Working 9-5: if only! Towards 24/7 healthcare

 http://youtu.be/UbxUSsFXYo4

If you work in healthcare you can’t have missed the recent outrage around government intentions to move the NHS to a ‘7 day service’. Thousands of people have signed a petition calling for a vote of no confidence in health secretary Jeremy Hunt. Mr Hunt hasn’t endeared himself to me, moly sorting from the point where he tried to shut Lewisham Hospital, a recently renovated site that serves a huge population of South Londoners and was noticeably not failing. Following public outrage and months of protest around the legality (not to mention ethics of making hundreds of sick people travel an hour to another busy A&E department when there’s a decent one nearby), the plans were reversed and Lewisham H still stands.

A 7 day health service is a good idea. People don’t just get sick on working hours and we need to accommodate them, not the other way around. But it’s also not a revolutionary idea. I don’t know if you’ve been to a hospital on a weekend. I have and I can assure you it’s still open. Doctors and nurses work long hospital shifts around the clock every day of the year. It is a fallacy to suggest that they don’t or won’t work weekends – they rarely have a choice. Walk in centres are open weekends, and many GPSs offer a Saturday clinic. Mental health crisis teams cover weekends, keeping people in great distress safe and out of hospital. But Friday night is still not a great time to get ill. Whilst NHS staff do work weekends, it’s usually not the full working force that you’d get on a weekday. Additionally, doctors don’t work in isolation. There work depends on other staff, many of whom do not work weekends. Discharges may face a length delay whilst waiting for assessment from a social worker, occupational therapist or physiotherapist. Scans and tests need to be carried out an analysed. If transferring to another team then liaison is needed, and administrative staff for all the records and associated paperwork. A 7 day service is needed from all staff to keep the operation working.

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On politics: idealism and inaction

A little prose and musings…will probably add to this in time

As a child I was very idealistic. It sound pretentious but I generally had a sense of a “calling”. I imagine myself holding hands with activists in the desert (where wars happen, obviously) to stand in the way of battling troops, or feeding water to a poor malnourished child in the slums. Princess Diana was my role model and I felt sure I was going to go out and do Good Things. Growing up Jewish I think you assimilate your own sense of atrocity. We were taught stories of slavery and learnt the turbulent history of the state of Israel. Everyone knew someone who had been in the death camps.  We learnt and practiced “Tzedakah” (charity) and were taught that the greatest thing we could do for another was to help them to reach independence and self-sufficiency.

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Intention achieved: frightening children

My first awareness of current politics as a child in the 90s. I remember the anticipation and excitement around “New Labour”. There was a feeling of change. My mother told me that the Tories supported people who had money, and this was a party who represented people like us.  I remember seeing the crowds on the news cheering after the 1997 Labour victory.

But it wasn’t entirely the promise we’d hoped for. I remember watching the news show the troops going into Afghanistan in 2001 and I actually cried. I thought this was the stuff of history books, not something that actually involved my modern country. An idealistic child grew into an idealistic teenager. My simplistic views were left-leaning: everyone should get along and be treated equally, war is bad and we should look after the planet. I felt strongly about the environment and became a vegetarian (I missed chicken burgers, but felt it was the Right Thing). At school I joined Amnesty and spent lunch breaks hearing stories of torture that left me feeling awful inside. I became drawn to mental health and set my sights on becoming a psychologist, and became involved in politics through the school.

Vince Cable, effective politician, once came round and had a chat with my mum, general all-round nice guy

Vince Cable, effective politician, once came round and had a chat with my mum, general all-round nice guy

Our local MP was the Liberal Democrat Vince Cable and remember him as a very visible member of the community. He visited my school and came round door-knocking and chatted with my mother. He was very well loved locally and gave off a sense of really caring about the local people.  The issues I felt strongly about (increasing access and reducing stigma in mental health, supporting the NHS, sex and relationships education, reducing involvement in foreign conflict, LGBT rights and gender equality, and evidence-based drugs policy) felt more closely aligned with Lib Dem politics than any other party. At university I became a party member and I was later involved in some local campaigning.

Then came the 2010 election. The party I voted for went into power! I was thrilled, my vote was actually represented. Then things began to sour. Prior to the election I hadn’t been aware of how unrealistic the Lib Dem tuition fee promise had been, and the backlash from the people was immense. People protested and were largely ignored. When it came to the Alternative Vote referendum the public seemed to vote to punish, destroying our highly anticipated opportunity to have a fairer voting system. Then the cuts began. At this point I had begun working in the NHS. I had no experience of working in healthcare pre-austerity, but older staff had plenty of stories of how it used to be. Over 6 years of work in mental and physical health, across the NHS and charity sector I never worked in a team that wasn’t being “restructured”. We were fined for not reaching unrealistic targets that did not represent the work we did (as though with less money we would be more productive). Our criteria for accepting referrals grew increasingly stringent, as we turned away people whose suffering  didn’t quite meet threshold. I let my Lib Dem membership lapse and kept my head down when people discussed Nick Clegg and his treacherous party.

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Being a Healthcare Assistant : Value & Experience

The term ‘healthcare assistant’ (HCA), ‘support worker’, nursing assistant and ‘care worker’ (and others) are used to describe staff would work to meet the care needs of patients in health and social care settings such as hospitals and residential homes. The job does not usually require a qualification and involves tasks such as assisting with washing, dressing, toileting and feeding, as well as sometimes engaging in other activities and daily tasks with service-users. It’s not a well-paid job, the hours are long and the work often tiring and repetitive  Sometimes agencies may provide staff, meaning that different staff will work in a setting each day, although many sites also have permanent staff.

Is this people’s image of care workers? Image from Parliament.uk

Care-workers have had some bad press in recent years. Winterbourne View shed some light on how staff caring for vulnerable adults are often lacking in training and supervision, and how in some cases these enables abuse to go undetected. Following the Stafford Inquiry, it was recommended that nurses spend additional time working as healthcare assistants to help them to be more compassionate and in touch with the ‘fundamentals of patient care’. Nurses have been very critical of this proposal but personally, I think all staff in healthcare would benefit from spending some time working ‘on the front-line’. Working in this kind of role can give you a greater understanding of the needs of the patients and a sense of the work of the people who provide the majority of the care for our country’s most disabled, unwell and vulnerable.

My first job out of university was was a healthcare assistant at a private hospital for adults with long-term and severe mental health problems, often with additional physical health needs and ‘challenging behaviour’. I was bright-eyed and interested in mental health, but I don’t think I had a clue about what the job might involve. I’d never cared for someone else before, unless you count babysitting and tending to hungover friends. It wasn’t long into my first day that I was filled with an over-powering urge to leave and never return. The building was over warm and was filled with a strong smell of cleaning product not quite masking that of human waste. I could hear yelling and residents walked the corridor slowly, giving me unnerving stares. The prospect of helping an aggressive man change his incontinence pad was somewhat terrifying.

The work was eye-opening and exhausting. I didn’t always like working there, but I still could my time at the hospital as one of my most valuable working experiences, and it has really shaped my perspective and professional identity today.

Getting to really know people. When you spend all day with someone, from helping them get out of bed and get washed, right through to the end of the day, you get a sense of their life that just isn’t possible in a once weekly session. I enjoyed the times I had a chance to sit and talk to residents about their lives, or to do activities with them. I liked the continuity I had with people, that I could get to know them, and them me. It was frustrating when other professionals would come in and talk as if they really know someone, when they’d barely spent any time with them.

Disgust, dignity and disability. As far as a first job went, there was far more contact with bodily fluids than I was expecting. But I think it significantly raised my threshold for disgust. It stopped really bothering me. And I hope that if I need it, there’s someone around to help clean me up too! What I found far harder was having so much exposure to how disabled and narrow the lives of the residents could be. Often there wasn’t a plan for residents to get better or leave, and many had deteriorating conditions such as dementia. One of the worst jobs I had was assisting a woman with Huntington’s who was progressively losing control of the muscles of her body, to smoke a cigarette. She wasn’t really able to suck and inhale, so she had the cigarette attached to a tube-like device, the inside of which was  coated in a black tarry substance, saliva and dirt from where she had dropped it. This device frustrated her, so she’d try and hold the cigarette, but her fingers were too weak and she’d drop it, burning herself. When I tried to take the cigarette and return it to the tube she’d yell and swipe at me. She was slowly dying but all she wanted was a smoke, and my job was to help her do it. It felt really harrowing, and it made me think about how small all of the things in my life that bother me are.

Lack of support. I had very little relevant experience, other than a psychology degree (which doesn’t prepare you much for working with a real-life person) and I received minimal training. I had a few days learning how to restrain someone and other staff quickly showed me how to wash, feed and transfer particular residents. And then they left me to it. Getting everyone out of bed, washed and breakfasted took me pretty much up to lunch, when it was almost time to start all over again. Nurses tended to stick in the office or the pharmacy (I know not all nurses do this, but it was mostly the case where I worked) and weren’t around when I needed their help, I was often left on my own or with other HCAs who on the whole had pretty low morale. The treatment I received from other professionals was often condescending and dismissive, I felt like the lowest rung in the site. I received minimal supervision, and when difficult or upsetting things happened at work there was no one to talk to about the experience. Apparently there’s a high-turnover for staff in these roles and I’m not surprised, though it must be very difficult for residents to see staff they get close to continually leaving and being replaced with new faces. The high demands placed on me to support basic needs such as washing and toileting left little time to go beyond this and engage in more personal and creative work with residents. I rarely even had time to look at people’s files, even when they had a substantial risk history, as if it wasn’t important for me to know much about the person I engaged so intimately with.

Many care-workers probably have better experiences than I did, the hospital I worked for definitely had some problems, but having talked to others I don’t think my experiences were all that unusual. HCAs and similar staff do the jobs that the rest of us are glad we don’t have to do, and receive little recognition for it. It’s a tough job and not everyone can do it. I’ve met staff who were truly brilliant, but the lack of  respect (not to mention pay) you receive on the job does limit how likely it is that skilled staff will stay in a post. These people need to be celebrated and given further training so they can develop in the role. The residents and patients deserve better. Though I found the job a useful experience and it helped me get further posts, I probably wasn’t the right person to be providing that sort of care to people with such particular needs. I tried to do my best, but I wasn’t experienced.

Now I’ve moved up a few pay-bands and I don’t have to clean up anyone’s vomit and it’s been a long time since anyone hit me at work. But my experience on the ward is still with me, and I often find myself drawing on it and using it in examples at work. It’s definitely impacted on how I think about healthcare, other staff and my own professional responsibilities. Though the work was tough, I definitely don’t regret doing it. Sometimes I even miss being in that community environment and having more time with patients (it seems as I develop more skills I get less and less time with the people I’m learning to support). I don’t think being a healthcare assistant/support worker/similar should be seen as a ‘lowly’ job that’s beneath the other professions. It’s not a job just anyone could do, and it takes a special kind of person to do it well. Unfortunately this isn’t reflected in the pay and  training attention that people in this roles often receive. For someone thinking of starting a career in healthcare I think you couldn’t have a better starting point, and you’d actually be at a disadvantage for skipping over it. It’s an enriching and insightful experience that I know I come back to again and again.