for me), and I could sense her irritation every time I asked anything. But I couldn’t stop. “What’s FLK?”
“FLK. Funny looking kid. You know, syndromey. Chromosome-gone-wrong type thing. End up with dozens of comorbidities.” I looked at her face, her close-together eyes and high-up forehead; her expression, matter-offact and without any sense of irony.
Later, the child’s father arrived on the ward, a thin man with arms swinging down towards his knees. He smiled and his face turned birdlike instantly. “Cancel the bloods,” she said. “Diagnosis FLK. Funny looking kids usually only need investigating if they don’t have funny looking parents.”
It turned out simply to be asthma, after all. As with many of the patients I looked after back then, he had a single, treatable condition that resulted in recovery. As someone who worked in the NHS for many years, I don’t have rose-tinted glasses for times past. I remember the archaic hierarchy, the antiquated technology, the maddening rules (disciplinary action for nurses if you weren’t wearing a belt at night). But, despite improvement in some services, many things have changed for the worse. The biggest change is with our patients, who now have complex patterns of emotional and social and physical and mental illnesses, and numerous comorbidities.
Mental illness is increasing in the UK year on year. We live long lives and, increasingly, with the advancement of technology and lack of ethical discourse about natural death and dying, our living is sometimes not really living, but simply not dying: prolonging life is often more truthfully prolonging death.
Almost 20 years after looking after the child with asthma, I looked after another patient with asthma. David was a 61-year-old on a general medical ward who had a cardiac arrest the night before I met him. I was sent to look at his notes and fill in an audit form. When I arrived, David was sitting up in bed, using a nebuliser, a mist of fog around his head. I found his notes in a trolley at the end of his bed.
David had: diabetes, heart disease, renal failure, high blood pressure, previous history of stroke, vascular disease, rheumatoid arthritis and chronic obstructive pulmonary disease.
He was also suffering from addiction issues, alcoholism, bipolar, generalised anxiety disorder and frequent bouts of serious depression. Oh, and asthma.
David was not alone. Allison Pearson described in this paper my depictions of the NHS as “Dickensian”. The NHS has always provided refuge, but it is increasingly true that our society seems now to be full of characters that belong in Victorian slums.
David pulled down his oxygen mask, his eyes dull and afraid: “I’m sorry for causing all this bother, doctor.”
He was right – like too many of us, he probably had caused a lot of his problems, certainly exacerbated them, but with his underlying mental health and emotional issues, his poverty, it was not a surprise that he hadn’t taken care of his physical health. Nurses understand that people are a giant jigsaw puzzle and their illness and hospitalisation just one small piece.
It turned out David was a primary carer for his elderly mother, who had advanced dementia, keeping her out of hospital for so many years. “I’m not a doctor,” I reply. “I’m a nurse. And don’t worry. That’s what we’re here for.” And we are. The NHS is an institution much like the Church; a place of sanctuary built on tolerance and respect for all human beings regardless. The NHS is so tied up with our British values and belief system that we can’t view both things separately. If the NHS is on its knees, then so are we.
After eight years of austerity, Theresa May’s promise last month of a cash boost simply isn’t enough. It equates to 3.4per cent per year for the NHS. The Institute for Fiscal Studies has long highlighted that the NHS needs at least a 4per cent year on year increase to meet the needs of the NHS or see any improvement. We are paddling backwards.
The recent report by The King’s Fund and others found that cancer, heart attack and stroke care in the NHS is sub-standard, mediocre at best. It also highlighted what we have been long shouting about: at a time when patients are living longer and with more complex problems than ever before, we do not have enough resources. We do not have enough doctors. We do not have enough nurses.
NHS staff battle on regardless, doing the best job they possibly can in impossible circumstances. Female nurses have a suicide rate 23per cent above the national average. I am not surprised. The job is impossible. That the UK is still among the best healthcare systems in the world for protecting those who cannot afford to get ill – despite having fewer staff, beds or equipment than virtually all other developed countries – is entirely down to those hard-working individuals who provide care, compassion and kindness.
It is now down to all those British people who hold dear our values to demand better from our government, but also, wherever possible, to care for our relatives, our neighbours, ourselves. We would do well to remember our origins, the power of our values. In old English, “kyndnes” (kindness) meant “nation”, also “kinship of the same (human) race”. We are in this together.
Names and details have been changed to protect patient identities. The Language of Kindness: A Nurse’s Story by
Christie Watson (Chatto & Windus, £14.99) is out now. To order your copy for £12.99 plus p&p, call 0844 871 1514 or visit books.telegraph.co.uk
For more on the 70th anniversary of the NHS, go to telegraph.co.uk/nhs70
‘Our living is sometimes not really living, but simply not dying’