Revolution, the youth paper of the International Marxist Tendency, met up with a representative of the Bursary or Bust campaign to discuss the terrible conditions faced by student nurses in Britain, who have lost their NHS bursary to Tory austerity measures. With this financial lifeline cut and further junior doctors’ strikes called off, the future seems bleak for British medical workers, but radicalised trainee nurses and allied health professionals vow to keep fighting.
Tell us about the Bursary or Bust campaign ‒ what is it, when did it start and what does it aim to achieve?
It started last year, with about twenty of us here at King’s College London. We were a rag-tag bunch of student nurses, midwives and different allied professionals: dieticians, occupational therapists etcetera. Our main goal was to try and reverse the Tories’ scandalous cut to NHS bursaries, which are a lifeline to so many medical students, especially from working-class backgrounds who need a bit more support to get through their course.
At the moment, it seems the government isn’t going to reverse the cut. Together with the junior doctors calling off their strike, it looks like things are going backwards ‒ but that’s not true. The new nursing cohort coming through is going to breathe new life into the Bursary or Bust campaign and we still have all the old hands as well. We’re aiming to spread it further, so we’re not just going to focus on the fact that the bursary is gone, we’re going to turn our attention to housing and we’re going to look at getting student nurses paid for their work, which would really help retention rates. At the moment lots of nurses and allied professionals give up and leave because they can’t afford to complete their training.
And of course, it’s simply right that they should be paid.
Yes, we started with the bursary because we already had that and if we had won that battle we would have continued to push for wages. The bursary, whilst being a lifeline, is still meagre because the maximum you can get, with an extra grant on top of it is £547 a month, which in London is absolutely nothing. And that’s the biggest one. A nurse on my course gets £80 a month. A lot of NHS students end up going to foodbanks. We also work additional jobs on top of our studies. We already do between 37.5 and 48 hours for our placements (the difference between us and other students is that we work for 50 per cent of our course) and we usually have a part-time job to boot. So that’s an extra 25 hours a week, and our weekend taken away.
What is it like to be a student nurse in Tory Britain?
Because the NHS staffing is so dismal at the moment, a lot of the time student nurses are used to bolster the amount of staff on shift. We’re supposed to be treated as supernumerary, but that’s never the case. We do a lot more work than we should be and you hear countless stories of students’ doing jobs they’re not supposed to perform. A day in the life of a student nurse is: we come onto the ward, we take part in the same work as regular staff ‒ we do all the paper work, we’re on the floor with the patients, we take all the emotional labour, all the physical labour to the point that we are essentially staff. But with no money and none of the recognition.
While the majority of qualified nurses I’ve worked with have been lovely, I’ve heard many stories of mentors who don’t support their student nurses, who aren’t very empathetic. The NHS bosses don’t see us as staff, because we’re not qualified, and a lot of the qualified nurses unfortunately take sides with management. I’ve seen a student nurse who was dealing with a mental health patient whose situation hit a nerve, because she’d experienced similar things in her life, and she broke down. The qualified nurses’ reaction to that was: ‘that’s the job – get on with it.’ There was no support or comradeship: it’s like they’ve already accepted their fate, that the profession is intolerable, and that’s just the way it is.
How widely unionised are student nurses?
Many of us are unionised. We’re represented by Unison, Unite and the RCN (Royal College of Nursing) and until recently they were all rather inactive but they’re starting to pull their fingers out ‒ under pressure from below. For example, in 2010 we had a pay freeze: the bosses offered a 1 per cent pay increase and promised to review it in 2016. The same offer came back this year and they said the pay freeze would remain until 2020. The RCN has said that this is not enough and it will campaign for a better deal. This is a good turn of events, especially compared to the terrible time the junior doctors are having with the BMA. Although when their strike was called off it taught nurses that they can’t rely on doctors to carry out the whole fight on their own. We have to step up, support them and receive support in return.
Historically the health service hasn’t been very politically radical, has it?
Actually nurses have quite a radical history! One of my newfound heroes, Thora Silverthorne, was a British nurse who joined the Communist Party when she was sixteen years-old, her father was a miner and very big in the unions. She said that back in the 1930s all nurses ever talked about was politics. She went to Spain during the Civil War as an international brigadier, and when she came back she formed the Nursing Associations Union as a counter to the RCN, which she felt was too conservative ‒ I wish I could’ve joined it, but it didn’t survive. We also have a hashtag called Nurses Roar which we use to raise awareness about different wildcat nursing strikes across the 20th Century to show new nurses how our predecessors fought for our profession.
Can you tell me more about your personal experience of being a student nurse?
I’m on placement, 40 hours a week unpaid, and on top of that I work two shifts at a low-paying job that I rely upon to pay for food, bills, schooling and travel. I have absolutely no social life, not that I could afford one anyway. It’s the little things that are the hardest to do without: there’s no time to get a haircut, to properly take care of myself, to go to Tesco ‒ things like that. It takes a toll on your health, your weight and on your mind. And my situation is better than some. I know people who pay even higher rent than I do.
I live in zone six, meaning I also have to pay £156 a month on my travel card, and King’s has created a loophole to avoid reimbursing students for travel. They will cover travel to placement but only if it costs more than getting to university, which is in zone one, so the only way to get money is to live in zone one and commute out to zones two to six. Most students can’t afford to live in halls, but even if they can they’re only there for a year.
The NHS considers one nurse for every eight patients to be ‘safe’ ‒ in mental health, I’ve been on a ward of twenty patients with two nurses, which is absolutely shocking. If one or two people were in crisis, that was my entire day. On my last placement it was just me and an agency nurse: she wasn’t a bad worker but she didn’t know the patients very well. Two elderly patients became unwell and we ended up having to get the doctor in, supplying oxygen to the patients, and technically I was second in command for an entire ward, which is very dangerous as I was just a trainee nurse, there with a nurse who doesn’t belong to the NHS.
It sounds like it’s impossible to give patients the care they require.
I spend my whole time looking after these patients, doing my best to ensure they’re in the best mental state they can be, but you’re basically encouraged to just load them up on drugs, because there’s no time or funding for other forms of support. If you give aspirin for a toothache, it numbs the pain but the tooth is still rotten. And that’s what we do to a lot of our patients. It becomes a revolving door. I feel like I’m just patching up workers so they can get back into their terrible environments, break down again and come back to me. That’s not the reason I got into this job.
So you think nursing has just become a flimsy bandage for the wounds inflicted by capitalism?
Yeah, and it’s not just nursing. It’s the whole profession, it’s the whole NHS. Capitalism has caused all of these problems and doesn’t know how to fix them. Mental health is the dark horse: it gets neglected, it gets no funding. We’re back to seeing things in a very Cartesian fashion: treating the mind and body as separate, when they’re not. If you’ve been walking your entire life and all of a sudden you end up in a wheelchair, your mental health is going to suffer. But we still tackle the physical and mental issues separately. And the waiting list for some carers is measured in years. I remember referring a patient to the trauma centre for refugees. He was suicidal – he told us he would take his own life given the chance ‒ and we were told that the wait time would be three to four months. What was I supposed to say to him? ‘Please don’t kill yourself, and we’ll get to you as soon as you can’? And data protection means I have no idea what became of him.
And of course, mental health is increasingly blighting young people in particular.
I work as a support worker on a Child Adolescent Mental Health unit on top of my training: we call them CAMHs and they’re critically underfunded. They’ve been cut by £80m and the Tories have got rid of early intervention, which is the key thing you need to help kids through their first crisis, to make a difference in their early life so they don’t grow up carrying that same mental health problem into adulthood. Instead they want nurses to go into schools ‒ which is a great idea, except they want overstretched nurses to do that on top of their normal caseloads. It’s the same as with the junior doctors: they want us to do more with less.
Journalists are just waking up to this. They’re writing lots of apocalyptic stories about how the NHS is going to be torn asunder by a whole new generation of mental health patients ‒ and it’s true! We’re better at diagnosing mental health issues now, but austerity and cuts make it much more difficult to nip mental health problems in the bud, so they progress into later life. Also, more diagnoses aren’t always a good thing. Pharma companies in the States make a lot of money out of diagnosing ADHD, for instance. Sedating children is a big business, and we’re only just discovering all the side effects from the kids of twenty years ago.
This situation sounds completely unsustainable. What kind of support and solidarity do you and your colleagues require from the student left and the union movement?
When Bursary or Bust marches, we’d like students to march with us; when we pull our little stunts, we’d like you to be there to support us. What I’d like from the unions is a drive to get qualified nurses more in-the-know. When I go out on placement, qualified nurses seem shocked by what we face, because the situation for them when they were students was a little better: they had help with housing, food and so on. We get nothing, except for the bursary ‒ which is now gone for the next generation of students. They will be essentially working for debt: at a rate of about £26 per hour (which is more than their wages will ever be!)
The NHS is fighting for its life. The idea of moving away from free healthcare at the point of use is one of the most barbaric things I can think of. It’s like taking a leap backwards into the dark ages. We’ve seen in countries like the United States the human cost of charging for healthcare: the deaths, people not going to their doctors early because of the expense and then ending up putting a strain on A&E further down the line. That’s what we could have here: it’s totally backwards. Harry Leslie Smith always talks about his sister dying of tuberculosis and how was nothing his parents could do ‒ they had to watch her go off and die in a poor house. What’s to say that couldn’t be the case for families in the future?
Only socialism can keep the NHS in our hands. The ruling class thinks it belongs to them: that’s why they’re taking it apart, because they can. They’re friends with companies like Healthcare America, Circle Healthcare, Allied Healthcare, Virgin Healthcare: the parasites buying up all of our hospitals and then closing them when they’re no longer profitable. Healthcare America have offices at the Shard, which is just across from Guy’s Hospital [part of King’s College London]. HTA was indicted in Florida by the FBI for doctoring patients’ notes so it could give people unnecessary open-heart surgery, and charge them over the odds for it. HTA paid the fine ‒ it was like losing a tenner to one of us, not the end of the world ‒ and now it’s vying for NHS contracts.
Things are dire, but we’re not giving up. Anthony Johnson, the current president of Nursing and Midwifery Society said in the Nursing Times: ‘This is something we must all remember now, when it looks like the bursary campaign is over, the junior doctors have lost their fight, and the deconstruction of our health service will be imposed: it is never over…Bursary or Bust is not the end, it is just the beginning. Whether you were with us last year, or just starting out, we urge people to get involved and see for yourselves. There will always be people like me and other student presences to support.’ We’re not done yet.
Dan Langley, aged 24, is a Revolution supporter and a second year postgraduate mental health nurse at King’s College London. He is also on the Bursary or Bust committee and is head of mental health for the KCL Nursing and Midwifery Society.