Britain's NHS needs a dose of Florence Nightingale

Britain has a history of invention. Golf, football, rugby and other sports have variants in many countries but the British developed, codified and organised the way they were played. You can tell by the names. Badminton has an English name but was inspired by poona, a game discovered in Pune in India by British army officers. When Americans spoke of the Qatar World Cup as “soccer” it’s an abbreviation of the English codification of the rules of “Association Football” to distinguish it from rugby football. And rugby was, of course, invented at the English public school, Rugby. That remarkable English woman Florence Nightingale is credited with inventing modern nursing, although she first studied in Germany in the 1840s. But what Nightingale did do, in her subsequent role in the Crimean War, was to organise systems of health care for wounded soldiers, insisting on cleanliness and order. When she returned to the UK, she inspired rigorous training for healthcare professionals. Her legacy has a powerful pull on the British imagination. One very popular TV programme is Call the Midwife . Others include hospital dramas from Holby City and Casualty to No Angels . The “angels” reference is an affectionate but outdated nickname. It suggested high public regard for what is even now a relatively low paid profession. During the first wave of coronavirus, former British prime minister Boris Johnson encouraged British people to stand outside their homes and “ Clap for Carers ”, applauding the extraordinary efforts of those who tried to keep us safe and cure the sick. But nurses cannot live on applause or being called “angels”. They have been on strike – something once unthinkable – over the failure to raise their pay in line with inflation. As the Royal College of Nursing noted, this is unprecedented: “For the first time in history, tens of thousands of our members took part in strikes in December 2022 to demand fair pay and improved patient safety. As governments have failed to act, our members will strike again on Wednesday 18 January and Thursday 19 January.” Nurses feel they have been very badly treated by successive Conservative governments, and unrest is spreading. Junior doctors plan a “full walkout” for three days in March with no emergency cover. The British Medical Association says in real terms doctors have suffered a pay cut over the past 15 years. Ambulance workers are planning further strikes. Hospitals and family doctors’ surgeries are shouldering enormous winter burdens with coronavirus, influenza, chest and other infections. Ambulances are often queueing for hours to get patients into hospital wards because there are not enough free beds. All this puts lives at risk and therefore is potentially very damaging for Prime Minister Rishi Sunak. He held an emergency health care meeting last weekend but there is no easy way out. The perils of people dying untreated in hospital car parks are obvious, but so too is the problem of agreeing big wage rises which themselves fuel inflation. If nurses secure 10 per cent increases, the precedent will spill over beyond health to other workers. All this is therefore a big headache for Mr Sunak especially since health care or lack of it obviously affects everyone. Over the past month, I have heard countless stories from friends and acquaintances of difficulties in seeing a doctor; of crowded conditions in hospitals for elderly relatives; of long waits for an ambulance and (in the case of a close friend) of turning up at a hospital late at night with a sick child whose temperature was 40°C, only to find staff on duty were overwhelmed. The invention of the NHS in 1948, like Florence Nightingale herself, is a source of real pride for every British person I know. But the inadequacies of the system are also obvious and shameful in such a rich country. To use medical terms, there is an acute problem with the British National Health Service, but also a chronic problem. Every year in January the NHS has a crisis of winter beds. The British Medical Association, using the latest OECD data, says the UK has just over 2.4 beds per thousand people whereas Germany has 7.8 and France almost six. Not having more available beds is a political choice. More money is needed, but so is structural reform, including a boost for social care so elderly people can be moved out to care homes rather than being stuck in hospitals. Nuffield Trust health experts say the NHS may be short of as many as 50,000 nurses and midwives and 12,000 doctors. Stagnant pay and difficult working conditions are undoubtedly a part of the problem, but the organisation of NHS services is also under scrutiny as the strikes continue. The British do indeed have a tradition of invention, but we also have a more complacent tradition of trying to “muddle through” complex problems. With lives at risk this winter this is not a time to muddle. It is time to be bold and think creatively. Florence Nightingale fixed problems because she refused to tolerate them. It is time to do the same.