“To a Nurse, this is just a job…

…but to me, it’s about the future of this organisation”. These were the words my Director spoke solemnly to me shortly after I joined the NHS in Cumbria in January 2012. I don’t know if the words were designed to motivate, appall or just make me feel privileged to be in the presence of greatness, but they were uttered worryingly, with all the sincerity of someone who believes what they are saying. It’s a quirk of fate that I come from a family with a long tradition of working in the world of healthcare. My Mum was a Nurse, my Aunty was a Health Visitor, my Gran was a Matron, my Great Grandfather was a Public Health Official in Gateshead and his Grandfather was a bonesetter for the pit ponies and miners of the North East, long before the NHS was a glimmer in Bevan’s astute Welsh eyes. I resisted the urge to punch my Director or to tell them my family had over 70yrs combined nursing experience between them and they clearly didn’t have a clue what makes most Nurse’s tick; and dear reader I can tell you from experience that it’s not KPIs, SpreadSheets or rolling out the red carpet for the CQC.

The Mum of an old friend of mine died recently. She had been a lifelong resident of Penrith and a Nurse at Penrith Hospital for many years, the Penrith New Hospital as it was proudly called when it was built to replace the old Cottage Hospital in the town. She was a kind and caring person and as a good friend of her son and a surly rebellious teenager, I remember her making meals and cups of tea for the room full of youths with strange haircuts that would congregate in her front room. When she retired from nursing, in part because of the bureaucracy which she felt was getting worse and worse, she took up voluntary posts and did a great deal of charitable work, helping other people and those less fortunate than herself. I wondered what she would have made of a Director who told her that the vocation she called nursing was “just a job”?

Perhaps I shouldn’t have been surprised or angered by such sentiments. This was after all the same Director that had asked me to spy on my Senior Colleagues for them because they said they could not be trusted. “Tom you need to understand that your role is really that of the school snitch, we can’t rely on managers to tell us what is really going on, it’s you and your team’s job to find out and report back”. These words were uttered to me whilst they looked out the office window in reflective Oscar-winning melodramatic style…and this time I was stunned; I thought I had read my job description properly and I was sure I hadn’t seen the word “snitch” in the main text. Was this really the modern face of the NHS I asked myself? Was this the type of divisive management behaviour my Mum had told me about that was driving good people out the NHS? I had spent the last twenty-five years of my life developing relationships built on trust. I had been told, assured, that the NHS of the 21st Century, the NHS I had been offered a job in on the 20th anniversary of my sister Alison’s death, was not the same divisive, defensive and broken culture that allowed the abuse of my sister to occur under its own nose 20yrs earlier. I didn’t need time to think, I made it clear to my Director that this was not something I was prepared to do or that was good for the organisation…I think that was the beginning of the end of my five years in the NHS.

I have often wondered what was going through his head when he asked me to put myself in an impossible and highly invidious position? Some colleagues of his who were aware of what he did have tried to explain it away by saying that he was only doing what he needed to do to survive in the culture that he found himself in. I don’t buy it, this explanation is simply an excuse for the absence of a moral compass. If we excuse such behaviour in people who occupy publicly funded positions of trust, then we have lost all hope of achieving excellence in Public Sector services. We have doomed services and those working within them to a life playing games and politicking with the public’s money whilst failing to meet the needs of those they are supposed to be serving.

So what of my former Director? Well, they are still in post, set to take an important role in what will soon become a new organisation, climbing ever higher until perhaps one day the heat of a more perceptive regulatory sun finally melts the veneer of wax holding their KPI’d wings together…and me, I was hounded out the management echelons of the NHS. There is little room for people with integrity, moral compasses and experience of the real world in management cultures that have mastered the art of chasing the target whilst missing the point. As for Nurses, someone told me there is a growing recruitment crisis?


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