NHS: A People's History
Alex Brooker presents a crowdsourced social history of the NHS, told through people's treasured mementoes.Read Article
Hospital returns for a sixth series to London’s Royal Free Trust, a world-leader in the treatment of infectious diseases and one of the biggest NHS trusts in the country.
If you'd like to find out more information about this series, you can do so by visiting the BBC programme page.
Discover the range of qualifications and modules from the OU related to this programme:
Staff from The Royal Free Hospital share their experiences of working through the COVID-19 pandemic.
Watch an interview with Sophie Hogg, a Paediatric Nurse, as she reveals the hardest moments of her career, plus her future ambitions.
Watch an interview with Taj Fragene, a Consultant Anaesthetist, as he talks about race and COVID-19, plus the risks he faces.
Watch an interview with Deny Chacko, an ITU Matron, as he discusses the difficulties faced due to COVID-19, plus the satisfaction he gets from his profession.
How has the way we communicate changed due to wearing a face mask? Dr Marina Cantarutti, Interactional Linguist and Research Associate at The Open University, shares her thoughts.
It is possible that a greater array of multi-modal resources will be used beyond the eyes in ways in which they are normally used, but now with intensified features: we may squint noticeably as we smile behind the mask.
This year has seen the world change in ways we never could have imagined: socially distancing from friends and loved ones, remote working implemented across the UK, washing and sanitising our hands for more than 20 seconds, and now wearing face coverings in supermarkets and shops.
One of the most powerful tools in communication is the face. People can easily make a number of inferences from facial expressions about physical health, emotional state, personality traits, pleasure or pain. When talking, we rely on reading facial expressions particularly when we don’t understand the verbal language and this may be one of the reasons that some people do not like wearing masks.
Dr Marina Cantarutti, Interactional Linguist and Research Associate at The Open University, shares her thoughts:
"Having a significant part of the face covered means that some of the nuance during our interactions may be lost, but people may find ways to compensate for this in interaction. We can engage in forms of conversational repair to fix possible misunderstandings, or try to secure certain kinds of affiliative response in alternative ways, for example through the repetition or reformulation of feelings or events reported in previous part of our conversation, done again more vividly with hand gestures or features of the tone of voice."
"It is possible that a greater array of multi-modal resources will be used beyond the eyes in ways in which they are normally used, but now with intensified features: we may squint noticeably as we smile behind the mask, we may produce more extreme head movements, nod more vigorously to display agreement, produce head tilts for sympathy, or use hand gestures with wider or bouncy movements. We may exaggerate features of our voice by increasing the volume, or producing a wider pitch range or stretching out sounds. We may find that we recruit the joint efforts of our words, voice and gestures in “extreme” visible and audible ways to make certain meanings and feelings clearer and more unambiguous to our listeners."
"Whereas mutual sustained gaze may often be a marker of intimacy but also of a threat (Eibl – Eibesfeldt, 1989), we can show engagement with what others are saying with verbal means, as well as with head or hand movements. The eyes are only a part of the composition of facial expressions and forms of displaying emotion and affect."
It has yet to be determined if wearing a face mask will be the ‘new normal’ and whether we will see anyone smile at each other in the supermarket any time soon. In any case, our facial expressions and eye contact need to adapt and change to reflect the times we are in.
Reflecting so far, 2020 and the unfortunate arrival of Coronavirus (COVID-19) has certainly given the Year of the Nurse, a unique position on the global health stage. Dr Rebecca Garcia explores.
The latest data from UCAS revealed a welcome increase of 15% in applications to nursing undergraduate courses (compared to 2019) in the UK, with England reporting increases of 23%
This time last year, The World Health Organisation was making plans to raise the profile of nursing across the world, in order to celebrate Florence Nightingales 200th anniversary and to increase the global workforce. However, in December 2019, Coronavirus made an appearance initially in Wuhan, then worldwide, demanding attention from the public, health staff and governments across the world.
In the UK, the NHS responded by realigning to meet the anticipated large numbers of acutely ill patients, with nurses rapidly trained and/or redeployed to meet the demand of COVID-19 cases. Third year student nurses were asked to volunteer to help with extended practice hours; while a further 10,000 ex-nurses returned to the profession to support the pandemic effort (Ford, 2020)[i]. The health and social care sector, and NHS received positive public attention, as never seen before. NHS and social care employees have seen a wealth of commercial privileges to acknowledge their valued contribution in saving lives during COVID-19.
The media reported on the unfolding pandemic, capturing nurses from a variety of settings, from nursing and residential homes, to highly specialised environments, such as intensive care. These media reports revealed to the public, first-hand, the reality of the nursing profession in 2020, the interviews revealed the extent of the nurses compassion, professionalism and specialist knowledge. This previously and often-unseen perspective from inside hospitals and caring facilities was a refreshing insight that positioned nursing at the heart of patient-centred care during the COVID-19 crisis.
This was a very different portrayal of nursing, from previous media coverages, which has historically portrayed nurses in a subordinate role to (often male) doctors, as their ‘handmaiden’ and other negative stereotypes (Bridges, 2004; Gordon and Nelson, 2005 ). Prior to COVID-19, the majority of the public had little awareness of what nurses actually did, unless they were in the unfortunate position to be unwell themselves or be in close contact with a family/friend who was receiving treatment. Few people understood that nurses today, are degree trained and highly skilled practitioners.
It is widely accepted that there are just not enough nurses, yet, figures are showing that numbers of qualified nurses have risen slowly over recent years . As of May 2020, there were 302,923 registered nurses and health visitors employed across NHS Trusts in the UK (Workforce Statistics, 2020), with growing numbers of male applicants . Furthermore, the latest data from UCAS revealed a welcome increase of 15% in applications to nursing undergraduate courses (compared to 2019) in the UK, with England reporting increases of 23%. With an unexpected increase of 26% from male applicants.
It’s essential that we maintain the momentum of a more accurate portrayal of nursing, keeping the importance of nursing and its standing as a skilled profession at the top of the agenda in parliament, within the sector and generally as past, present or potential patients. Let us not forget what nurses really do - not just during the pandemic but, also when moving into the future as we learn to live in a new world alongside COVID-19.
Julie Messenger, Senior Lecturer and Nursing Lead at The Open University, and a nurse with more than forty years NHS and educational experiences, looks at the staffing challenges facing the NHS.
The NHS is the fifth largest employer in the World, and yet has a shortfall of staff; particularly in nursing. These shortages have been widely reported on, with the ongoing coronavirus pandemic further highlighting the strain that staff and funding shortages cause across the health and social care sector.
It's no secret that our hospitals are short of staff and do not have enough equipment or sufficient room in the United Kingdom. No single ‘magic formula’ will address all of the staffing shortages. Some rightly argue that these problems are due to lack of adequate funding in the NHS, as well as for social care. I trained to become a nurse in the NHS, I have worked in a range of hospitals, and I am certain there is truth to the funding shortfalls. This was most evident to me when I supported a partner with acute and life limiting conditions and complex care needs, and experienced a range of NHS services from a family member’s perspective.
It’s not just staffing issues that need addressing. Innovative practices, such as robotics for the treatment of individuals with prostate cancer, have the potential for positive and profound impact on many, yet are likely to be limited to the few patients who have the fortune of living close to where the practice has been developed and used, or have the opportunity for referral to specialist services. This we refer to as the ‘postcode lottery’ of health services, which persist and result in inequities of access and opportunity around treatment choices. No easy answers or quick wins here!
But what about the NHS workforce? Is there really not enough staff?
A report from the Nuffield Trust published May 2019 found that the NHS was the fifth largest employer in the world with 1.5 million staff - following closely behind McDonalds with 1.9 million employees worldwide. Of the 1.5 million NHS staff in September 2018, 306,996 were employed as Nurses or Midwives. However, in the period from July through to September 2018, more than 40,000 vacancies were advertised just for nursing and midwifery. In the Thames Valley area, for example, there was an almost 12% deficit in NHS clinical staff vacancies; the bulk across nursing and midwifery. Focusing solely on England, these vacancy factors are cause for concern.
At the same time, the Health Foundation (2020) has shown that student applications to nursing from 2014 - 2018 showed an average decline of 43%.
Taken together, it is not hard to see how practitioners struggle to meet demand. Is there an answer for this? Significant efforts have been invested to market nursing through campaigns, as shown in the video below, to recruit new nurses. The importance of NHS recruitment campaigns shows the work of frontline workers in the NHS, such as nursing. I am hoping that as a result, there might be some of you reading this who feel motivated to pursue the options available to work as a nurse. Who knows, this could be the first step to something positive for yourself.
Despite the strength of these messages, nursing needs to compete against other professional options, many of which may be more attractive than nursing involving less unsocial hours working practices or risks. As a nurse of many year’s standing, I wouldn’t hesitate in entering the profession again, or indeed recommending to others the value of nursing as a career. To be able to share experiences with our patients at their highest and lowest points is a real privilege and life changing.
Tapping into the existing talent within the healthcare support workforce may go some way to filling the nursing shortfall. Flexible or part-time routes, or apprenticeships, which enable support staff to train and progress into nursing roles while they continue to work, can help attract career changers or those who did not have the opportunity to study through a traditional university route.
We must also consider the funding available to nursing students. In England, the nursing bursary was scrapped in 2017 meaning nursing students must now access the same funding and student loan options as other students. However, in late 2019, the government announced that from September 2020 nursing students will be eligible for a grant of £5,000 a year which they would not have to pay back, with up to £3,000 further funding available for eligible students. This might attract more applicants but growth in student numbers is constrained often by the lack of practice learning opportunities available for students. Even if the 40,000 vacancy deficit of 2018 has diminished, it is unlikely that increasing the number of students is likely to have significant impact - at least in the shorter term – and retention of staff is therefore another important factor.
One recent initiative that should impact on care in the NHS is the Nursing Associate role implemented to date in England only. Nursing associates work with healthcare support workers and registered nurses to deliver care for patients and the public. Over the last two years there has been government pressure alongside workforce efforts to create and promote this new role.
Although there has yet to be substantial evaluation of the impact of Nursing Associates on care delivery, I feel confident that their impact will be felt across England. For once, as frontline workers those supporting the registered nurse are accessing substantial educational and training provision expected for their roles. Investing in education and training should see nursing associates being able to respond appropriately to needs using person/family-centred practices.
In addition, the NHS Long Term Plan (2019) highlights the importance of Advanced Clinical Practitioner roles in meeting current and future workforce demands. Nursing staff progressing into advanced clinical practitioner roles will be enabled to take on additional responsibilities within their scope of practice, such as prescribing for and diagnosing service users. This will increase operational efficiency while also encouraging retention of nursing staff by encouraging clear routes to progress their careers.
Finally, therefore, we need to have the courage to review role expectations; to ask people to step up and practice to their level of ability but always remember the need to invest in appropriate training, education and supervision of the workforce so that the NHS can continue to deliver the quality of care that others expect of them.
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