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Row over nursing training highlights NHS ‘entitlement culture’

Last week, Margaret McCartney took the BMA to task on Twitter over its decision to include private health insurance in the remuneration package for some of its senior staff. The ethics of the BMA rejecting NHS healthcare in this way and using the fees of its members to fund the private health industry deserves a healthy and robust discussion.

What struck me as I write this post, however, was the argument the BMA used in their defence by declaring: ‘It is part of a package to help us attract very senior staff by offering benefits comparable to similar roles in other organisations.’

It seems that the ‘Culture of Entitlement so eloquently criticised by the Archbishop of Canterbury Justin Welby last week, is not confined to the City, but also applies to senior staff in the BMA. It is not sufficient that they have a high profile post, reasonable pay, good job satisfaction – or maybe even think a role has an important and worthwhile function. Apparently, senior staff expect private healthcare – and so they should have it. This culture of entitlement is matched equally by a culture of acceptance among the rest of us, as year-on-year we fail to prevent the rich from getting ever richer.

The Government, however, is on the case. In fact, they have been at pains to remind us that dedication and service should be the key drivers for any upright member of our Big Society. Naturally, they have set their sights upon nurses. No more of them will nurses be able to bask in the extravagant life-style afforded to them by starting salaries of £21 388, or the indulgent luxury of working complex shift patterns, until they have first proven themselves worthy. Jeremy Hunt believes that the only way to embed a culture of compassion in our nurses is to compel them to work as a healthcare assistant for a year before receiving funding to train as a student nurse.

The contrast could not be starker: jobs at the top of the pile can only be filled by making them more financially attractive, while those at the coalface – where we really need to attract the very highest quality people and make them feel valued and appreciated – are not to be encouraged by improving the current insubstantial level of reward, but to have another sizeable hurdle placed in front of anyone aspiring to enter the profession.

The Government’s response to the Francis report, which is the origin of this proposal, conceded that ‘the vast majority of…nurses give excellent care day-in day-out,’ and yet, by issuing this unilateral imposition on nurse training, it has insulted the entire nursing profession by casting doubt on their vocational calling. Has it not occurred to the Department of Health that nurses may enter the profession full of compassion and a desire to serve, but that it can be gradually squeezed out of them by chronic under-staffing, excessive bureaucracy and repeated  top-down reorganisation?

Perhaps they should re-read the report – for that was what Robert Francis concluded. If they lack the time to wade through its many hundreds of pages, perhaps they could spare four minutes to listen to the eloquent and heartfelt words delivered by student nurse Molly Case at the RCN Congress. Her poem ‘Nursing the Nation’ leaves no room for doubt that compassion in nursing is – and always has been – the norm.

The practicalities of Hunt’s suggestion do not fare well under scrutiny. We already have a recruitment crisis in nursing which this proposal can only compound, while the hidden message behind the proposals are frankly discriminatory. It will not be a requirement of all nurses to undertake this unnecessary work, but only those who wish to receive NHS funding for their training. Presumably, therefore, a trainee nurse from a rich background could forego the funding and skip the year as an HCA.

We can only conclude, then, that the Government believes it is only nurses from poorer backgrounds who are ‘too posh to wash’. No wonder the RCN President declared the whole idea to be stupid. There really is no other word for it.

I’m not sure we should throw the idea out altogether though; there is merit in the idea of work experience as a healthcare assistant. The benefit must surely be greatest for those who really need to understand what it means to be a nurse but currently have little or no idea. I wonder who that might be – hospital managers, perhaps?

No, I’ve an even better thought – why not make it a requirement for those aspiring to become Secretary of State for Health?

Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.