The NHS is where health becomes political. As the UK celebrates the 70th anniversary of its health system, IN wanted to meet the people uniquely placed to understand the relationship between the politicians who make health policy, and the frontline staff who have to implement it. Of the 650 members of the House of Commons, five are nurses (three Conservative, two Labour). Two of them agreed to speak to us, Conservative MPs Anne Milton and Maria Caulfield.
How did you become a nurse?
MC: ‘I trained in the early 90s at what was then called Mayday in South London, now called Croydon University Hospital, near to where I grew up. At that time, I didn’t really have an area she wanted to specialise in typical student did a couple of placements, but didn’t have an idea of where I wanted to go.
‘At that time, it was really hard for nurses to get jobs when they qualified so there were many of us hunting for jobs. I didn’t get a job at Mayday as there were none available and the jobs that I could get were maybe a 3-month contract. It’s hard to believe now, and the only permanent job I could get was at St Thomas’ so I came and worked there. It is just across from Westminster, so I see it on a daily basis today.’
AM: ‘When I left school in 1974, middle class girls from Sussex like me became teachers or nurses. I suppose it felt like a good idea that the time. I wanted a job that involved working with people, and the training hospitals were a good place to train. My father told me that I’d always have a job, and a London-trained nurse would be able to get a job anywhere in the world.’
How did your career develop?
AM: ‘In those days nursing was an apprenticeship. You qualified after 3 years, and I worked on a neurological ward as a staff nurse, and a general medical ward, which concentrated on people with arthritis, and people with cardiac problems. I stayed on for a fifth year, and then I worked on a neurosurgical ward, which is probably the busiest ward I’ve worked on. Lots of agency nurses, we had about 9 nurses a shift and it was frequent that we only had 2 regular staff. We were meant to have 11 permanent staff and we had 2. This would have been 1977. Nurse shortages in the NHS are not new, not very much is. I wanted a change and more regular hours so I went to work for a chest consultant at Barts hospital.
‘I then moved into district nursing, working in Hackney. I loved it. I think If you work in hospitals you don’t understand what a completely different job it is working in the community. I then worked at St Thomas’, where I was employed to set up a scheme to discharge people early from hospital. So nothing has changed. I worked with the palliative care team, as well as GPs on discharging people early. And then I worked with social housing providers in Hackney. I never really moved far from Hackney.’
MC: ‘I worked on the first oncology ward there. I really enjoyed my time there, but I wanted to get some more knowledge, so I worked in A&E, which was great. I saw all sorts of conditions and situations. A&E is really good for getting a round experience, but I did miss when people were discharged and went home, you never really found out what happened to them.
You would be emotionally involved with someone going through the most traumatic period of their lives and then never hear from them again.
I missed that experience that you get in oncology were you get to know patients and their families. I went to the Royal Marsden after that and specialised in oncology.
How did you get involved in politics?
MC: ‘In the 1990s I was working as a Macmillan nurse at the Royal Sussex County, when there were plans to close the sister hospital in the trust. Most of the elective surgery was going there, and that if it were to close, their patients would have to come to our hospital, which was already overworked. My job on a Thursday afternoon was to phone patients up and say ‘I’m sorry your operation has been cancelled again’.
So I joined the Save the Princess Royal campaign and it was the local Conservatives who were running that campaign. A number of constituencies joined in and thankfully it was saved. And it’s still going strong now. Politics is a bit like anything in life, once you dip your toe in it grabs you and the next local campaign comes along and before you know it you’re standing for local council, your local seat comes up and you stand for that.’
AM: ‘I had two children, wondering what to do with the rest of my career. And I thought I’d like to be an MP. Not enough women, not enough people with my background, particularly in the Conservative party. I’d never been politically active but I did think about it. I felt the House of Commons was very thin in terms of real life experience.’
‘I joined the Conservative Party because I believe in rights and responsibilities, as well as providing a safety net for people. To some extent, it was to do with my background. I had worked all through the 80s in London, when the Labour Party was very left wing, similar to how it is now. I was there when there was a lot of trade union action going on, I remember the porters going on strike for 48 hours because a nurse had wheeled a patient up to the wards – so they went on strike because she did their job.
‘I saw the health service close to brought to its knees by trade union activism. There was a lot of left wing activism in Hackney, some of it very damaging to the community. I was working a lot with Hackney council, who owned 44 000 properties, they were in a shocking condition. It was one of the most deprived parts of the country and it was ill-served by left wing politicians in power. And they were a community that most needed to be served well.’
What is it like transitioning from a nurse to a politician?
MC: ‘It’s a bit of a culture change. Everyone loves nurses, it’s difficult to find someone who dislikes nurses, and being a cancer nurse, people love you even more. So going over night from that to being an MP, where even estate agents are more popular than you, is quite a culture shock. I have found it difficult to deal with the abuse you get, when you are trying to do your best, as most MPs are. MPs work incredibly long hours. I thought I worked long hours as a nurse, and its nothing compared to the hours you work as an MP.’
AM: ‘The skills I learned as a nurse are invaluable to my work as an MP. Working in a London teaching hospital, there were a lot of homeless people, living next to stockbrokers. You learn to deal with people from every single walk of life.
‘I think being a district nurse had a profound impact on me. Probably a quarter of the households I visited in the 80s didn’t have an inside lavatory, so you see a side of life that you would never see. I knew how to talk to people in a way they understood. It gave me some credibility here, the fact that I’d been a nurse, a profession people understood, people knew I had seen a side of life they hadn’t.’
MC: ‘As a nurse you learn not to take it personally when people are angry or upset. That’s been a very helpful skill as an MP. People will shout and rant, but that doesn’t mean they’re angry. If you take it personally, it begins to wear on you. Also being able to prioritise. When I worked in A&E and even within the cancer setting, you think you’ve got your day mapped out and then something happens and the whole day is out of sync. Being an MP is like that, you might think ‘Today I’ve got an easy day,’ and all a sudden the Prime Minister makes a statement and things change completely.
‘It helps that you have experience in being an advocate as well. When you’re a nurse you’re an advocate for your patients, and when you’re an MP you’re trying to do the same thing for your constituents. There are many skills you learn in nursing that don’t necessarily make you popular with management, but still need to be done.’
What are you most proud of in your political career?
MC: ‘There are two or three I’m particularly proud of. The pay rise is one of those. I met with teachers last week, who are marked for a pay rise, which will have to be paid for out of existing budgets. And they had a moan that the NHS got a pay rise and they didn’t. so I was proud we were able to get that extra funding. I was also quite outspoken against the abolition of the nursing bursary. And while that happened I worked really hard to convince ministers that we needed another way into nursing other than tuition fees. And we now have the nurse associate and apprenticeships. People tell me how great it is. Much better than the bursary system. While I didn’t manage to keep the bursary, we’ve certainly got a better route in. we just need to scale that up on a massive level.
‘From a clinical point of view, I was particularly proud of my work on stem cell transplants. The government had announced that they were going to scrap them for patients with blood cancers. And I supported the Anthony Nolan trust campaign, because actually there’s a really good success rate. And we managed to secure it. When I work on a chemotherapy ward now, and someone has a transplant, it puts a smile on my face.’
AM: ‘I trained as a nurse, worked in the NHS for 25 years and then I became
a health minister, how good
Interviews by Alex Turnbull