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So you go and work with his patients and don’t have anything to do with other patients even if they desperately needed our skills. We needed to break down those old taboos. Macmillan nurses were always intended to be available for any palliative condition throughout the Trust. We belonged as much to the General Practitioners as to any consultant. Some new roles have been developed with the intention of contributing specialist skills wherever they are needed. An example of this type of role is the Macmillan nurse, whose skills are in palliative care and intended to support any individuals with a terminal illness and their carers.
Patients would be with us for twelve months or so. They would get to know us as nurses, as doctors, the whole team. We had a family environment and carers wanted to be seen as part of that family. Doctors were called by their first names, nurses were all called by their first names. It was the first time I came across a consultant who said, ‘I’m Jack’, not Doctor something. It was a multidisciplinary team where we’d have an afternoon each week and talk about individual people. Our plans, our fears, how we were going to deal with it ourselves, how the families were going to deal with it, where we’d go from there, who else we’d need to involve, whatever.
More time to prepare, more dynamic in some way. I worry about patients who don’t want to be fitted into this system. The people managing the health service want to be in charge. To take over from medical people and control them more. They think it can be better managed, more value for money. The people who are most resistant will retire, so these ideas will have to gain more purchase as new people come in. I think a lot of things are quite positive. We treat patients much better than we used to but because of the costs, the whole system is not being pushed in the right direction.