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My Big Fat Nursing Nightmare

August 4, 2014

I’ve been trying to lose weight recently. This a new experience for me – up to now, I’ve always been pretty slim. Earlier this year though, I noticed that clothes that used to fit me didn’t seem to fit me any more, and worse still, something like a rubber ring I couldn’t take off had lodged itself around my waist. At first I was in denial: I’m a veggie! I eat healthy! I don’t have ‘a weight problem’! Eventually though, I had to face facts: the scales don’t lie. Happily, things hadn’t yet got too out-of-hand and a combination of more exercise and less food has seen me shed five kilograms in as many weeks. Already I’m feeling a lot more comfortable.

 

I’m also pleased to report that Simon Stevens, Chief Executive of NHS England, approves of my resolve. In an exclusive interview with The Sun last week he declared 700,000 of the NHS’s 1.3 million staff to be overweight or obese and in need of incentives to help them get fit. And what might those incentives be? Well – try to contain your excitement now – I’m reliably informed that ‘prizes such as pedometers will be on offer for staff who shed the pounds’. Pedometers? For crying out loud Simon, what kind of a prize is a pedometer? Do you seriously think staff are going to storm the salad bar just so they can get their mitts on an NHS pedometer? You’re talking about one of the most redundant inventions in the history of mankind! Those of us in the real world might not say no to a few high street vouchers though. We’ll be needing some new kit after losing all that weight.

 
Actually, it turns out that the architects of the new plan have considered the possibility that the allure of the of the pedometer, may not, on its own, be sufficient to achieve the results they want. So Mr Stevens also gave a promise that ‘more gyms are to be built’. OK – at first glance, this looks like a goer: many staff might welcome an on-site gym. But how would it work in practice? Well, first-off, forget any notion of a free post-work workout. Hospital gyms would be built and run by private companies and would be open to all-comers because that’s the only way they could turn a profit. The best that NHS workers could hope for would be a few quid off the joining fee. But then, how could the public be persuaded to take out gym membership if every time they wanted to use it they had to pay notoriously extortionate hospital parking charges? As a business plan, it doesn’t stack up.

 
The difficulty Stevens is grappling with here is that the market cannot provide solutions to problems that the market has a vested interest in perpetuating. Gym companies don’t want you to be fit – if you were fit, you wouldn’t pay to use their machines. It’s the same story with the food on sale in hospital canteens, the unhealthy content of which was also bemoaned by Stevens. But with most hospital catering farmed out to private contractors who are there to make money, it’s not surprising that if the place where they can make most money is chips and burgers, chips and burgers are what they’ll sell – although when challenged, they will, of course, hide behind the plea that ‘it’s what people want’. Of course it’s what people want if there’s no alternative!

 
Embarrassingly for Stevens, further evidence of the way the free market operates to encourage the consumption of high-calorie foods and drinks inside hospitals was supplied over the weekend when The Telegraph published an article on hospital food outlets. An investigation by the paper found that the 160 Trusts it surveyed between them boasted ’92 branches of [Costa Coffee]…alongside a host of burger chains, pizzerias, muffin shops and patisseries’. The article pointed out that hospitals built under Public Finance Initiatives ‘do not own their own premises, but lease them from buildings consortia, who also rent out areas to commercial operators’. If they want to get rid of retailers they consider inappropriate, they have to shell out big bucks. In 2011, a Trust in Croydon reportedly paid £24,000 to oust a branch of Burger King.

 
Laying into NHS fatsos has backfired on a number of fronts. Firstly, at a time when the government is trying to convince us of the benefits private enterprise could bring to the health service, it has drawn attention to the darker side of an unrestricted market, and the damage it can do. But also, and perhaps most importantly, it alienated staff. The NHS would be OK, Stevens seemed to be saying, if it weren’t for these tiresome blubbergutses with their lack of self-control. I felt insulted, and my BMI is back in normal range now. To be fair to Simon Stevens, in his original interview, he was careful not to single out any particular group of staff as being more culpable in this area than any other. He left that to the rest of the media. And whose body shape do you think they found most offensive? That’s right: nurses.

 
What’s particularly instructive in this context is to read the Simon Stevens reportage alongside another story that appeared the following day. It was headlined variously as ‘Nurse paid £1,800 for shift’ (Daily Mail); ‘NHS hospital paid £1800 a day for nurse (Sky News); ‘NHS hospital paid £1800 for agency nurse on bank holiday’ (Guardian). Accompanying stories invariably made it clear that hospitals had paid even higher rates for locum doctors – but it was the rates paid for nurses that were seen as most shocking. Why? Because it’s another example of the uglier face of market economics? Because slobbish lifestyles make health care professionals undeserving? Or because unlike the rest of humanity, nurses are supposed to do their job for love, and be untainted by filthy moneygrubbing?

 
This double standard, the idea that nurses are supposed to espouse higher ideals than other people, permeated an article by Christina Patterson in Saturday’s Guardian. Patterson’s journalistic record is one of sympathy towards care workers, so it was disappointing to find that while she was outwardly supportive of outsize nurses (‘some of the best nurses are the biggest’), she couldn’t hide her disgust that nurses too exhibit the human failings we take for granted in others. So although she breezily confides that ‘when I’ve been weighed by a nurse who looks twice my size, I’ve been tempted to ask whether she’s ever been asked to step on a set of scales’, she seems unashamed that she herself has been described as ‘a heavy social drinker’. On this logic, the fat nurse is the literal embodiment of a potent symbol: the feminine ideal gone awry.

 
Seen in this light, Patterson’s conclusion – that health workers need to get fit in order to to ‘fight the health problems that threaten the future of the NHS’ is an insult. Of course no one wants to see avoidable health problems in nurses or anyone else, but in a fight for the NHS the priority is not health workers who are petite and unthreatening, but those who are educated and informed. A couple of weeks ago, Professor Anne Marie Rafferty challenged the Guardian ‘to lead a campaign to show how nurses can become a more powerful force for the NHS and highlight the extraordinarily important work we do’. If this is the best they can come up with, we’re in a worse mess than even I thought.

 

 

The Simon Stevens interview in The Sun, like the rest of the Murdoch press, is paywalled. Other news outlets ran a Press Association version of it, all very similar to this one: http://www.theguardian.com/society/2014/jul/30/doctors-and-nurses-told-to-slim-down-for-sake-of-patients
For the Christina Patterson article, see: http://www.theguardian.com/commentisfree/2014/aug/01/nurses-obesity-fitter-nhs
For the Telegraph article on NHS food outlets, see:

http://www.telegraph.co.uk/health/healthnews/11006903/NHS-hospital-cafes-are-helping-to-fuel-the-obesity-crisis.html
For a very funny satire on why Simon Stevens decided to give The Sun an exclusive on fat NHS workers, see Julian Patterson’s blog for NHS Networks at:

http://www.networks.nhs.uk/editors-blog/fatal-attraction

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