When I trained as a nurse I received a bursary which paid my university fees and I was entitled to a student loan. I was guaranteed a career and although probably, only two thirds of my cohort ended up working in the NHS, we were all trained in the NHS as the gold standard and for most that is where we wanted to be.
Having lived in Mexico for a while before deciding to train as a nurse, I was immensely proud of the NHS and it was well respected around the world. I have never felt so lucky and grateful as when I had just landed back in the UK and on the coach back to my parent’s house we were passed by a police car and an ambulance. I knew that at any time day or night, regardless of my situation, I could ring 999 and get help. I would never take that for granted again I thought. Probably naively, back then I believed that modern medicine was nothing short of miraculous. I believed everyone involved in medicine, in the UK at least, was deeply committed to the principles of the Hippocratic Oath, specifically to ‘do no harm’.
Returning to the UK as a Youth and Community Worker under a new Tory government meant there were no jobs for me and I enjoyed instead various jobs as a support worker. This opened my eyes to the history of asylums, mental health, learning disabilities, Autism and social care in the UK. We had a lovely time. I was getting paid to have fun with people and the people I was working with were generally very well cared for but it was clear with older clients that this had not always been the case. I thought by training as a nurse I could have a greater influence over people being able to get their needs met within a system that, at that time, was well intentioned and inclusive. I could also earn more money to meet my basic needs and build a life of my own.
Huddersfield University was brilliant when I was there. The teaching team and my tutor in particular were inspirational. There were a couple of red flags such as one tutor saying that ‘getting pregnant isn’t like falling down the stairs’. I’m still not sure if she was trying to provoke debate or what, but that was a small glimpse of the hardness and lack of sympathy displayed by quite a few nurses I’ve come across in my time. I soon learnt that the NHS and in particular mental health services were not the well oiled machine I had naively thought them to be.
First year students on their first placements are generally considered a hinderance and that was made very clear to me on my first placement on a forensic unit. The power imbalance between staff and patients and the strict hierarchy was unbearable at times and reminded me of when I worked as an aupair in Switzerland for a merchant banker and was instructed to use the servants entrance to the million pound plus penthouse apartment unless I was accompanied by the children. There were some very kind staff who I consider friends to this day but I concluded forensic units are weird places and not for me. It was very strange that I wasn’t allowed keys for my first week so on my first day I found myself locked in the lounge with a group of male patients I knew nothing about other than they had committed a violent crime, with no other staff in sight. I did feed that back to the placements coordinator and I think I may have got the ward manager into trouble because he moved on after that and was always a bit icy with me. Looking back this was my first lesson in keeping schtum.
I went into the community for my next placement and was mentored by a complete maverick, anti-psychiatry and religious. He taught me a lot about keeping myself safe and sticking up for myself. I remember going to work one morning with what turned out to be a TMJ disk displacement, moaning about how much pain I was in and being told to shut up and go to A&E, so off I trotted. After that I learnt to be more directive with my placements. This is me, this is what I’m capable of and this is what I need to learn. I think the university also must have learnt what a softy I was because all my mentors after that were the most caring, kind and patient people I’ve come across and all good at their jobs in very different ways.
I loved working in the community, mainly because the food was much better. I learnt all the best places to stop when out and about. Olive said to me when I got in her car one morning, ‘today I’m going to teach you how to eat chicken’. She was not impressed that I didn’t eat the cartilage but I only needed one napkin compared to Olive’s seven! Working in the community felt more like real life and I was helping people to help themselves.
I got really lucky in my final year. I firstly specialised in drugs and alcohol. Which changed my relationship with substances a little bit in so much as I stopped worrying about my habits because I saw how bad it can get. I worked with a beautiful soul called Linda who went way above and beyond for her clients including running a crafts/social group in her free time, which kept me out of the pub for the evening as did working in the local soup kitchen.
With my final placement I struck gold with the Early Intervention in Psychosis Team. This team nurtured me for the next 5 years. I grew professionally and personally and they gave me the stability and love to disclose the sexual abuse I experienced as a child. The Trust provided the counselling I needed to start processing what had happened to me. It was never portrayed as a negative that would hinder my career. I was able to understand my experiences in the context of them making me a better mental health practitioner. My role as a professional in the NHS undoubtedly carried me through a very challenging time in my personal life. I was encouraged to continue learning and keep developing the service to be of most benefit to clients. There was passion there and it was rewarding.
I made a snap decision one day, as ADHD brains are inclined to do, that I wanted to live by the sea. So I went on the NHS Jobs website and applied for the first two jobs I was qualified for by the seaside. I turned down the job I was offered in Brighton because it was another big, dirty city and expensive, and accepted a post in the quieter more rural option on the south coast. I could not wait to leave the violent crime capital of the UK and stroll along deserted beaches.
Naively I thought that all NHS Trusts around the country were the same, operated the same and had the same familial and supportive culture as the team in the trust I had left behind. There were some major red flags from the beginning both personally and professionally. The induction on my first day started with a very stern presentation on fraud within the NHS telling us that the majority of fraud against the NHS is committed by staff and that they would prosecute. This was followed by a presentation by the CEO who told us how much money the Trust’s forensic services were making. I plucked up the courage to ask about the Early Intervention in Psychosis Service and was told that that was something for the Children and Adolescent Mental Health Service, which completely baffled me. The CEO wasn’t even aware of the existence of the team that I had been employed to work on, in contrast to the CEO of my previous Trust who was familiar with all the services in the Trust.
That same week I reported one of the trainers for making sexist and sexually explicit, inappropriate comments during our moving and handling training, making people very uncomfortable. I was told this was an outside provider and they would not be returning. I couldn’t understand why the Trust was using outside agencies to provide basic mandatory training. It took me months to slow down and not be shocked or frustrated by slow and non-existent responses, and a complete disregard for national and international guidance. No, it was more than a disregard, it was either ignorance or outright dismissal.
I was made to complete a course at the local university, one day a week for a year, that I had no interest in. I later discovered that the Trust had contracted the university to provide the course for more staff than it was relevant to for quite a few years. If you are currently working for the NHS as a domestic and would like to expand your horizons with a masters level course in family interventions in psychosis – get down there!
I couldn’t find any professional mentors. Whereas in my previous role I had been surrounded by experienced, dedicated and enthusiastic professionals who nurtured and supported me, I suddenly felt very alone. I was living alone for the first time which increased my loneliness and the amount of time I was spending in the pub. I fought with the Trust to allow me to do the Independent Nurse Prescriber course. I had never had to fight for my professional development before as I had entered the NHS into a Trust that promoted individuals professional development with the idea that the more highly skilled the team is, the better the service you deliver. I was grilled over my intentions and had to promise that I wouldn’t leave the Trust to inject Botox. Leaving the Trust was crossing my mind more and more but I’ve never been a big fan of needles so private aesthetics was not for me.
Whilst I was completing the prescribing course Covid arrived. Suddenly we were caring for people in the community that needed to be in hospital. Our community team were left caring for people who were a risk to themselves and/or others, discharged to emergency accommodation with no food, no money and no entertainment. These people are another unseen group of victims from Lockdowns. Whilst I was studying all aspects of pharmaceuticals from pharmacokinetics, research and licencing to adverse side effect reporting, the covid vaccines were released. Colleagues were clamouring to get their ‘jabs’ and I couldn’t find anyone who was willing to talk openly about the concerns I had regarding the lack of human testing and the flaunting of licencing laws. I was told to trust the science. I was told to shut up and get the ‘jab’. One colleague asked me, on our Christmas do, if I was scared of dying from covid and said they worry for people who are not vaccinated. I responded saying that I’m worried for people who are vaccinated. I qualified as a nurse prescriber in the January as the government were threatening vaccine mandates to NHS staff, giving 3 months to get jabbed or get sacked. I had never felt so alone.
A friend of mine from my previous team had heard that I was ‘unvaccinated’. I was so relieved that he got in touch. He told me about NHS100K and I was no longer alone. I found my local Stand in the Park, we went on a march and I found more people in the trust who were ‘unvaccinated’ and we started a telegram group to support each other. The official line of the Trust in emails sent only to those who were not vaccinated was that we should disclose to them that we are not vaccinated so that they could support us to become vaccinated as if we were just scared of needles and needed our hands holding and maybe a lollipop for after if we didn’t cry. I was like getting a letter from a debt collection agency, you don’t respond because if you do you are accepting that their information is correct. So it became an unspoken discrimination. I was very vocal in my private life but in work I didn’t dare utter a word. I sat making purple ribbons in early January to represent support for the one hundred thousand unvaccinated NHS staff that stood to loose their jobs. I had them in a pot on my desk and they were still there when I left nearly 2 years later. Of course the government decided not to sack one hundred thousand staff but the damage was done and the divisions were made.
I had joked with my team in Huddersfield on my leaving do that I would be team manager within 2 years and to my surprise I was! I applied for the post three times before I was offered the job and started in post the day after the government u-turned on the vaccine mandate. The two things are completely unrelated however because a Trust of such high moral standing would never discriminate against anyone. I also signed a document more binding than the official secrets act when I left.
Despite all of that I still hadn’t given up on the NHS. I still believed passionately in the EIP model of care and I believed that the service could do much better for people experiencing or at risk of experiencing a psychosis for the first time. Then I moved into middle management where all hope was drained from my exhausted body. I, again naively (do you notice a theme of naivety here?), assumed that everyone had the same professional work ethic as me. I don’t mean to blow my own trumpet here, I’m referring to very basic ethics such as, don’t tell lies, don’t go for a haircut in the middle of your working day and don’t accuse people of being racist when they question your work ethic. I used to joke with some of the staff that genuinely cared for people that we were only in it for the pay check, it made us chuckle because we were grossly underpaid for the amount of risk and stress we carried everyday. This stopped being funny when I discovered that a lot of people really are only in it for the pay check and really don’t care about peoples health and wellbeing.
I soon realised that I would never make it into senior management because I wasn’t any good at telling people what they wanted to hear. Senior managers are now so far removed from the ‘coal face’ that they don’t know what its like to get covered in soot. They no longer know how to talk about human beings they only know how to talk about budgets, targets, portfolios and performance and as long as that all adds up it doesn’t matter that little Lisa threw herself off a cliff because she was alone in dealing with the voices in her head. They feel no responsibility because they did the best they could and if their portfolio is not performing they’ll move on to the next role. Superficial success overrides real people and real rewards. Who cares for the carers? No one. is the sad answer.
I’m incredibly grateful to the NHS, it has been a huge part of my life both personally and professionally and I am so proud of the people that are still advocating for patients who really need them. It is an incredibly difficult job. I’ve learnt a huge amount working in the NHS and I’m also very relieved that I don’t have to work there anymore. I learnt that people really don’t like it when you point out their faults or how they could do things better. I was offered a job back on the dream team in Huddersfield but I don’t feel working for the NHS is good for my soul anymore. A friend of mine who also used to work for the NHS told me that its comparable to a diplodocus. The NHS is the largest employer in the world and as such it has a massive body and a tiny brain. I was very surprised at how differently policies and guidelines are interpreted in different places. In my experience some trusts, usually in places of higher social need, are genuinely trying to build services to better the lives of the populations they serve and others are just trying not to look stupid.
I believe that what was once an incredible institution that served the population from birth to death and everything in between has been hijacked by pharmaceutical companies and the technocratic banking elite that run them and control the World Health Organisation. It is not their intention to keep us well but to treat sickness because that’s where the money lies. I found that I couldn’t justify working in a mental health system that treats people with antipsychotics that shorten peoples lives by a third and that expects people to recover on hospital wards where they don’t feel safe. It was becoming increasingly difficult to feel any reward from making a positive impact on peoples lives because as practitioners you only have time to deal with the crisis in front of you in an institution that wants to keep its staff in a state of fear, so they will do as they are told, make them take the pills and move on to the next crisis. I’m really saddened by what the NHS has become. I’m grieving its loss but also trying to build a better future because there is definitely a better way if we all calm down, discern what is in our highest good and respond to ourselves and others with love and compassion. Getting pregnant is not like falling down the stairs.