Do the general public know how bad the conditions in the NHS are?

[Gakatsbsk]

Hello

Expecting to be roasted.

However, I’m an NHS staff nurse. Qualified almost 2 years. I’ve worked through the pandemic. I initially worked in England and now work in a different UK nation - which is better but only because England was so poor.

My union is about to start a consultative ballot for industrial action in light of the nhs pay offer. I have had two family ‘acquaintances’ (who do not work or have immediate family that work for the nhs) complain in one breath about delayed appointments, delayed A+E waiting times, cancelled surgeries etc but then in another tell me that nurses going on strike is disgusting, lucky to have a job, NHS more secure employment etc. These are of course English Tory voters who said this

For reference, I have never and will never cross a picket line and will be voting in favour of industrial action (whatever form that takes due to emergency cover staffing etc).

When I was a few weeks qualified as a nurse I was looking after double the safe ratio of patients in my speciality. Completely unsupported, me and my (equally junior) colleagues having to consult google for solutions to our patients problem, if a medical emergency occurred (in ICU there should always be medical cover - this isn’t the case) we had to pull a buzzer, put out a page and get on with it until a medic appeared. This has not improved post pandemic.

In my current workplace (same speciality area), different country we are the only part of the hospital that is safe staffed, because of this every single day nurses and HCAs are sent to general wards, A+E and different hospitals often to be the only RN on a ward for 30 patients. There is such a crisis of care home beds, and ward beds that patients are staying in critical Care for weeks waiting on a ward bed. On the wards patients aren’t able to be washed each day as there might only be 1-3 staff members for 30-40 patients, meds rounds take 4 hours and ultimately patients who are sick go unnoticed until they are peri arrest. Nurses from day shift often have to stay on to night shift as there is no night shift nurse available.

I have only had negatives from the general public - it’s our fault for having degrees and being too posh to wash, bring the matrons back, etc etc. our colleagues who trained in the 80s and 90s pre degree say it is the worst it has ever been for safety and staffing. Racism and xenophobia towards our brilliant overseas colleagues is rife when they keep the NHS clinging on by a shoestring.

Four and a half years ago I was a first year student nurse and times were hard for the NHS, it has only got worse and worse for my patients since then. For the sake of my patients I will take industrial action.

However, it is so concerning how anti union, anti public sector and pro Tory the English public seem to have become? The decisions and government of Westminster negatively affect every nhs patient and worker in the UK. Just look at the widespread abuse, disdain and disgust directed at the RMT workers recently. I fear the same or worse for NHS workers.

So, is this NHS worker wrong for not enjoying being told to be grateful to work for the NHS? Is there any future for the public sector of the UK?

I apologise if I seem to have generalised England but I am English and from a northern Tory heartland. An area completely brainwashed.

I've been a nurse for ten years, ward based mostly- HDU paeds settings. I'm pretty sure I have PTSD, o have no job satisfaction anymore as it kills me to work so hard and still not be able to provide my patients with basic care. I can barely pay my bills.

@Agreeeeed thanks for clarifying, apologies if I may have misinterpreted your post

@RosesAndHellebores agree with your post. It’s been absolutely shit for years.
I needed an MRI a couple of months ago. Was sent round from A&E after 6.5 hours to wait in the radiology dept corridor for 2.5 hours. For almost 55 mins of that time, 8, YES 8!, nurses stood talking leaning over, and some sat at, the nurses station. I knew how much one spent on their weekly food shop, what school another children went to, where another was going out that weekend but not a clue why any of them couldn’t be doing any work.

It’s been an absolute shit show for years now. This is notning new.

My grandfather died alone this year in his hospital bed as the nurse tried my grandmothers number once, none of the other numbers they were given to call in an emergency, and didn’t try again when my 87 year old grandmother didn’t pick up.

We are thankfully in a position where we won’t use the NHS again now but many don’t have the option of private care and that’s worrying.

@Windypants21

Nurses dont have to privilege of going into an office and being selective about answering or not answering a phone call because they're too busy. They get sick too, feel unwell, tired and have the same stresses as everyone else but the way we are treated is as if we as human beings dont matter.

No harm, but is this not what GP receptionists do daily?

I’m not sure what jobs you’re thinking about, but I certainly can’t go into mine and ignore emails and customers, regardless of how busy I am. I have to deal, skip a break more often than not (not that I ever get a break, anyway, it’s always interrupted with something) and get the shit done. I can’t talk to customers and my staff like shit because I’m stressed, I’ve got too much to do and I’ve got 0 hours sleep the last night because I’ve been up with a toddler. Yet many NHS staff so talk to people like they’re shit on their shoe. I’ve barely been in hospitals my entire life yet my very few experiences of them have been horrendous. I struggle to believe I just got “unlucky”.

Yes agree. This is where the problem is! Social carers are underpaid,understaffed and not appreciated or valued!!

@Bpdqueen

Student nurses are unpaid and not included in numbers - they are not workers.

Also, you might not realise this but students complete placements - they are not a permanent fixture.

I am glad staffing is so good at your hospital, I’m sure the staff would agree. Safe staffing to provide adequate patient care is 1 RN and 1 HCA per 8 patients. In HDU it is 1 RN to 2 patients and ICU 1 RN to 1 patient.

I don’t think there’s any point us arguing over it, I myself am a chronically Ill patient but have no expertise in mental health services, or endoscopy and am wise to not think I know better than the people who work in these areas

Current Band 5 salary (NQ) range is £25,655 - £31,534. Over 3 pay points. This is a basic rate for 37.5 hours per week, with not enhancements and would equate to a Mon-Fri only role such as Out Patients clinic (obviously there are other areas which provide similar shifts) Only a minority of Band 5 nurses work in these roles. The majority of roles involve shift/weekend/out of hours working for which there enhancement payments are made, these by their nature increase pay significantly. Not underpaid.

The NHS is also still suffering from the the white/red elephant of PFI funding, tying in to 30year mortgages and contracts-thank Tony Blair for that.

Band 5 salary is:

<2 years' experience £25,655
2-4 years £27,780
4+ years £31,534

Hourly it's:
<2 years' experience £13.16
2-4 years £14.25
4+ years £16.17

That's for full time. Full time in the NHS is 37.5 hours, breaks are unpaid. Saturdays and nights add an extra 30%, Sundays and Bank Holidays are 60% extra. Take 9.8% off for pension contributions, whatever the student loan repayment is, and normally about £25 a month for staff car parking. Plus £120 yearly NMC fees. And £16 per month for a union in case you need legal help.

The difference between a receptionist and a nurse is incomparable! As a nurse we also have the patient to look after !

I’m going to bow out for the night

Thanks everyone for the replies. Some of you have all the answers on how nurses can care for patients in unsafe ratios. A nursing degree is 3 years and 40 grand - I look forward to you all bringing your solutions to the front line.

To my fellow health service, emergency service, social care and primary care workers I send my solidarity. I hope it gets better - plus there’s a few tips on here on how to do our jobs better which is clearly what we need 🤐

Thank you for your post, from a fellow nurse.
It is the same in the community. Myself and colleagues feel like we are failing families and the staffing levels are only getting worse.
I love my job but I am dreading my maternity leave coming to an end.

There is a marginal difference in the pay between the four nations of the UK - hence why my salary is slightly higher on the same band and increment than when I was in England

@Gakatsbsk it's irrelevant whether student nurses are counted in the numbers their still an extra pair of hands to help which means its not just 1 nurse and 1 hca like you originally said and when students complete placement a new set come. Student nurses and junior drs are the best ones they still care about their patients and don't talk to them like their 💩

A typical shift from my mental health ward days (it's a good day, no seclusion):

In at 6.45am for 7am start. Shift ends at 19.30.
21 patients: 2 RMNs, 3 HCAs (at least one agency and never been on the ward before)
Full handover of all patients at start of the day, risks, changes in presentation, plans for the day etc. It will over run. Night staff will be late leaving.
Sign keys out.
1 patient is on 1:1 observations so needs a staff member with them all shift. Staff have to be swapped every hour.
5 patients have unescorted leave so can come and go as they please but need to be signed in and out each time, leave documents completed, physically let out of the building (takes staff off the ward)and searched on return (2 staff needed)
1 patient has a planned hospital appointment, it will take 2 hours, they need a staff escort
4 patients want to use escorted leave, it needs to be fitted in around the other leave, it has to be before the shops shut at 5 and can't be at meal times or meds. RMN needs to risk assess all leave and complete documentation.
Medication rounds are at 8.00, 13.00, 18.00, each takes about an hour, some patients are on 13+ medications, some are on controlled medication which requires 2 staff (can't be the agency, could be an HCA but only if they've done extra training)
Ward round for 5 patients, from 9-12. Family need signing in, nurse needs to be present throughout (off the ward). All actions need completing and documenting afterwards (such as contacting community teams, walking over to pharmacy to drop off / collect new meds).
Meals are off the ward. Patients need to be accompanied in the dining room, 3 need food charts completing so there need to be enough staff to keep an eye on this and bring people back.
All patients need their whereabouts and wellbeing checked at least hourly. Some every 30 minutes, a couple every 15.
There's the ward meeting for the patients and the bed management meeting (which needs a nurse)
1 staff needs to be on security to get items out of lockers for people (things like lighters, not allowed on the ward but people might want them for leave)
All of this needs planning at the start of shift, who will do what and when, how it will all be fitted in.

Then you have all the patients who want to use escorted leave in 15 minute blocks since smoking is banned on site.

The patient who is experiencing hallucinations which are frightening and needs extra time to talk and additional medication.

The patient who has used an item to wrap around their neck in an attempt to end their life / express their emotions, this needs cutting off safely and quickly, medical treatment and lots of time to talk about their distress, increased observations.

The patient who is angry because ward round didn't go well and is shouting and threatening to throw things (or throwing things) and needs skilled deescalation.

The family who need to talk about what is happening and what might happen next.

The alarms are going off on the ward next door and you need to send staff to respond.

Any of these need incident reports.

If any staff are on short shifts so go home and new staff come in someone needs to give them a handover.

Oh and we are supposed to do some therapeutic work with people.

Every patient needs a note for the day. HCAs can write some but the RMNs have to countersign those.

It is like trying to square a circle even on a good day. Staff numbers are too low and turnover is high. In acute mental health they go through newly qualified nurses like they're going out of fashion.

Better pay would attract more people and I believe it is deserved for the skill and responsibilities but really it is better conditions and better ratios that would retain more people and give better care.

My union is about to start a consultative ballot for industrial action in light of the nhs pay offer.

@Gakatsbsk I'm sorry but I don't support these strikes. I also find it difficult to comprehend how striking for higher pay in any way resolves any of the issues you outline in your post. The objective of these strikes is as you say, to get more money. Will more money make the 'sub-optimal' conditions for patients better? No, it won't. Nurses being paid more will not magic more beds, address staffing ratio's, lack of skills etc.

I'd also offer the perspective of my Mother - a nurse who qualified in the 1970's and worked alongside the pilot cohort of nurses who undertook degrees. Mum worked in A&E, pediatrics, surgery, rheumatology etc - tough wards. All of the issues you allude to existed back then, as did the grueling shifts (alternating with night duty!). None of these things are new, yet according to my Mother at least, what is new is reduction in the level of care offered. Patients were not left to deteriorate un-noticed on her ward, they were monitored appropriately and cared for holistically - and back in those days it was the nurses job to clean the ward as well as wash patients and tend to their personal care - tasks now divested to others. She was routinely responsible for 40-50 patients, and the only qualified nurse on the ward - except those who had done degrees (who in her view simply created work and had no clinical skills whatsoever - hopefully that has improved since the pilot intake). My Mother never striked, she considered it to be unprofessional and to put patients at risk.

She was utterly appalled when she visited me in hospital over a decade ago, when I'd given birth. I have complex medical needs and was a high risk pregnancy. My drip had run dry and my catheter bag was so over-full, it was bloody, flowing back into me and leaking on the floor. I hadn't noticed as I was in so much pain from the episiotomy and not having eaten for 14 hours (they'd run out of meals and I was too weak to walk to the kitchen to make toast for myself). Concerned at the state she found me in, she went to find a nurse. She found the nurses sat at the nurses station having coffee and chatting. The nurses did not even know the conditions I had, and were very put out when she asked they address my drip / catheter bag. Filthy looks and snotty comments later they very roughly tended to me. Half the beds were empty on this ward, there was no excuse. Mum was gob-smacked - in her day there would have been severe consequences for neglecting to address these basic things let alone the reaction from the nurses when asked to rectify such an oversight. I've spent a fair amount of time in/out of hospital all with similar experiences as I had giving birth, a very traumatic birth at that. I struggle to reconcile the claims of being ''over stretched'' with the sitting around, smoke breaks, coffee breaks, gossiping etc I've observed on each and every occasion. I personally don't have time to do that when I am at work. I am weary of being expected to be grateful for this kind of care. No support with a very sick child (I thank god every day for the private gastroenterologist who saved her life and lamented the disgraceful state she had been allowed to get to in her short 5 weeks alive), no support for PND, no support with child's ongoing needs, no care for chronic life long conditions (sorry we don't have anyone with expertise in that condition this area - you can apply for out of area etc), no support with anything. Having experienced continental health care for 15 years of my life, I know only too well how different it can be. It pains me that many in this country will never experience this.

The NHS is not fit for purpose, it's barbaric. Blame the Tories all you like, but the facts speak for themselves - the NHS is funded along the same level as many continental health systems yet unlike their continental counterparts can only deliver a very poor, often unsafe, level of medical care. If you want to improve conditions strike for reform not more money. Nurses being paid more will not make one iota of difference to the care provided to patients.

@Gakatsbsk If nurses want better staffing levels there's 2 things you need to do first stop telling people what a horrible job it is and putting people of and secondly stop being bullies if you weren't all horrible to each other less staff would leave

@Bpdqueen
I agree that student nurses are often brilliant and do a good job. However, they are not on every shift, every Ward and every time of the year.

currently in my hospital there are around 100 student nurses on placement. That is 1-2 per ward on average and working 3-4 shifts a week.

I will not allow brilliant, unpaid, supernumary student nurses to be used as an excuse to justify unsafe staffing. I have been moved to wards where students are so busy because of A LACK OF REGISTERED NURSES AND HCAs that they are trying to bridge a gap. I have worked in five nhs hospitals in two countries and have worked or been a student in the NHS for 5 years

Also, do you think one RN, one student nurse and a HCA is safe staffing for 30+ patients?

I’d seriously encourage you to work for the NHS as you are effectively trying to gaslight me about my own working conditions. Student nurses aren’t HCAs and aren’t Registered Nurses, they deserve more respect.

I won’t be replying further as we aren’t getting anywhere. However, I’m sorry if you have received sub standard care and attitudes - I myself have complained formally after being told endometriosis was normal, ADHD wasn’t possible in a professional and other issues

Obviously…?

Receptionists are often the patient’s first point on contact within the NHS. It would be fucking fantastic if they actually

• answered the phones for the duration the practice is open


• weren’t rude


• didn’t treat patients like a nuisance to their day of sitting on a nice little office chair sipping coffee


• opened 7 days a week because people get ill on the weekends, too

So it’s hardly every single NHS employee who is worked to the bone. GP staff have a pretty cosy time of it, by the looks of things.

The previous poster made a point of people in other careers getting to pick and choose what work they did- it isn’t true. Most jobs are stressful these days, it isn’t just limited to the NHS. A lot of jobs have to deal with members of the public who are rude and abusive, too. Again, not limited to the NHS. Far too many people are in severe poverty, earning much less than NHS wages.

At this point the NHS isn’t worth saving. It’s been done for years. Patients don’t get cared for anymore, they’re pushed from pillar to post until they either

• die


• give up and live with it


• chase everything up continually to the point where it consumes their life

People aren’t treated with respect and dignity anymore. We pay for a shit service that makes it as unpleasant as possible to be ill.

You very may well be a good nurse, but it doesn’t fix the fact that in most people’s journeys, they have at least one bad experience. If I spoke to a customer how a HCA spoke to me, I would have been sacked immediately. Regardless of how stressed and tired you are, no one should be acting like that. If you reach that point, you need to leave.

Well fucking said.

In your opinion, why now?
There has always been poor bed management and short staffing.
Lots of people, mainly elderly died in 2020 who would normally be the revolving door patients.
Treatment delays are in the specialisms and clinics.
Sheer volume of traffic has been happening since 2021.
Staffing has always been low but with less patients expected, why now is it crumbling in your opinion?

Also, what sort of alternatives or back up plan would you suggest to help the problem?

My relative is not a nurse but a HCP and has been doing some work in the NHS in an eye clinic for the last 4/5 years. So before Covid. She says the absence level is ridiculous with the same serial offenders off sick (presumably on full pay) every 10 mins. I worked in the public sector as well and the absence and piss taking was something else and never managed properly. Of course being in the NHS is a responsible job and it isn’t a race to the bottom but I can’t imagine how much their absence must cost them.

@Pinkyxx

Thanks for your input and opinion.

As an intensive care nurse I strive to provide my best for my patients. I will continue to do this to the best of my ability and provide the full nursing care In intensive care. The wards are facing the worst staffing crisis and that is where safety is particularly compromised.

My colleagues who qualified in the 80s and 90s paint a different story to your mother. My own mother qualified in the 80s, my aunty in the 70s. If it was truly just the quality of nursing care then that would be an easy solution. But I don’t have the energy to argue with you.

Industrial action and strikes took place in prior decades, it isn’t just a modern post matron post degree thing.

Respect to your mother for her service.

Can I ask OP, what training, cpd and requirements do you have to meet for that wage? I expect 3 years at university is just the start of it?
I earn £125 a week less than you (quick calculations) I am a supervisor/duty manager in a hotel. No degree, no cpd, no professional registration, no lives at risk, we get to kick people out that abuse us not get told it's our fault, if there's not enough staff then life and limb isn't at risk with the staff that are there taking the blame.
I worked in social care, I love the job, it's so fulfilling, but unfortunately when you do actually care and want to look after people, when you feel shit and guilty because you can't because there's not enough resources, time or staff to do it, and then get the blame for that, you leave, when you give everything you have, are demanded to give more and can't pay your bills, you leave, when you're abused and blamed for the failings of the organisation, over and over again, you leave.

The current system is driving out those HCPs that are giving everything they've got to treat their patients properly, they have nothing left to give, they're not the ones withholding care, they're the ones trying to facilitate it - and when they leave you're left with those that don't care and so care gets worse.
Raising pay and conditions will hopefully, encourage those who do care to stay, others to train, we've got to give them something to stay or train for because they're leaving in droves - and what does the general public, government and press do? They blame the ones who stay. Not the ones who are mismanaging the services and money off a cliff. Spectacular own goal.

Of course there's shit employees within the NHS, but ask yourself who's letting them stay and why? Is it because it's getting to the point that they're all that's left?
This has been coming for years and no one, least of all the government are doing anything about it.

The NHS should not be a sacred cow, and we should not be grateful for diabolical care at all, but we also shouldn't be scapegoating the wrong people either, that changes nothing, it actually is making things worse, the wrong people are being held accountable for systematic failures.

I would support industrial action, unfortunately though I think that it will whip up even more bad feeling towards the NHS and the workers within it, because people can't see the bigger picture and everyone is scared that nurses might get 'one over' on the tax payers and might get something they're not.

For me I'm just glad that I'm not in the position of working in that environment day in day out, and I'd encourage anyone who thinks that it's easy and it's all because nurses stand around chatting all day to get themselves off to university and step up and save us from all this.
I don't suppose they will though.

Again you've misinterpreted what I'm saying. I'm not saying 1 nurse and 1 hca is acceptable staffing levels I'm saying iv never seen it in the four different trusts and 9 different hospitals iv been under and find it quite difficult to believe that this is normal in your hospital. I mean how does that work with 1 nurse when you go for your breaks or to pee oh no thats right you don't get breaks or pee in the 13 hrs your there I think you need to change hospitals as any iv been in the groups of nurses have ample time to have a good chat with each other

OP I agree with you and I think it comes down to a few things-

1. Conservatives hate paying for public services, they want to privatise as much of it as they can to sell it off to their mates for them to make a profit from it.
2. I believe lots of Conservatives and their voters can afford private health care so don’t really care. If you’re an MP you probably think you’ll get better service anyway.
3. People are always being told the NHS is on its knees, it’s just become an accepted fact that it’s dire, so until people are on the receiving end of it they don’t take it seriously. I also think given that the cabinet is full of millionaires they are out of touch with the real world and the cost of living because few of them have ever had to worry about it.
4. Because so many staff are overworked and underpaid the care isn’t always great and instead of it being identified as due to lack of staffing, it’s easier to believe it’s incompetence or mismanagement because they are annoyed at their care.

I do not live in England as you might guess, the Tories are despised in Scotland - most people in Scotland cannot understand how so many people in England can vote for them when they do not represent their interests, and have proven time over what they stand for.