Job Security is a
Redundant Concept?
Or
A bitter pill is
still a pill
A Blog Pitch by Andrew Stimpson – Health & Justice Lead
WSYBCSU
In 2011 I was made redundant from a post within the
NHS. It was a bewildering and
disorientating experience, and the wound was not salved in any way by the
earnest, but rather ineffectual consultations that punctuated the process.
The redundancy followed a three year spell working
regionally on Offender Health issues, never the most glamorous of fields, but
nevertheless extremely rewarding. Prior
to this I had spent six years of my life working in Her Majesty’s Prison Hull,
a classic Victorian pile populated by shady reprobates, oddballs and
misfits. It also houses prisoners. I could classify those six years in a number
of different ways but essentially, they were the best six years of my working
life. Quite apart from the social life,
which was admittedly fabulous, it afforded me an incredible opportunity after a
number of years flirting with other careers and flitting from job to job.
It enabled me to effect real change.
Prison nursing at the time was generally operated ‘in-house’
by Her Majesty’s Prison Service (HMPS) and delivered by a combination of nurses
and Health Care Officers (HCOs, some also trained nurses). It was, in many ways, the nursing equivalent
of the Wild West, complete with swaggering cowboys and brawling drunks. There were also prisoners.
The case is well made today for the prevalence of complex
conditions, multiple co-morbidities, mental health and substance misuse issues
amongst offenders, and it astonishes me to this day how effectively many of
these conditions were managed in an extremely restrictive and poorly equipped
environment. That said, many mistakes
were made and many problems existed within the systems of care thanks to
outmoded concepts and attitudes amongst the Healthcare Team. The prison is a demanding, high pressure
environment and emotional burnout was a common problem. A stubborn
unwillingness to adapt to change in some quarters contributed to low morale and
further poor practice, leading many of
the ‘old hands’ to leave the job once the NHS took charge of health provision
within the prison and introduced new-fangled concepts like ‘clinical
governance’ and ‘hand washing’.
Ironically (perhaps) the HCOs, some of whom had traded in
nursing uniforms for prison officer garb, were the most skilled, compassionate
and caring individuals in the team. They
were a far cry from the stick wielding ‘prison warder’ image, although they
could certainly wield the stick when merited.
Recently NHS England, in response to Francis, unveiled The 6 Cs (http://www.england.nhs.uk/wp-content/uploads/2012/12/6c-a5-leaflet.pdf)
in an attempt to educate the nursing profession that it has some obligations to
patients. In my experience these prison
officers were as caring, compassionate, competent, communicative, courageous
and committed as any clinical practitioner I have ever worked with in my
longish career. They responded extremely
well to new ideas and saw myself, and another colleague who arrived at the same
time, as a breath of fresh air, which never goes amiss in an establishment that
generally smells like a combination of ash trays, teenagers’ trainers and
poorly maintained toilets. Together we
instigated a culture of care and recovery that, for a golden 18 months, saw
real improvements in a number of areas.
I moved on from HMP Hull in 2008 and took a role with the
Yorkshire and Humber Offender Health Team, broadening my experience base and
working with police, courts and probation services on responding to the Bradley
Consultation, and subsequently implementing the recommendations of the Bradley
Report.
The Bradley Report was a useful tool. It cemented a lot of things that, although we
knew already, gave real drive and
impetus to a change movement that was sadly derailed by the wholesale changes
instigated when the current government was elected.
Swings and roundabouts.
Following two and a half years in the wilderness I returned
to offender health (courtesy of the CSU), now rebadged as Health & Justice
(not to be mistaken with the 1969 All-British Wrestling Tag Team Champions). Unsurprisingly the same issues remain...
- High rates of mental ill-health in offenders
- Variable standards of care in criminal justice settings
- A lack of cohesion in commissioning services for offenders
- Prisons still smell like old cabbages
On a positive note however I have been able to revisit my
old stomping ground and conduct meaningful work around health care in prisons. I have even been able to catch up with old
colleagues and bear witness to the tremendous developments that have taken
place in HMP Hull’s Healthcare Department in my absence. Many of those old colleagues remain some of
the most skilled and capable carers of people it has ever been my pleasure to
witness. The reasons why that should be
the case could be debated at length but, thinking back to those 6Cs, in some
ways it appalls me that we need to spell out in massive letters to nurses that
they should be caring and compassionate. In my mind, they are core tenets of the very
vocation that prospective nurses seek to undertake, yet often seem more likely
to be demonstrated by non-clinicians such as nursing assistants and HCOs,
thanks to the relentless procedural and task orientated drift of nursing focus
over the years (another debate there perhaps).
Of course there are other reasons why the 6Cs become
threatened in practice. In a prison for
example, as in an A&E department on a Saturday night, repeated barrages of
verbal abuse and the occasional physical assault tend to sap even the gentlest
of spirits. More broadly however we now
occupy a space where nothing is a given and public sector jobs are no longer
the sure deal they once were. It isn’t
only the prospect of impending cuts, redundancies and rationalisations that
cause considerable anxiety to the work force, but the prospect of next year’s and the year after that and so on.
TUPE issues, relocations, management restructures, downgrading,
re-profiling, applying for our own posts... all are possibilities.
The CSU itself is, like all other providers, a reflection of
its work force in macrocosm. It will
effectively be reapplying for its own job, only dozens of times per year, and
those of us that occupy the spaces between the machinery are manning treadmills
to keep it running.
Being made redundant once, from a job that would have been described
many years ago as ‘safe as a bank’ (pun very much intended), had the unforeseen
benefit of making me somewhat philosophical about the prospect of undergoing
the same process once again. Last time
my colleagues and I had no power to alter our destiny, and despite being a high
performing team we were simply pushed over a cliff.
This time is different.
In joining the CSU we all went down the rabbit hole.
We can
choose one of two pills.
Choose wisely.
As it happens it didn't matter which pill we chose. The CSU model was largely disastrous, with most falling by the wayside or being subsumed into even larger organisations. In the case of WSYBCSU, it merged with NYHCSU to become YHCS. None of that matters other than to say it never got any better and ultimately failed, despite the best efforts of us drones, because it was operated by morons. Reading this back though I can relate to the sense of guarded optimism I felt when writing it, because I still feel that way three or so years on. Now we have a fully blue blooded Tory government, the NHS is collapsing in a mire of willfully created debt and doctors are going on strike, yet the bulk of the rank and file believe in their vocation and in the NHS as a concept.
That's somewhat encouraging I suppose.
