Nurses were playing good cop, bad cop at their annual conference last week. Or perhaps they were just too discreet to tell the politicians how they really feel. Either way, speakers were cheered while on the conference platform, then jeered after they left.
Health secretary Alan Milburn's government goody bag fared better than Opposition leader William Hague's claims of a new-look Conservative Party that really, really likes the NHS. Mr Milburn's offering went down well, despite Royal College of Nursing general secretary Christine Hancock's dire warning at the start of congress that the government had just six months to save the NHS. Mr Hague, the first Conservative leader in anyone's memory to come to RCN Congress, had a rougher ride.
But then the health secretary had come prepared. Among the pressies Mr Milburn was handing out like Father Christmas on speed were£5,000 for each ward sister to spend on repairs and equipment, nurse leadership programmes, opportunities for 12 nurses to hang out with the big boys at Richmond House and a national nurse housing co-ordinator to 'get more affordable homes for more nurses'.
Not to mention national standards on ward cleanliness and a big stick to be wielded against trusts which failed to recruit enough nurses or encourage their staff to take on extra tasks like running their own clinics.
He was applauded six times in just two minutes for mentioning student nurses and reciting a long list of Labour's achievements in office.
Warmed up by the appreciation, Mr Milburn stayed beyond his allocated slot and easily fielded challenges on student nurse poverty and patients who can't get expensive chemotherapy drugs.
Students were invited to come and talk to him, winning yet more approval. And the National Institute for Clinical Excellence was going to sort out all those nasty rationing issues. In fact, he hinted, it could back the use of taxanes for ovarian cancer.
Mr Milburn was just as reassuring about long-term care of the elderly.
To applause, delegate David Phillips challenged the health secretary: 'Will you give us a commitment to look at the report on long-term care and give us a commitment to fully implement every single part of the report?'
Mr Milburn didn't falter, saying: 'I understand how strongly you feel.'
The current system of paying for long-term nursing care was 'chaotic and unfair'. He had taken steps to set up a national commission for care standards. Now the government was 'looking very seriously' at 'free nursing care'. Note the reference to nursing - the report itself was careful to avoid the word because it is so difficult to decide which tasks are nursing and which are social care.
Anyway, the pledge was that a decision would be made by July. And 'your views are very close to my own on this one'.
After Mr Milburn had left, the comments got stronger. A student nurse warned that he had taped the health secretary's comments, which would come back to haunt him unless accommodation improved in the next six months. Betty Kershaw said she was 'not reassured' by pledges to increase student numbers. Phillip McCaffrey said he didn't trust the health secretary.
Labour 'had only been forced into action by the beds crisis', he warned.
There were some supporters - including Mike Walsh ('at last a politician I can believe in') - and Linda Bailey, who said there was no alternative to Labour ('We cannot go back to the 1980s.') The vote, when it came, was surprising. Only 63 per cent of delegates backed the health secretary, with 32 per cent against.
Mr Hague also earned applause and a polite ripple of laughter at his jokes. But it didn't matter how often he said he and his family used the NHS, and that he was committed to it 'in his bones'. Nurses weren't impressed by his admission that in the past few years 'we have not cracked the problems, and I am not saying that the problems started in May 1997'.
When it came to those key-pads, the verdict was damning. More than 81 per cent of delegates voted against him.
True, the questions to Mr Hague had given some indication of delegates' feelings. The last Conservative administration's failings were cited. Jason Warriner told Mr Hague: 'You must think we are stupid. All the problems in the NHS relate to your administration.'
Perhaps he would have done better to be more specific than 'we should tackle low pay'. An adviser claimed he was not in a position to make pledges on nurse salaries, but suggested he would look first at the position of students.
He admitted there was 'mutual suspicion' between Conservative politicians and NHS workers, which was why Mr Hague had travelled to Bournemouth.
But Bournemouth wasn't far enough for some delegates. Bruce Fraser challenged him to spend a day on the wards at Wansbeck General Hospital in Ashington, Northumberland. Mr Hague said he would 'be delighted'.
Mr Fraser and the stroke unit at Northumbria Healthcare trust are ready and waiting. l What trusts have to do next In his speech, Mr Milburn said trusts will be assessed on their success in recruiting nurses and on their ability to encourage nurses to:
order diagnostic tests;
make and receive referrals;
admit and discharge patients;
manage their own patient caseload;
run their own clinics;
prescribe medicines or treatment;
carry out resuscitation ;
perform minor surgery;
triage patients;
take a lead in the way health services are organised and run.
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