Former NHS Nurse and manager now contemplating the NHS from outside

It is only two days since I ceased to be employed in the NHS and I know that it will take a little longer for my mind to defog and my brain to clear. The main thing for me right now is the amazing tiredness I feel. On one hand I want to do so much with my free time, I want to sort out the spare room and make it in to some kind of office space – I have brought home a load of personal and also kind of work related stuff that I think will be useful in the future. I also want to have a bit of a spring clean around the house, I want to declutter and I also want to do some fun things. I want to organise trips away. I am also mindful that I will need to work at some point soon, so I have some work to do in following up contacts and preparing for work.

Usually, I find myself rushing around, doing a bit of this and a bit of that. Rushing to complete things over the weekend or during a few days off. I am aware that this is different. I no longer need to rush anywhere, to complete everything in double quick time. I am also aware that I do feel weary as I said above.

I need to spend some time right now reflecting on what has happened, thinking about the process that I was involved in. A process that started with me feeling incredibly hopeful that I would get a job and a good one at that and ended with me being made redundant. I hope to use this blog to help in that process. I have been a poor blogger for a couple of years now. Firstly it was because I was unhappy in my commissioning job, then too busy in my new cancer network job and then because I feared saying something which could ultimately get me into trouble with my employers.

This morning, there is lots on the news programmes about the various changes that have come into force in both the NHS, in welfare and in local government. I feel I should be able to say some profound things about all of this, today, indeed right now. But actually I don’t think I can.

I am going to take a few days. I am going to read a book or two. I am going to get back to reading  some of the blogs around and about, and update my blogroll here. I am going to start sorting out the spare room and I am going to look around the shops. After all a girl is entitled to retail therapy when she has been made redundant!

Then in a few days, as my brain and my mind begins to clear I will write about the past and about the future. I will talk generally about my take on how things are in the NHS and also about my role in it (if I am to have one). I am not meant to work for the NHS for a month. I don’t think that will be a problem for me.

My first day has started a bit strangely. I was happily blogging, sitting up in bed when the phone rang. My son who went off to visit and stay with friends yesterday called to say he was on the train and could I pick him up shortly. I found myself scraping the ice off my car at 7.30am; not the way I expected to start my first day of freedom!

The end

Tomorrow is the last day in which I will (for now and and perhaps forever) be employed in the NHS. More than 32 years has passed since, as a young student nurse I began my career. Of course it is just my employment that has ended. I fully expect to be working again soon and likely as not some of that work will be for various NHS organisations.

But because of my age (over 50) and the fact that I joined the pension scheme such a long time ago, I have actually technically retired. From now on, I will be receiving my pension. In reality this means the salary I need to earn through paid work is much smaller than it was. I will be able to take on projects or a longer term job, part time.

For the next few weeks though, I intend to take stock. To have a rest and to sort things out at home. I intend to meet friends for lunch, to take a trip or two and to plan a new kitchen. 

I will have lots of time to write and I intend to pick up this blog again and to write lots about what has been happening. I took the decision over the past few months not to write here. The process has been painful and unpleasant. I was fearful of writing things here that might be best left unsaid while I was still unemployed. Now I will be able to say a little more and give a bit more of my opinion.

I don’t know if I will keep the title ‘Life in the NHS’ for this blog. I am not going to worry about that yet. There is more than ever to write about the NHS and the mess that is being created in the name of progress and of change. There is even more to be written about the way nursing is being described and evaluated in 2013. There are things to be said about compassion and the way we treat people in this country, not just in the NHS. There are things to be said about the politics of health generally. 

I have lots to say still. This time my return will be on a more permanent basis!

Life outside the NHS?

Having said in November that I would start to post regularly again, life took over and I haven’t. I have some personal stuff happening that I won’t go into right now, but the main problem is work.  It seems highly likely that from 31st March, I will be, for the first time in my entire life, unemployed.

Things in the job market have not gone as well as I would have liked, and the early optimism I had on finding I knew my new potential Network boss, turned to bitter reality. The process has been particularly bad this time. But the first interview I was mainly under prepared. i think I believed I would be given a job with little effort. I wouldn’t have appointed myself, though even then the process was odd and we were told to reapply and answer questions differently next time. Many applications and 2 interviews followed, and I definitely equipped myself well (so I was told) but to no avail.

so redundancy beckons. With it will come opportunities to get debt paid, things done at home etc. also though lots opportunities to work as a contractor so all will, hopefully be we’ll.vat last I will be able to write with freedom. But I will need to change the name of the blog!

Business as usual

In the middle of a chaotic reorganisation we carry on regardless. We are busy supporting our network groups, arranging workshops and training, recruiting users to help with service developments and reporting on things that have been done. We are busy full stop. We work hard and we work pretty long hours between us. But, you might ask and I often ask, why? Why are we bothering to put so much effort into things that we don’t know will continue in the future?

Well partly because we are kind of required to do so. There are rules in place, there are requirements on us and they haven’t gone away. There are also people out there, clinical people, who still need our support to be able to meet together and discuss how they can continue to improve things for people with cancer. There are campaigns for early diagnosis that we are still involved with and detecting cancer and doing so as soon as possible is a priority area. We are also trying to create some kind of legacy, to make sure that what we do, what has been done continues. While people in high places continue to work out how the new world will work, we carry on working in this world.

We are interacting now with the new CCGs; the board members, GPs who are finding out about their responsibilities to their populations. They find that we do useful work, have knowledge they can’t hope (or want) to learn. They wonder how, come April they will be supported in making sure that cancer and end of life care is best commissioned.

We prepare to apply for jobs. The adverts were meant to have been released last week, now apparently it will be this. The top job will be appointed to in the next week or two and then that person (and who knows who else) will interview us sometime in the run up to Christmas. In the new year we will know more about what those with jobs will do in them and we will discover if we continue with business as usual in the old set up.

It all feels a little unreal. But of course it is real. These are real people, with real jobs, real mortgages and bills who shop in real supermarkets and go on real holidays. It is easy to write off those who work in some kind of administration. But the fact I left clinical practice enables others still seeing patients to spend as much time as possible doing so. If there are fewer of us doing those supportive jobs, either fewer patients will be seen or else fewer patients will be able to be sure that advances in implementing best practice will take place.

Those of us who get jobs in the new world of strategic networks will work hard to make sure this doesn’t happen of course. But there are no guarantees. Of course I may be wide of the mark and the new systems may be an improvement on the old ones. Lets hope so for all of our sakes!

My last two jobs have heavily emphasised the involvement of patients in healthcare. When I was commissioning maternity services, those patients were called women and now in the world of cancer they choose patients and carers over the more common term ‘users’. Both of these areas of healthcare have, for many years placed the experience of patients using their services at the centre of planning and delivery of services. At times those involved have felt that professionals pay lip service to this prescribed requirement. But I know that my senior midwifery and nursing colleagues have taken their role seriously as have I. Putting what is discussed in meetings into practice can be difficult as real events take over and people struggle with the realities of their job.

Most of the NHS Trusts (providers) have specific Patient and Public Involvement committees and groups, but these are not specific to a single condition or disease. Maternity is definitely different from the mainstream, given that in the main pregnant women are not ill and are not patients as such. Cancer (rightly or wrongly) also considers itself to be different with unique needs.  Peer review measures for User Involvement require us to have a User Partnership within the Cancer Network, laying down a number of ‘measures’ relating to both the experience of patients and the involvement of service users and carers in services.

The new NHS throws all that we know about this kind of service (or disease) specific involvement will take place. I have had the pleasure of working with some amazing people in both areas over the years. They work hard, give up so much of their own time, often in conjunction with running their own busy lives. Sometimes in the case of my current user colleagues, they continue to manage the after effects of cancer or to battle recurrences of ill-health. They are not surprisingly a little anxious of what will become of their efforts once PCTs (who have been statutory expected to manage Maternity Services Liaison Groups) have been abolished and Cancer Networks have been subsumed into Strategic Clinical Networks.

Will the clinical networks be able to support real patient involvement within the entirety of their portfolio (cancer, maternity, children, mental health, stroke etc etc). Or will it be left to the NHS Trust, CCG and other more general Public and Patient Involvement groups to pick up the mantle. Will the stalwarts of maternity and cancer involvement join in with them, will some of them who are part of the Links mechanism become part of the Health and Well being Boards. Does it matter if this is about general patient experience and involvement or should their be something special for specific groups. Or will we lose something from all of this and will some of those committed individuals walk away. From some of what I have heard, many are disgruntled and hurt that the work they have done so far will apparently be lost, and they might just.

Time for an update

Was it really March when I last posted here? For a long time this year, very little happened in my bit of the NHS. Essentially we got on with the day job and waited. I had got fed up with writing about it here and if I am bored, I can guarantee that it wouldn’t make very interesting reading. I think that situation has changed and that what is currently happening in PCTs (and elsewhere) to be honest needs to be written about, since there is little being said in the media or newspapers (other than the Guardian). I predict that once the dust has settled and the ‘bureaucracy’ has been removed, some people will be very shocked by what is left. They will be surprised that the NHS isn’t actually being run by GPs (though they have a wonderful nominal role) but by rehashed senior managers some of whom work in Leeds and many more work out in the local areas.

Over the next few days and weeks I will try to explain the mess that Andrew Lansley put in place and what the implications are for people like me. More importantly though what are the implications for people working on the front line, and vitally what does it mean for patients? Will any of this matter? Time will tell I guess but I suspect that perhaps it will.

The Cancer Networks, one of which I work within, will be subsumed into a new kind of Strategic Clinical Network. This will include not just cancer, but heart disease and stroke, mental health and maternity and children. There will be 12 of these networks which will be hosted within some of the Local Area Teams of the National Commissioning Board. Staffing will be reduced from current levels, but with just a few months to go, we don’t really know by how many nor indeed to we know exactly what these people might do.

My job is about facilitating clinical people to work together to improve cancer outcomes. Some clinical people, I might tell you, need a hell of a lot of ‘facilitating’. I also work with patients and carers to make sure that they are able to contribute to the development and delivery of services. When (rather than if) that kind of support is not available, I am not quite sure what will happen. The work of course will go on and best not to engage in some kind of amateur dramatics here about the value of me and my colleagues. But there are lots of things that we do, that appear to be valued and necessary that I can’t imagine being picked up by any one else. So as things emerge, I will try to discuss them here.

We really are on count down now, and likely by the end of the year many of us will be on notice of redundancy. Others though are luckier, particularly those working in areas where they can be mapped into jobs in the CCGs, the CSU or Public Health. I hear you cry what is a CCG? What is a CSU. Well good question and perhaps I could do a little bit along the lines of trying to define them. Maybe you can tell I am just a little bit more keen to return soon and say more. Time to resurrect this dying blog and wonder about what Life in the NHS is like right now!

Spring has sprung

I love this time of year. Each day as I look out of the window, drive to work and back I notice that the leaves have a little more blossom, a few more leaves. The daffodils are now in full flower and to top it all we have been experiencing highly unusual sunny and warm weather. It makes you feel good. Spring is a time of new beginnings a time to clear out the cobwebs, to clean the house, to get ready for the summer ahead. This year I approach spring feeling refreshed because I have recently had 3 weeks off work; 2 in USA and 1 at home. I have taken a break from work, and from concerning myself with the problems of the NHS. Now though I am back in the mix and raring to go.

The Government must also be glad that with the advent of spring, they have finally got their Health and Social Care Bill through; it will receive royal assent within the next couple of weeks. Mind you I believe they have other worries (a budget that many felt favoured the ‘haves’ rather than the ‘have nots’, scandal over dinners with David Cameron and an impending fuel tanker strike to name a few).

Next week we start a new financial year, the last of the PCTs. This is going to be an interesting year as we head towards transition towards the new world of healthcare commissioning and provision. Already our PCT is getting ready to become a Commissioning Support Unit. Local Clinical Commissioning Groups are preparing to be ratified or whatever the process is called and everyone without exception working in the health economy faces the reality of doing more for less money (that’s just the budget but personally we face similar challenges).

I don’t agree with the Bill but enough is enough. We have to move forward, we have to prepare for new beginnings. I fear things won’t go completely as the Government would like and in a perverse way I am quite looking forward to seeing how it all pans out. It would be fun if this wasn’t public money, real lives and real jobs. What is worse is that this is healthcare; mistakes can lead to people missing out on the care they need and it can lead to death. We watch and wait.

Meanwhile I’ll enjoy the good weather while it lasts; it will turn cold by the weekend and eventually it will rain!

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