The NHS has become the National Suffering Service
So says former nurse turned award-winning writer CHRISTIE WATSON who spent two decades on hospital front lines. As new data suggests long A&E waits are causing thousands of needless deaths, she reveals the mental toll on burnt-out medical staff who have a ‘deep sense of failure about the system they work in’
IT’S BEEN another terrible week for the NHS, even by what can now be regarded as “normal” standards. A damning new study found that more than 250 patients a week may have died unnecessarily last year due to long A&E waits, adding up to 14,000 deaths.
More than a million patients waited 12 hours or more for a bed in England, data analysis by the Royal College of Emergency Medicine shows. The hearts of all doctors and nurses in front-line medicine are bound to sink at the depressing numbers.
Indeed, trying to provide first-rate care in under-resourced circumstances is already pushing health professionals to the brink, says novelist and former NHS nurse Christie Watson, who spent almost 20 years in paediatric intensive care units across London.
In her new psychological thriller Moral Injuries, Watson, 47, from Stevenage, in Hertfordshire, has explored the high-stakes domain of morals and ethics.
Struggling
She calls it “that sticky grey area where there is no right and wrong and where doctors have to make complex, difficult decisions”. Her book charts the 30-year friendship between three doctors – ambitious heart surgeon Olivia, spirited GP Anjali and anxious perfectionist Laura, an air ambulance doctor – who all meet at medical school.
It transpires the trio share a shocking secret from their youth, which threatens to tear them apart in adulthood when their teenage children face a tragic event.
Christie – who won a Costa Book Award for her 2011 fiction debut, Tiny Sunbirds, Far Away – had a short stint as a resuscitation officer in St Thomas’, responding to crash calls, and wanted to explore what “keeps people working in these really highly pressurised jobs”.
The term Moral Injuries is not new but it is increasingly relevant in hospitals worldwide. Christie calls it a “betrayal of what is morally correct by someone who holds authority in a high-stakes situation”. American psychiatrist Dr Jonathan Shay coined the phrase after working with traumatised Vietnam veterans. These days, it can refer to doctors and nurses who feel they are providing sub-standard care because of systemic failures.
“Moral injuries were the price of war and they’re now the price of medicine,” says Christie. “I speak to people who are on the clinical front line at the moment and they are definitely struggling with all kinds of mental health problems, but moral injuries are definitely on everyone’s minds.
“It’s because, after the first pandemic, nobody had time to decompress at all.”
Christie left nursing in 2018 but returned briefly in 2020 to help her beleaguered colleagues at Guy’s Hospital, her former place of work, and at the Nightingale Hospital in east London. And she hears about the longterm implications of Covid’s impact from her former colleagues still there.
“Staff were psychologically on their knees anyway but they were straight back into catch-up mode as the waiting lists were so long that people were expected to do almost double the work without any kind of traumatic or psychological support,” she says.
Caring but firm, Christie is outspoken about the crisis in modern NHS wards. Having authored two nursing memoirs, 2018’s The Language Of Kindness and 2020’s The Courage To Care, she writes unpalatable truths much in the same vein as former doctor Adam Kay did in his tell-all memoir, This Is Going To Hurt, televised on BBC One two years ago.
“The fact that we have corridor nurses is to our national shame,” she says. “It means you’ve often got elderly patients lying in hospital trolleys in the corridor outside A&E.
“NHS staff are the most incredible, amazing human beings but they are only humans doing their best in an unmanageable situation. That leaves them with this deep sense of failure about the system they work in.”
Christie joined the nursing profession at age 17 and enjoyed her work. But she always harboured a secret desire to write and started scribbling in snatches after giving birth to her daughter Bella, now 19, in 2005.
It wasn’t until 2018, however, that she knew she could make enough money to pursue her dream of writing full-time. She still keeps her hand in as professor of medical humanities at the University of East Anglia.
Medical staff retention is a hot topic in any NHS discussion these days, but Christie acknowledges that the needs of patients have altered over time, too. “When I started, peo-
ple generally came in with one problem that tended to be fixable.
“Now people have many complex, difficult comorbidities – lots of things going on at the same time. Along with that, the workforce is not being sustained; it’s been underresourced for 14 years.”
Christie cites long-term cuts to adult social care, councils and youth services as the main culprits. She’s no fan of the current government.
“Where budgets are cut to the bone, then all those people get washed up into primary care as they’ve got nowhere else to go, which creates other problems,” she says. “People come in because they’ve got nothing to eat. They can’t pay their heating bill and that affects their health: physically, mentally, socially and emotionally.
“During my time as a nurse, I felt like the National Health Service became the National Illness Service. Now it’s the National Suffering Service. That’s how it feels.” Despite writing about ethical dilemmas, she doesn’t have a view on assisted dying. But she expresses interest in the Daily Express’s Give Us Our Last Rights campaign that has successfully secured a Commons debate on the issue. “Most conversations around death are a shock for people because we as a society and culture don’t really talk about death in the same way that other cultures do,” she says. “Any conversations around death and dying will be welcome.” Christie says communication between doctors and patients is now more frank. In the old days, family members were often reluctant to press doctors for more information on their sick relatives. “An emotional distance between doctor and patient,” is how she describes it. “A reverence that certainly wasn’t encouraged by doctors but something given by patients. In society, on television and in films, there used to be an idea that doctors know best – don’t question them. “But that certainly didn’t come from doctors and those I worked with always advocated for their patients, voicing their concerns and opinions, enabling questions.”
She pauses. “Often doctors don’t have the answer and that’s OK. There’s an element of honesty going on now, which is a good thing. Sometimes that can be a bit terrifying for patients, but it’s important to have it.”
Christie disliked the hero worshipping of frontline staff that occurred during the pandemic, in the form of clapping and banging pots and pans.
Astonishing
“They’re human beings, not gods,” she says. “If the NHS is a religion, it’s a godless one.
“They’re just normal, complicated, flawed human beings like the rest of us. But they go into the system wanting to help and give so much of themselves.”
Her favourite nursing memory was meeting a young girl who returned to Guy’s and St Thomas’ Hospital two years after she nearly died of meningococcal sepsis. She wanted to thank the staff who saved her life.
“This little girl was on every kind of life support machine you can imagine but then she suddenly turned a corner,” Christie explains. “You rarely hear about people after they’ve left the hospital or ward.
“Seeing her living her life and appreciating a normal childhood made every single thing worthwhile.”
Christie says the little girl would have undoubtedly died if she had lived in a country with an inferior health service. What helped her survive were the developments of technology and the dedication of doctors and nurses.
“It’s really hard for staff and patients in the NHS at the moment but when it works, it’s the most astonishing privilege to have a system like that,” she adds. “It will be such a terrible thing if we lose it.”
● Moral Injuries by Christie Watson (Orion Publishing Co, £16.99) is available to order from Express Bookshop. To order a copy for £16.99 visit www.expressbookshop.com or call Express Bookshop on 020 3176 3832. Free UK P&P on online orders over £25.