BLOG: Geraldine Walters reflects on 70 years of the NHS

Our Director of Education and Standards shares her experiences of the NHS

As the NHS nears its 70th birthday, it’s been quite nostalgic for me to reflect that, when I began my nurse training in 1975 - on one of the first nursing degree courses in the country - the NHS was not yet even into its 30s. The next birthday I remember well was in 1998 when the NHS was 50. So in human terms, the NHS would now have been a pensioner for five years.

So much about the NHS and training for nurses has changed since I first stepped foot in St James Hospital in Leeds as student. A patient going to a hospital now would be very unlikely to recognise the care they received or the technology in the ward itself, if they had attended the same hospital all those years ago. While we were not quite working by candlelight, much of the technology we take for granted today, simply didn’t exist then.

In the 1970s student nurses were employees of the Health Service and a crucial part of the workforce. This gave trainee nurses lots of practical experience which helped to build their confidence. As they are today, registered nurses were helpful and happy to be a part of providing ‘on the job’ training for students. The flipside was that the workforce requirement could sometimes take precedence over learning. I knew one person who spent most of her first year of training in areas which offered much the same clinical experience because that was where the staff were needed. Everyone of that era, I imagine, will have at least one anecdote about second and third year students being left in charge of wards at night. Similarly, Junior Doctors were the staple medical workforce. They worked, literally, all of the time. This was great for continuity, great for team work between different professionals but similarly, the result was overreliance on a junior, and in this case, exhausted workforce.

We sometimes have a rosy view of those days, but I often wonder to what extent patients were put at risk as a result of large amounts of care being overseen and delivered by unregistered student nurses. I don’t recall lots of serious incidents and complaints from patients – but then the approach and culture to reporting incidents wasn’t the same as it is today. Unless they were extremely serious, the reporting of incidents didn’t really happen and patients very rarely complained. Many users of the NHS were of the generation that still remembered having to pay for healthcare, or even worse, getting none at all. I believe they were simply grateful for what they received and were often either unaware of mistakes that had happened, or just very forgiving.

The much quoted phrase by Professor Sir Cyril Chantler is also relevant: “medicine used to be simple, ineffective and relatively safe. Now it is complex, effective and dangerous”. In other words, what we were doing then was less effective, but also less likely to result in harm.

When the NHS was 50, in 1998, we had arrived in a different place. The Bristol Heart Scandal had happened and complaints in the NHS were on the increase. The previous year a new government had taken the reigns and poured resources into the NHS. Much was put in place to respond to the public’s growing concerns about the quality and safety of healthcare, and inconsistency of treatment between organisations. “Trust me, I’m a doctor/nurse” was no longer enough. NHS organisations were going to have to actively demonstrate that they were safe to treat you. The National Institute for Clinical Excellence was set up to provide best practice guidelines for all organisations to follow. The Commission for Health Improvement, now the Care Quality Commission, was set up to inspect hospitals and take action if standards were poor.

Nurse training had by now also become a full time course, and the number of degree course routes into nursing increased. There was initially a mixed response to this. There was concern at the time that student education and training being moved into Universities would lead to less emphasis on the practical aspects of nursing in favour of academic study, leading to newly qualified nurses being less confident and competent in the actual job of nursing. However, care was becoming more complex and there was a drive to expand the nursing role. At the same time, nurses’ aspirations were increasing: they wanted to deliver more clinical care and lead services for patient benefit. This increased the demand for a more knowledgeable AND practically skilled workforce, which required a change in the attitude toward to education of nurses and how this was delivered.

So where are we now, with our 70-year-old NHS? Clearly medical technology and clinical treatments have advanced significantly. 70 years ago rubella, the measles and polio were huge killers in the UK; they now barely exist. And if you had a heart attack 70 years ago the chances are that you wouldn’t survive for long, whereas now you can be treated by effective surgery and live a long and healthy life. But as the boundaries of medicine expand so do the clinical risks associated with more interventional treatment. As we now live longer the care demands of an ageing population are also increasing. The workforce demands to cope with all of this have exceeded the traditional supply of people coming into the professions. In response, new roles are being created.

In spite of all of its challenges, the NHS remains the envy of the rest of the world in terms of a model of delivering health care which is free at the point of use. For nurses, we now have a totally degree based profession. Nurses are emerging as leaders of services and have the skills to be more clinically autonomous.

Nurses have always done great things in the NHS, but we have not yet reached our full potential. Our recently published standards for nursing education are higher in ambition in relation to knowledge and skills than ever before. They really reflect the aspiration for nursing both now and in the future. They ensure that nurses retain care and compassion but also embrace the need for more clinical knowledge, leadership preparation and political awareness. We developed these in close consultation with stakeholders – nurses, employers, patients, educators, all who saw the potential of nurses to contribute more to the NHS for the benefit of patients.

We are part of a noble profession, we have a great legacy, and promise of a great future.

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