Beverly Malone packed her bags last week to return to the US after more than five years as general secretary of the Royal College of Nursing, one of the profession's most powerful positions worldwide. In her final interview, she told the Guardian about her passion for dancing and rap music. She explained the personality differences between Alan Milburn, John Reid and Patricia Hewitt, the three health secretaries she has crossed swords with since she took over at the RCN in June 2001. And she ended barely able to hold back the tears as she reflected on the moment she described as the best time of her life.
It came this year and it concerned the politicisation of nurses. Malone was not referring to the confrontation at the RCN's annual congress in Bournemouth, where Hewitt endured 50 minutes of catcalls, barracking and derisive laughter from delegates who were angry about job losses. It was, she says, an "unfortunate but real" display of nurses' resentment that they were taking punishment in what Hewitt had called the NHS's "best year ever".
For Malone, the moving moment came a few weeks later when 800 nurses came to parliament to lobby their MPs. "It showed the power of nurses when they seize on the political part of their job ... The power is incredible." The tears well up as she continues: "When I can facilitate that, I feel I am sitting on top of the world."
Malone is one of the NHS's biggest fans. "When people ask me what I'll miss most when I return to the US, I tell them the NHS. It's golden. It's a treasure. I think it's the cat's miaow. It is really the tops. I know now about the weaknesses and the struggles. But, oh my goodness, to have a system that really does say healthcare is a right - wow! One thing I am not looking forward to back in the US is healthcare that is regarded as a privilege."
Ill-considered cuts
But she is worried about the damage being done to patients by ill-considered cuts aimed at eliminating NHS trusts' deficits. "Patient care is the core business of the NHS, not something on the side," she says. Ministers and NHS managers claimed to understand this, but their behaviour suggested the opposite. "We get services cut without anything yet to replace them in the community. We get nurses coming out of the universities and there are no jobs for them. We have specialist nurses, whose job is to keep people out of hospital, told that their positions are at risk to save money for the NHS. That is when it doesn't make sense, when people's behaviour is the opposite of what they say they want. It's that sort of paradoxical behaviour that I find it unacceptable."
One of the main aims of the NHS reform programme was to keep people out of hospital by providing services closer to home. For that, the NHS had to employ more specialist nurses in the community. Instead, some trusts had become obsessed with deficits, and others with regional reconfigurations. "It is unclear whether they are now interested in managing money better, or improving patient care," Malone says. She believes the problem is partly at the top political level and partly in the trusts. "It is not ill intent, but it is unwise and short-sighted."
She had a rough ride when she took up the reins at the RCN. Her critics within the college may have helped to fuel media criticism of NHS treatment provided for Malone's American mother while she was living in Britain. The general secretary's use of taxis, and other parts of her remuneration package, attracted snide comment in the press.
On the point of departure, she shows no inclination to settle old scores with adversaries. On the media, she says: "I was an appetising individual. I was available for the media because I was an African-American from the US, new to the RCN, new to London and the UK. They basically did their job. But there are different ways to do your job. I got the harder brush, not the soft touch. I know if you stand up, you will get shot at. It's not personal. The British media is fine with me. I get more media here than I will ever get in the US. Nursing has such a high visibility here, and I want the American media to catch up."
On the RCN, she says: "It is a membership organisation. That's its power, and the opportunity for a leader is to exercise his or her ability to act with it."
Malone gives an insider's perception of the qualities of the three health secretaries she has known. "They were all straightforward, but in different ways," she says. "I really enjoyed Alan Milburn. I'd arrive and he'd whoosh me into the room. Before his people sat down, he would start talking about what he wanted to make happen. Or he'd call me on the mobile to ask my opinion on something. It was fast and furious, and he valued nursing.
"With John Reid, I'd arrive and he'd make sure I was comfortable. He'd usher me in and make conversation that was light and humorous before getting down to business. He was engaging and challenging at the same time.
"With Patricia Hewitt, I welcomed the opportunity to work with a woman. That was, and is, special. It brings something of real value to nursing. One time she invited me to accompany her on an early morning engagement. I was with her at home in her kitchen and it was just like being with any other woman trying to get out of the house. It was a warm partnership. We were women trying to make things happen to the best of our ability. I enjoyed all of them in very different ways. There's room for diversity, you know."
Malone's big motive for returning now to the US is her wish to be a more engaged grandmother. Weekend trips never allowed enough time with her daughter, director of physiotherapy at a hospital in Virginia, and the two grandchildren, aged two and three months. Her son also works in healthcare as the representative of a vascular equipment company.
On returning to the US, Malone intends to resume a campaign to change the US system that foundered when Hillary Clinton's health reform proposals were rejected by Congress in 1994. From a senior position at the American Nurses Association, Malone was in regular contact with Bill Clinton's White House, helping to frame legislation that would have established core rights to healthcare for every US citizen. She regards the proposals as "unfinished business" that can be revived whether or not Hillary Clinton is the Democratic contender at the next presidential elections. Malone says: "In my lifetime, I want to see that happen in the US. It is a good time to be alive."
Curriculum Vitae
Age 58.
Status Divorced, two children, two grandchildren.
Lives Moving from London to New York City.
Education Nursing qualification from College of Nursing and Health, Cincinnati University, 1970; PhD in clinical psychology, Cincinnati University, 1981.
Career 2001-2006: general secretary, Royal College of Nursing; 1999-2001: deputy assistant secretary for health in former US president Bill Clinton's administration; 1996-2000: president, American Nurses Association (ANA); 1986-1996: series of academic posts and ANA positions; 1973-1986: specialist nurse, professor and administrator at University Hospital, Cincinnati; 1970-1973: nurse in Newark and Irvington (both New Jersey).
Interests Music; dance; theatre; running; Baptist church; grandchildren.
