Banks and the NHS: the joy of numbers

Numbers are such fun.

Here are a couple. Barclays Bank has 481 senior staff who were paid over a million pounds last year. A large proportion of that money came out of its bonus pool that amounted to £2.4 billion.

Meanwhile, the National Institute for Health and Care Excellence (NICE), which offers guidance on safe practice in healthcare, has reported that nursing levels have fallen to levels at which many hospitals can no longer operate separately.

Nurses: numbers are falling to levels where safety is compromised

The government maintains loudly and repeatedly that this has nothing to do with funding: “...hospitals must balance their books whilst ensuring compassionate quality care for all. We know this can and is being done – safe staffing levels lead to better care and can save the NHS money.”

Nevertheless, the service itself knows that faced with the challenge to save £20 billion by 2015, issued when the current government took office in 2010, many hospitals responded by cutting staff numbers. The Royal College of Nursing finds that there are hospitals now with 16% of their nurse posts unfilled. 

Ironically, the economy drive while damaging hasn’t even achieved anything like the savings wanted, as the service is spending several hundred million pounds a year on bank nurses. Just to avoid confusion, that’s not the same kind of bank: it’s the system by which nurses can earn more by doing extra shifts for a fee significantly higher than normal pay. That’s what hospitals are having to pay to make up shortfalls.

NICE now calculates that to get back to safe levels would require in the region of 20,000 more nurses in the service. The cost would be around £700 million: the rule of thumb figure used is £35,000 per year per nurse.

That’s what it would cost to make us all safer at those moments when we most need to be protected, when we’re ill enough to be in hospital.

Now let’s look at those figures again.

481 staff at Barclays bank made at least a million last year. That’s enough for nearly 30 nurses each. And that’s a minimum: many of those million-plus executives took a great deal more.

Barclays Bank set aside £2.4 billion to pay its staff bonuses for last year, a year in which the Bank’s performance actually fell. So for bad performance, it set aside nearly three and a half times what it would cost to make the whole of the NHS safe for all of us.

Barclays Bank has also just announced 19,000 redundancies. Those powerful executives, being paid enough to staff an entire hospital ward on their own, are going to earn their money by taking a lot of people paid a great deal less, and throwing them onto the unemployment scrapheap.

Meanwhile, the government is extremely unlikely to dig up the funds to find the 20,000 extra nurses our hospitals need.

It may, of course, just be me. But I feel these figures say just one thing: this society of ours has got its values into a complete mess.

And just one question springs to mind: how can anyone still be planning to vote again for the parties that make up the current ConDem government? Or, given that UKIP shares its stance on the NHS, its main challenger to the right either?

Pride comes before a fall. Or sometimes just a stumble

It had been a great day. 

The presentation had gone without a hitch, the team’s performance had been exemplary, we’d achieved all our aims. And it didn’t make it any less satisfying that the working day was ending early. I might even be home by 4:00.

I left the hotel which had been the scene of our triumph with perhaps not quite a spring in my step – the intensity of the occasion had left me far too tired for that – but certainly with a gratifying sense of accomplishment. My mood was helped by the clear blue sky and the wintry sun, a pretty afternoon which, though cold, was a welcome change from the grey and fogbound monotony of the morning.

So even crossing the car park was a pleasure.

I opened the car boot, threw my heavy rucksack into the back and slammed the lid. It did make a lightly odd noise, I noted, but at first I thought nothing of it. But then, ‘damn,’ I thought, ‘I need my wallet and it’s in the bag.’ I went to pop open the boot, but it was locked.

I tried one of the passenger doors. Locked too.

‘How on earth can that have happened?’ I wondered as I checked my pockets for my keys. Pocket after pocket. Coat, jacket, trousers. Each as keyless as the one before.

Slowly the terrible truth dawned on me. The exquisite delight of this day was about to be broken. Somehow I’d managed to lock the car, with the keys inside it.

I tried the breakdown service. It was going to take hours and cost a fortune. I tried my few remaining colleagues. No one was going my way. Finally, I tried my wife.

‘Give me a minute,’ she told me.

When she rang back, it was to announce my forthcoming rescue.

‘One of the nurses has lent me her car.’ Danielle works in a hospital. ‘I’m on my way home to pick up the spare key and I’ll be with you in a bit over an hour.’

We’ve made friends with a group of nurses from the hospital. They’re a joy to know. Traditionally, we call nurses angels, but these are far better: wonderful human beings, much harder to be than an angel, and a lot more real. No one needs to tell us they work for a caring profession: they embody caring. 

We often think of the one who lent us the car as ‘Frankie’, because she reminds us of the eponymous main character of the TV series Frankie, about a district nurse whose patients matter to her much more than her personal life.

Eve Myles as District Nurse Frankie
Our own is just as caring and has the advantage of being real

When we eventually got the car back to our ‘Frankie’, she told us, ‘well, that’s what we’re for, isn’t it? To help each other out.’

Well, it’s a lovely idea and I wish that kind thinking was more common in our daily lives. Still, it’s good news that it continues to flourish in some places at least. That nursing should be one of them seems particularly appropriate.

At any rate, thanks to Frankie I only lost a three hours of my day, hardly an unbearable misfortune. As I sat in the hotel’s lounge, slumped on a sofa and drifting in and out of sleep, I really couldn’t get myself worked up over that minor inconvenience. It may merely have been proof that pleasures don’t come unalloyed; it may even have been the punishment of destiny, nemesis for my earlier hubristic self-satisfaction; either way, it was pretty mild.

The kind of karma which leaves you calmer, I felt.

Sandy and the fair value of people

It was great to get this picture from friends in the States, in the wake of super-storm Sandy. 

As always in such cases, if there is a positive message to come out from a disaster, it’s that of human courage and selflessness. And in this case, the humans are manual workers many of whom are unionised. 

The unions are the organisations that, somehow, it has become fashionable to belittle. Bureaucratic. Obstacles to progress. Sinister even.

So they’re easy game. To a governor of Wisconsin, for instance, intent on dismantling all collective bargaining arrangements. And the onus of proof seems to be on those who oppose him, who say that rights should be defended, while the common view seems to back his onslaught on them.

It’s as true in Britain. The latest government wheeze is to buy out rights: smaller companies could offer share options in return for workers giving up for example, on suing over unfair dismissal. Odd that government seems to view unfairness as something of a good thing.

Which ought to be a warning to anyone in the States who depends on employed work and who’s tempted to vote Romney. Take a look at what his brother-in-outlook Cameron is doing in Britain, and think again. Just how well will you do out of unfairness?

There’s certainly plenty of unfairness around. When Bob Diamond stepped down as Chief Executive of Barclays Bank, he had the decency to waive £20 million of bonus. Perhaps that’s not unreasonable: after all, the justification for high pay is the responsibility its recipients take, and on his watch Barclays had lost half its share value and engaged in practices that are still the subject of investigation that may lead to criminal proceedings.

That left him with only the relative pittance of £2 million to soften his departure in disgrace.

Which is only 80 times the yearly salary of a fully qualified nurse and only 25 times the salary of a top nursing manager in the NHS. And the NHS is in the second year of a pay freeze.

So that picture really is quite a useful reminder. After all, when a storm hits, I think I’d much rather have those workers up the pylons repairing the lines, rather than rely on a banker. And if I’m ill I’d much rather see a nurse. It may be heretical to say it, but when things get tough, I’d value those low-paid workers rather more than the prosperous financier.

Which suggests that it would be no bad thing to redress the balance a bit, to stop making quite such a virtue of unfairness. And if the unions can help make things fairer, the playing field more level, well, perhaps it’s time to review our image of them too.

Nightingale and Seacole: 12 and 14 May

If one bothers to learn any history at all, one often learns it from strange sources.

A favourite of mine is W. C. Sellar and R. J. Yeatman’s 1066 and all that which sets out to record all the history any Englishman can remember at the age of 40. Its explanation of the causes of the Crimean War is particularly instructive:

  The Holy Places. The French thought that the Holy Places ought to be guarded
  (probably against the Americans) by Latin Monks, while the Turks, who owned
  the Places, thought that they ought to be guarded by Greek Monks. England
  therefore quite rightly declared war on Russia, who immediately occupied
  Romania.

  The war was consequently fought in the Crimea (near Persia).

The Crimean War was where Florence Nightingale made her name. I first became aware of her thanks to another classic in history education, Ladybird Books: with large, brightly coloured pictures and not much text, they provide just the combination of sentimentalism, patriotism and unchallenging entertainment that is so essential to the development of historical perspective in today’s world.

The Ladybird view of the Lady with the Lamp

Aged ten or eleven, I read the story absolutely spellbound. The sufferings of the wounded soldiers and how little was done for them until Nightingale showed up at the military hospital in Scutari. Her habit of walking the wards at night, leading to her earning the title ‘the lady with the lamp’. The recovering soldiers who would apparently try to catch the hem of her dress and kiss it.

It occurs to me that this may be the source of the tradition honoured in so many war films of showing wounded men in hospital behaving reprehensibly towards nurses. Not that it's usually the hem of a dress they want to kiss. 

Nightingale didn’t get everything right at Scutari. It was the stubborn refusal of the mortality rate in the hospital to fall, despite all the care she provided, that brought home to her the importance of protection from infection: the deaths due to poor sanitation taught her to stress the importance of hygiene in nursing.

Overall, her work in the Crimea and the way she built her experience into her later teaching, made of Nightingale one of the central, if not the primary, figure in the launch of nursing as a profession.

All the same, though her record is outstanding, it isn’t unique. That’s why I didn’t publish this post on 12 May, the anniversary of her birth, but on the 14th, which marks another event that deserves a great deal more recognition than it generally gets.

During our recent break in Istanbul, I saw that several of the ferries that ply back and forth across the narrow waterway dividing Europe from Asia were heading for Üsküdari. That, it turns out, is what Nightingale called Scutari. Not exactly the Crimea. In fact, some 395 miles from the British encampment at Balaclava. Four days, at that period, by boat. Yet another source of misery for the wounded soldiers.

Not that the problem escaped Nightingale, who did open a second hospital on the Crimean peninsula, much closer to the fighting.

Meanwhile, another woman, a contemporary of Nightingale’s, had also discovered a vocation for nursing and an understanding of what a key profession it was. She too set up her own nursing operation, and from the outset it was a lot closer to the wounded men than Scutari.

Mary Seacole, who had learned her nursing in the Caribbean and then in Central America, was unable to obtain any kind of funding to take her skills to the soldiers in the Crimea, and was even turned down by Nightingale herself.

Undeterred, she raised whatever funds she could to get herself to the Crimea. There within a mile of the British field headquarters, she set up her ‘British Hotel’ which was, as its name implies, a hotel and a business: Seacole had to raise money as well as care for soldiers. Supported by her hotel, she would travel out daily to treat the wounded just behind the lines. Her critics, including Nightingale, would later accuse her of keeping something little different from a brothel, but she enjoyed a far better reputation among the soldiers, particularly the many she helped.

At the end of the fighting, forced once more to fend for herself, she struggled back to Britain, only to face crushing debts and eventually bankruptcy. Fortunately, she had some powerful admirers who set up a fund to get her out of trouble, to which, to her great credit, Florence Nightingale anonymously contributed.

Seacole ultimately attained a degree of success and comfort, with property in Jamaica and a good life in London, protected by figures from royal, noble and political circles. She died, admired as a pioneer of nursing, on 14 May 1881.

Following her death, her reputation faded for the best part of a century. However, in the last two or three decades a campaign to recognise her contribution has begun to have some notable success. Both in Jamaica and in Britain, numerous institutions associated with nursing now bear her name, and there is an annual Mary Seacole award for excellence in her profession.

Florence Nightingale undoubtedly deserves the reputation she has won, and her contribution to nursing was historical and monumental. And achieving so much as a woman in Victorian England is all the more remarkable.

But on the anniversary of her death, let’s set Mary Seacole up on the pedestal alongside her. An outstanding champion of nursing and a woman, just like Nightingale. But she laboured under other and greater handicaps that explain her greater misfortunes. Seacole was of humble origins. And she was black.

I’m looking forward to the day when little boys get starry-eyed from reading the Ladybird book about her.

Mary Seacole, 1805-14 May 1881
Pioneer of Nursing