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Letter from London

The Black angels of the UK’s National Health Service

The Black angels of the UK’s National Health Service
  • PublishedMarch 6, 2023

Forced to spend a good deal of time in hospitals recently, Clayton Goodwin praises the contribution of African nurses not only to the health of patients but also to the UK’s National Health Service (NHS) in general.

Over the last few months, I have spent as many days in hospital, either as an inpatient undergoing operations/procedures or as an outpatient going in for appointments/treatment, as I have out. This experience has given me a first-hand view and understanding of how the country’s most treasured institution, dependent on Africans for its very existence, is creaking at the seams and is very nearly crocked. Africans? Oh yes, Africans are the life-blood of the National Health Service (NHS).

Nurses are popularly portrayed in television drama as angels: it has traditionally been one of the few ways for African actors and actresses to obtain a footing in the industry, by playing the role of doctors or nurses.

They actually reflect the situation in real life. It is not yet three years since we as a nation stood at our open doorways at an appointed hour each week cheering and applauding the ‘hero nurses’ during the initial Covid lockdown. Admittedly, one or two Africans as much as any other nationality, can be mulish and downright awkward, but the great majority are exemplary in carrying out an arduous task in very difficult circumstances.

In the hospital which I attend, just beyond the outer reaches of London, the evening and the dire night shifts have been staffed almost exclusively by Africans, a good number of whom are employed from agencies rather than directly by the hospital or the NHS. 

While the world is sleeping, Africans carry out the vital blood-pressure measurements and take temperatures. Today the ‘Lady with the Lamp’ trudging the wards to bring comfort to the afflicted in the hours of darkness – a story told to every UK primary school child of my generation (and, assuredly, also today) – will be an African.

Much the same can be said of day-time treatment in units which involve some of the most intimate care. The bulk of the work can be routine, but other duties require a high degree of specialisation and responsibility. All demand commitment.

African doctors are prominent in A & E (Accidents and Emergencies), dealing with acute cases. The removal of that African content from the hospitals would be disastrous for the NHS. Yet the government is gambling recklessly on their loyalty and the mistaken belief that they have nowhere else to go.

Nor is it only the government which threatens that loyalty. Even as this letter goes to press, the Independent national newspaper has published a report that one in three Black and ethnic minority staff face discrimination or bullying – much of which is “systemic” and “deeply embedded” within the NHS organisation.

Mainly as a result of international and overseas recruitment, the number of minority staff has risen by 100,000 since 2018 but with only 10% representation in the top jobs.

Even so, just a cursory glance will show that the NHS is ridiculously under-staffed and under-resourced. Nurses do much more than perform the laying on of hands and when the ward-nurse is engaged on an administrative task there is often nobody to replace them.

The unanswered ‘attention!’ buttons provide a constant backdrop to the day’s and night’s activities. Some treatment may be ‘paused’ while the only nurse available snatches a drink-and-sandwich during her 30-minute lunch hour.

To my elderly and untutored eye it seems also that staff are spread particularly thinly at specific levels of responsibility. I had to remain in hospital one day after my official departure, blocking the bed for use by another patient, until somebody of the necessary authority could be found to sign the discharge papers.

First strike in history

The time in hospital coincided with the start of the nurses’ strike – the first such strike in history. While, it is argued, strikes should not be permitted in such a vital sector, the country is morally bound to reciprocate by providing decent working conditions and sufficient remuneration such that the staff do not have to contemplate withholding their labour.

A strike may be hazardous to individual lives, but the only feasible alternative, the mass walk-out of nurses/medics to better appreciated positions overseas, into private practice, or out of the health service altogether, would be a body blow from which the institution would not recover.

That appreciation deserves to be demonstrated in something more substantial than honeyed words and muffled applause. If the purpose is to make the purchase of the NHS cheaply attractive to private (and possibly foreign) investors, as critics allege, the ploy could well backfire – who would want to buy a broken-down car, house, or even health service?

Mooted proposals by some politicians that patients should pay for visiting their GP (general practitioner) or A&E at hospitals hark back to a painful past.

Before the NHS was founded, my grandparents had to watch their two-year-old daughter die from a routine complaint because they could not afford to pay for the doctor to visit her – and they were far from being alone. In many ways Africans today provide the thin line between a national health service and a return to those dreadful days.

Away from hospitals, the teams of night-shift district nurses and individual day-time nurses are also exclusively African. Theirs is an impossible task stretched to the limit of resources. One night-team (they operate in pairs) tried to stay with me until an ambulance arrived but were called away to other equally pressing emergencies.

Despite being designated as ‘highest priority’, I had to wait for five hours before an ambulance was available. (It has been suggested wryly that some shifts exist only on paper). Nevertheless, the nurses kept in telephone contact until I had been collected safely. Without them … there could be nothing.

Our gratitude to the many African doctors, nurses, medical technicians, ward-orderlies and other staff obscures one guilty question which all of us who benefit from this vulnerable yet still vibrant NHS must share. While we are being so well tended and cared for by Africans here, who is looking after the ill, the afflicted and dying in Africa?

Following the cutting off of its traditional European sources in the wake of Brexit, the UK government is reported to have targeted recruitment particularly from Nigeria (with all that that implies) to fill the still thousands of vacant places.

Lying in hospital beds or on treatment tables, I have had plenty of opportunity to read the newspapers. The reports haven’t all been bad – have they? There was encouragement in the New Year’s Honours List. In particular the award of the prestigious CBE to Rosamund Adoo-Kissi-Debrah for services to public health was heartening and well merited.

Rosamund has launched a high-profile campaign to make breathing clean air a human right. The Clean Air (Human Rights) bill is known as ‘Ella’s Law’ after her eponymous nine-year-old daughter died in 2013 from asthma caused by toxic air generated by the heavy traffic on the South Circular Road next to her home in south-east London. 

The severity of asthma is often under-rated. Ms Adoo-Kissi-Debrah has campaigned at the grassroots, in elections, and in obtaining the support of public, press and politicians. The proposed law was passed by the House of Lords towards the end of last year and is shaping to be a major issue in the next London mayoralty elections.        

The government, which shows a strong affinity for (very) rich Africans, has a distinctly different attitude to those on the front-line of the under-funded, beleaguered NHS. For the latter it is enough to ‘give them a clap’ (especially if there are cameras present), and if they then ask for a decent living-wage, let them go to …anywhere for that matter, as long as it is out of sight and earshot.

The dismissive approach that there will always be more in the recruitment pipeline is hardly likely to attract new blood, a transfusion of which is essential for the survival of the NHS, to a sector which is already seriously understaffed.

It does not do for anybody in the UK to think of what would happen to the loved and respected NHS if the African nurses and medics took their skills and experience back to their Motherland, where their talents are also urgently needed.

Written By
Clayton Goodwin

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