When Jeremy Hunt recently attacked the Royal College of Nursing (to be called, henceforth, Cecilia), by calling “ridiculous” its perceived threat to recommend nurses strike over plans for a seven-day NHS, he sent a warning shot over Cecilia’s bow. This worked, for Cecilia, wetting her knickers, soon sent out clarification of her position, her spokesman explaining: “There’s a big difference between industrial action and strike action. Nurses are never going to do anything to damage patient care and the RCN’s own rules would not allow that. What we want to do is sit down with the Government to work on how to take this forward in the interests of better patient care”. Cecilia is reprieved, no chopping block for now.

Some words to Cecilia: Of course, the issue of ‘unsocial’ hours payments for nurses is being considered by the government, but there are far more dangerous plans under the government’s microscope, one of which is the issue of split shifts. Nursing colleagues in Australia have battled against this ‘market friendly’ imposition for years, as headlined: ‘State Government proposals for nurses to work split shifts are an attempt to pass on cost savings being forced on hospitals, the nurses union says'(www.theage.com.au/victoria, 2011).

This report quoted ‘State secretary of the Australian Nursing Federation, Lisa Fitzpatrick, (describing) as unbelievable a government proposal for nurses to work split shifts from 7-9.30am, then midday-3.30pm, as part of enterprise bargaining negotiations. Fitzpatrick hit the proverbial nail: ‘All of the shift reduction initiatives the government is proposing are about reducing the nursing pay budget … If you pay less nurses for less hours then hospitals can make the savings the government is forcing them to make because of the decreased budgets they are receiving this year‘. Sounds uncanilly like  UK 2015.

Dear cecilia, before you curtsy to those who will ordain such a system on British nursing, please consider the full extent of it. The government’s plans mirror those found in restaurants – cooks and waiting staff often work only during mealtime rush periods, which means they might work the lunch shift, clock out for a few hours, then return for the dinner shift. A nursing split shift might mean being on duty from 7am-10am, then 2pm-7pm.

This is not the worst case scenario, as gaps between ‘shifts’ might only be two hours. In California, nurses with more than one hour between shifts receive a split shift premium of an extra hour’s pay. Union contracts also sometimes mandate special benefits for split shift workers, such as a minimum or maximum amount of time between shifts. There will be no such ‘benefits’ in the UK, for such as Cecilia will merely curtsy to the lord on whose table they wish to sit.

But a double commute will reduce personal time, and be expensive, especially if you live far from work. Tough luck on any partner or children.

Computer programmes for split shifts in nursing are already used throughout industry: ‘The Split-25 Excel spreadsheet creates schedules where each employee can be assigned to 1 or 2 categories … 1 or 2 locations … and 1 or 2 times (10:30 AM – 1:30 PM and 4:00 PM – 8:00 PM) each day for up to a month. Shift assignments are made from drop-down menus of qualified employees. The spreadsheet can … also keep track of your payroll budget based on employee wages and scheduled hours’.

Factoring in agency nurses is not a problem: ‘One option for scheduling a difficult-to-fill shift is to “split” the shift so that it is worked by more than one provider. For example, if no single provider is available to work the entire shift, the first half could be worked by one available provider and the second half by a different provider. Split shifts in EPSKED are shifts that are normally worked by only one provider, but are instead being split between two or even three providers’ (www.rsoftr.com).

The salient point here is cost reduction. These systems can find the cheapest mix of staff.

Hours of work may not be known in advance. Nurses await a text message.

Another facet of the torture to come is that these split shifts may be ‘floating split shifts’, which mean that a nurse starts their shift in one unit and then at some point during the shift is moved to a different unit. If you are late at the next unit, you get a bollocking. No time, then, for a full report to the next nurse, thus, patients’ continuity of care is likely to suffer. This system is quite common in America, and will be introduced under the Americanisation of British Nursing Plan being fine-tuned by the corporation-serving UK government. (These ‘reforms’ will also include doctors and care assistants).

Some nurses, rather like Boxer of ‘Animal Farm’, will embrace such change, internalising government rhetoric into their belief system: “I’m a flexible, modern nurse, fit to meet the demands of a changing society” – to paraphrase Wordsworth, people think what they must, then call it by another name. Some nurses will leave, the strain on their social and family life being intollerable. The army of foreign nurses will just get on with it, and jump through whatever hoop is put before them, as long as they can continue sending money home.

Cecilia, meanwhile, will continue to chant: ‘What we want to do is sit down with the Government to work on how to take this forward in the interests of better patient care’, whilst quoting selected studies which the government does not care a rat’s ass about, for they will commission studies showing right to be on their side.

Oh my dear Cecilia, they so dislike you that you are not even told of their plans. Do you honestly think they give another rat’s ass if you sit down with them or not? You are like a little girl in a school yard who is not part of the gang.

Cecilia will not do anything to damage patient care?

Leave that to the government, as long as Cecilia can negotiate the best terms of nurse ‘flexibility’, thus damaging patient care!

Must not strike like naughty Australian and American nurses!

Will Cecilia recommend that ‘enterprising’ nurses work in McDonalds between their split shift? “Get those fries down you, I’m due to give an injection in 10 minutes”!

Oh Cecilia, have you ever considered that nursing exists within a starkly political world, in which the only defense of nursing is a robustly political one?
lenin nightingale 2015





It was very heartening to see that the New South Wales Nurses and Midwives’ Association (NSWNMA) commissioned a television advertising campaign in February, 2015,to warn of the perils of Australia adopting an American-style health system.

The campaign went under the banner of ‘Patients before Profits’. ‘General Secretary of the NSWNMA, Brett Holmes, said ‘the Liberal-National Government’s current health agenda of privatising public hospitals and services could result in a public health system in NSW where patients pay more and corporate shareholders make profits on taxpayer-funded services’ (1). Mr. Holmes spoke of the Americanisation of the Australian public health system, and detailed the present scope of this policy: “Sub-acute mental health services are being privatised, new palliative care services have been gifted to the for-profit sector and disability services will cease to be government-run by 2018” (2).

This is the same process which is being planned for Britain. When politicians use weasel-words to advocate why and how the British public health system should be ‘modernised’, they really mean ‘Americanised’, which is to fragmentise and corporatise.

The plan is to introduce a seven-day NHS, but as with everything gushing from the mouth of neoliberal politicians, the devil of the lie is in the detail. There will be seven-day GP services, but if the gullible think that equates to getting a weekend GP appointment, they are deluded. The service to be offered will be a ‘local’ one, serving a relatively wide area – you will be able to see a doctor at a regional clinic, some 10-20 miles from your home. Will there be public transport available for the sick, elderly, young, and disabled who do not have access to a car? Will they be able to afford a taxi? Will a ‘Big Society’ neighbour come to their assistance?

All other services, once under the roof of the local hospital, will be similarly dispersed, with patients being asked to attend far-flung speciality clinics, catering for diabetics, pregnant women; those in need of physiotherapy, and radiotherapy. These services will be privatised. At first, private companies will be paid by the government,but such changes will be accompanied by offering a queue-jumping, two-tier standard of service, built on private health insurance, currently experienced by Australians, and commented on by them in blog posts:

‘The mix of insured and medicare only patients in hospitals is already producing a two level system. A single mother, public patient with no private health insurance falls down the operating list behind those with health insurance even when this involves the hospital’s own protocols are being ignored. A surgical procedure which is determined should be carried out in 24 hours after admission can be delayed for a non-privately insured patient. In one instance where the delay was a big factor … this resulted in death. We already have a two tier system of health care because of the involvement of private health insurance – paying customers are given priority over the non or low payers’.

‘Patients in private emergency departments who get investigations that are absolutely not required, an example , serial ECGs, for presentations that are blatantly not even remotely cardiac, that adds up to a pretty large amount when 80-100 patients run through the department each day. Proceedures that aren’t even performed, for example claiming for a fracture manipulation under a form of regional anaesthesia (known as a Biers Block) when then fracture had no manipulation and had a simple cast applied by a plaster technician (not even a doctor)’.

‘We already have a two level system. Recently a friend found out she had a tumour that needed to be urgently removed. She is not privately insured and was told by her surgeons that to receive the best outcome from the surgery she should have the procedure done as a private patient. Faced with a very delicate and dangerous operation she felt she had no alternative but to pay over $40,000 for the operation in order to ensure the best outcome. I was shocked and suprised that our health system cannot guarantee the same quality of service for both private AND public patients when dealing with serious and/or life threatening conditions’ (3).

The plan for seven-day hospitals is also a sham, predicated on the prediction that seven-day services would save lives. However this may be, it is a Trojan Horse, the real aim of which, as elucidated by David Cameron, is to see NHS staff work “different shift patterns” (4). This is weasel-speak for ‘split-shifts’, with ‘flexible’ staff waiting to be summoned to work via a phone or text message. It is also the precursor of ditching unsocial hours payments, for, without this cost-cutting measure, ‘reforms’ would not be funded. This was what Cameron meant when he said people should “not automatically assume” increasing services would cost more, without any explanation (5).

These ‘reforms’ will also bring about a ‘skills-mix’diminution of nursing – ‘nurse technicians’, trained in specialities over one year, will replace nurses, whose three year degree covered a Jack-and-Jill spectrum.

It should not be expected that such as the RCN will take a political stance against the cultural vandalism planned for the NHS, repeating the sentiments of Mr. Holmes: “The American health system is not a model we want replicated here in Australia or, importantly, in NSW. It is plagued by unethical corporate interests and health outcomes for patients are far worse as a result of exorbitant medical costs” … “Rather than criticising the workforce who stand at the frontline of our health system, the Liberal-National Government should listen to the nurses and midwives who endeavour to deliver safe patient care and the best health outcomes possible to the people of NSW” (6). RCN members will pass resolutions at their ‘coffee and bun’ conferences, but these will go as unheard as farts against a gale.

The context of the aforementioned ‘reforms’ is the Americanisation of Europe, taking place under what is euphemistically called the Trans-Pacific Partnership trade agreement, otherwise known as TPP. In its simplest terms, “free trade” means one thing only — the ability of people with capital to move that capital freely, anywhere in the world, seeking the highest profit. It’s been said of Bush II, for example, that “when Bush talks of ‘freedom’, he doesn’t mean human freedom, he means freedom to move money’ (5). Under this plan, all national sovereignty is lost, as the treaty terms are enshrined in law, with its own court system, the TPP court, in which American corporations will be able to sue participant countries for “lost profits”, that is, profits denied them by not allowing unfettered access to markets; whether that ‘market’ is fracking or health care. No national court will be able to overturn a TPP court decision. Corporations of the American-World-0rder rule.

Thus,however the forthcoming debate about Britain’s membership of the EU is conducted, however much disinformation is given, the one certain thing is that it is a meaningless sham – Britain will be forced to abide by its TPP treaty obligations, with all its ramifications for nursing.

A question for all nurses is this: should the RCN enter the political arena in which health care is determined, as gladiators, or should they sit at Caligula’s table and nod at every downward thrust of his thumb? It should be added that being a groveling, obsequious, sycophant was not a guarantee of survival – (Caligula had recovered from being very ill). A senator: “I offered my life to Jupiter to spare our beloved Emperor”! Caligula: “Jupiter accepts your offer”. Caligula, turning to his guards, “Execute him”!

You who are about to be struck, strike first!

lenin nightingale 2015


(1) http://www.nswnma.asn.au, 8th February 2015.
(2) ibid.
(3) http://www.abc.net.au, 13 August 2013.
(4) http://www.gov.uk/government, 18 May 2015.
(5) ibid.
(6) http://www.nswnma.asn.au, supra.
(7) americablog.com, 2013