Where’s it gone? You’ve got more chance of finding beef in your beef-burger than care in the caring profession.
Nothing about the report into the Stafford hospital was more soul-destroying than that single word in this sentence: ‘There was a lack of care, compassion, humanity and leadership’.
We are all children at heart when we are sick or injured – it matters not whether you have just been pulled from a mangled car or fallen victim to some as yet unknown disease that makes you feel like death warmed up – what we want more than anything is a substitute Mother to mop our fevered brow, hold our hand, and tell us everything is going to be alright.
We are adult enough to understand that the Doctor may not be able to save us, may not even take the pain away. Mortality rates are neither here nor there in the great scheme of things; we know perfectly well that some people may die, may be beyond the limit of medical knowledge. Telling us that one hospital has a 6.7% mortality rate for one type of operation against another hospital which has a 14.6% mortality rate for the same operation doesn’t tell us whether all their patients were equally ill, nor whether any of the patients suffered from complicating factors. It encourages us to believe that hospitals are like car factories; that they should be able to achieve robotically similar results.
Whilst we merely hope that the Doctors will be able to help us, pray even, we do take it as a given that someone within those walls will attend to the frightened child lurking within us. Someone will sit with us, talk to us as we slip into the unknown, not just report having found us dead at 6am when they came on duty, carefully filling in the correct forms. We want someone to make us a cup of tea at 4am as we lie awake filled with trepidation for the operation ahead – not to fill in more forms explaining that yes, they had heard we were so thirsty we were drinking water from a vase, but do we understand how much paperwork they have to fill in on every shift?
Would we have been so angry if we had heard that the Stafford nurses had failed in their duty to fill in paperwork? Would we have erupted with rage if it had turned out that they didn’t all have matching uniforms because ’of the cuts’? Would we care if it turned out that the nurse holding a sick child’s hand as she went into theatre didn’t actually have the correct paperwork to work in the UK, hadn’t been through the ‘diversity training course’ because she was late off duty that day – too involved in explaining to an elderly man the right way to manage his new stoma?
I don’t think we would. I think it is the lack of that basic compassion for the fear and the pain and discomfort that being sick involves that has gripped us all.
We shouldn’t be ‘inconveniences’ in the smooth bureaucratic progress of a busy hospital. We’re not cars, waiting for repair. We are human beings.
You can probably predict what I am going to say next. Yep, you’re right, it really isn’t like that in France I’m glad to say. The land that invented bureaucracy; that likes its paperwork in triplicate at all times. They’ve never lost sight of compassion being the prime need in any hospital though. Their Doctors are no better trained than the English version; no less fallible; the much vaunted death rates reasonably comparable, though marginally better. By God, I’d eat my own Raccoon tail if a report detailing ‘lack of compassion’ was ever written about a French hospital.
Family and Friends visiting aren’t grudgingly treated as a necessary evil to be admitted between the hours of 2pm and 4pm. They are there at all hours of the day – and night. 10, 12 round some beds at times. The nurses will apologise if they need to temporarily uproot them to carry out some medical procedure – and that of course makes a vast difference. For if your daughter or sister are sitting by your bed when you want that cup of tea – they go and get it for you. It frees the nurses up, and there are no health and safety rules about family using the kitchen. Every ward has ‘cots’, small barely comfortable extra beds that fit between the real beds for family that need to sleep overnight. Of course they get in the way, but I never heard anyone complain about it. It gives the nurses more time to spend with those who do not have such family – and they do spend that time.
There isn’t the same reticence to touch another human being that English culture engenders. Nurses will freely cuddle you, stroke an arm or a leg in a consoling gesture. Male as well as female nurses – it did feel peculiar being propped up on a bed pan by the strong arm of a male nurse with an excellent supply of jokes, when I was too weak to sit upright unaided, but I needed that help – and the jokes – and was grateful not to have been left to fend for myself by a distracted nurse too busy to stay with me. Perhaps it is a cultural thing, all that kissing and hugging that the French indulge in, or maybe it is that they don’t see waiting on another human being, ‘doing’ for them, as somehow subservient and demeaning. Witness the difference between a French waiter, ever attentive, and the English version who appears to be doing you a favour throwing a plate of food in front of you.
Now Cameron thinks that ‘being paid by compassion‘ will change the culture? That compassion should be something you get a bonus for? An extra tenner at Christmas for having remembered to ask the patient in bed 6 ‘three times’ in front of the line manager whether she wanted sugar in her tea? For crying out loud – how about instant dismissal for any nurse found to demonstrate a lack of compassion; unfit for purpose? Because that is their purpose; and I’ll hear no wailing about understaffing, or ‘cuts’, or pension rights affecting their morale. No compassion, no job.
Give families the free run of hospitals too, day and night. Sure they are messy, noisy, inconvenient things; but they are also dedicated, free of charge, quality control inspectors.
Cut out all the ‘class war’ nonsense that obsesses politicians and affects the entire country. This idea that some jobs are demeaning, that ‘servant’ is an insulting word. Nurses are, should be, our temporary servants for when we are too sick to do things for ourselves. We trust them to do that when we are at our most vulnerable. That some of them have betrayed that trust is unspeakable perfidy.
I really cannot believe that Cameron thinks the answer is to reward those who don’t betray that trust, and still leave us at the mercy of those that do.
Knowing it will be reflected in their paypacket is no consolation if you find yourself in the un-tender hands of someone who isn’t that bothered about the bonus.
Ms Raccoon lives in the Monbazillac area of South West France, renowned for its fine wines and gourmet food, so she frequently finds better things to do than sit in front of a computer all morning. She is liable to take off traveling at a moment's notice. Consequently this blog only gets updated these days when it is raining - and it doesn't rain very often round here...
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Management deemed there was no budget or ‘Tick Box’ for “compassion”.
So those whose performances were measured by the number of boxes ticked, didn’t bother.
Compassion relies upon the individual and too much reliance on the individual will lead to a “Post Code Lottery”.
The UK did have a free-house for visiting times not so long ago, but that was curtailed by the MRSA scandal.
Some of the issues probably go back to our increasing reliance on regional “super hospitals” and the closure of what we used to call “cottage hospitals”.
We were *repaired* in the old medical hospitals, but then would be *cared for* in the less sophisticated satellite establishments.
Having read that you live in Monbazillac, which is not far from us near Villleréal, it seems as though you have your own special microclimate as it has been raining every day here for at least the past four weeks!
Thanks for your posts, they are very enjoyable and constructive unlike many blogs today.
Sincerely
Jane Bird
Too true, Ms Bird, it has rained relentlessly for the past four weeks here too. Hence the number of posts recently; too wet to do owt else!
I can believe all too easily that Camoron thinks the answer is to reward those who don’t betray that trust. He’s a vacuous hollow man, a sound-bite machine.
Bring back Matron and stop this “nursing needs degrees” nonsense! You cannot teach compassion, but the present nurse training regime and line manager structures are impediments to it.
I would go further and say they could remove 90% of the present management structure without any loss of medical functions (it would also save a lot of money).
They should also start using all the ultra expensive equipment they have on a round the clock basis with the operators wages being paid out of the savings realized by cutting management.
“Bring back Matron and stop this “nursing needs degrees” nonsense! You cannot teach compassion, but the present nurse training regime and line manager structures are impediments to it.”
I think this is looking at the problem ass-backwards.
Nursing needs people who can understand human physiology and laboratory results as a competency background for carrying out procedures to which they understand the scientific rationale and so that they can speak the same language as doctors. They also need a considerable technical knowledge of how drugs work and what possible side effects and interactions drugs have. Hence it is logical for them to do the same introductory courses in microbiology, anatomy, physiology, pharmacokinetics, and so on as done by doctors and pharmacists FOR THE SAME REASONS. Are you going to say that pharmacists don’t need a university education, because you can just bring back the old-fashioned chemist who makes his own patent medicines from commonly available ingredients?
What is apparently lacking in NHS hospitals are enough lower level health care givers to deliver basic hygiene measures, bedmaking, feeding, dressing, assistance, empying urinals, etc. which CAN be done by people without a university education. In the US Certified Nursing Assistants do a 90-day course in a technical college to get the basic knowledge and techniques and a lot of them perform very, very well, and in fact some go on later to become degree level nurses.
Most degree level nurses do know how to do those things, but it is not usually an effective use of their time, or cost effective for hospitals to pay degree level technicians to empty bedpans, etc. Obviously in an emergency situation when there is no one else available, they may have to, but this is not a very desirable solution to the lack of direct-care staff.
This situation seems to have been exacerbated in the UK by the restrictions on visiting imposed after the MRSA epidemic. As in France, here in the Dominican Republic visiting is normal 24-hours a day and people although meals and sheets are provided, people are expected to bring their own food.
and drink, blankets, and pillows. That is what cell phones are for.
Reading about this scandal from afar, it seems to me that there is a huge element of unspoken class warfare aimed at middle-class (“too posh to wash”) nurses at the managerial or organizational level, when the real problem is that there are not enough assistive staff, or that they are not adequately trained.
Yes, a compassionate person may well stop what they are doing to help out a distressed patient when there is no one else available, perhaps at the cost of completing their own work later, or doing unpaid overtime if they can’t get home on time, or perhaps at the cost of delaying a prescribed treatment for another patient, but should the health service really depend on exploiting employees in this manner rather than using existing resources more effectively?
I am not endorsing nurses or other staff who are just lazy or cynical, but I think one has to take into account that people observing in hospital wards when they are visiting cannot always be aware of all the assigned responsibilities and working time frames that each employee has.
So what has happened is the public have had an insight to what is really going on in the PHS (Private Health Service), mass murder of the English.
Its been going on for over 20 years, just look at how many of the 40′s, 50′s born generation are gone in a poof of cancer? Why, because they are the generations that were brought up to give absolute trust in the NHS.
I was born to the sixties generation parents and as you all know the men were perhaps the hardest men this country has bore for many a century, try to find one left not hooked into the corporate state and you will find them at the crematorium or cemetery with the epitaph, cancer.
The game works because they are twenty acts ahead, do not waste this glimpse into the Temples of the Hospitallers, they prefer the old and ancient rites to thjose we would recognise as Christian.
Did it get this bad in the USSR before the whole damned thing collapsed? Or are the English uniquely lacking in humanity?
I was in a Rumanian hospital twenty years ago and although the place was filthy, the nurses did their best, with what they had and were compassionate under awful conditions.
I would have thought the essence of nursing was compassion. But it is not a universal human quality. When it is present it transcends the instinctive human response usually to walk on by, like everyone except the Samaritan.
If the culture encourages all those involved to exercise compassion even though they might not feel like it, its effects can be created by will power, especially if people are told it is their duty, but the NHS seems to encourage exactly the opposite.
And isn’t paying people to be ‘compassionate’ an oxymoron?
Mind you, there is also a corresponding obligation on the part of the patient to be as grateful for the compassion shown as his circumstances allow. Many patients in the English hospitals I’ve visited do not make it easy to be kind to them.
The images of the Rumanian Orphanages following the collapse of Communism are still fairly vivid in my mind. I recall thinking that the people running those places probably thought they were a doing a good job, “under the circumstances”. Nobody would have bothered to tell them any different.
One big problem for any monolithic organisation is that because one bit of it has a disaster, then the whole shebang is tainted. Presuming this report on Mid-Staffs is not going to become echoed by other areas, then the fault roosts there, presumably, and must per-se be a local problem and a local answer is probably what is required… and ironically by now it has no doubt already been found. I wonder if anyone has bothered to make a note of it before the next reform sweeps through and wipes away all traces of the past. Not so long ago…. months? We were being alarmed that the old peoples homes care system was collapsing. Then everyone forgot about it and enjoyed the Olympic summer and basked in the NHS glory of the Opening Ceremony.
Agreed. Either Mid Staffordshire must have been a unique “perfect storm” of dysfunction, in which case the specific local problems should be indentified to make sure they cannot occur elsewhere, or else there are lots of other NHS hospitals that are offer a similar standard of care.
If I remember correctly there where 10 hospitals with higher death rates. Ironically the 2nd worse being in Andrew Burnham’s own constituency. You couldn’t make it up could you ?
Mid Stafford may not have been the norm in the brutal NHS but it was by no means unique. Remember the great superbug scandal at Maidstone hospital in 2007 that killed 270 with its Chief Executive Rose Gibb walking away with a £150k pay off. The wards in that hell hole at the time were absolutely filthy.
I can’t help feeling that this is the result of too much managing and not enough doing.
Spot on!
Seconded…
One line of enquiry must be to determine how many immigrant staff were operating the hospital at the time they got caught?
Not enough, obviously. As Belsay bugle so eloquently puts it – in third world countries where they have a lack of doctors and medicines, they do manage to dole out compassion as a last resort.
It is an interesting point, though, which does not seem to get aired in the media. In the bitter criticism aimed at nursing staff who do not have “compassion” one wonders if there is an racial element, depending on the ethnic make-up both of the staff and of the patients in that hospital.
The health system in the US has many undesirable aspects, but in the 20 years I spent in that country I never remember any health care scandals in which the lack of “compassion” was the key element.
The thing is one of the other four with huge mortality rates is Blackburn Royal, and just after it completed the last huge phase extension did the death toll rise like crazy. Perhaps the most obvious aspect to this hospital would be the lack of British staff on all levels. It is a very strange place indeed.
Indentured servitude is the one to grasp as many immigrants are here in that capacity yet unknown, the NHS has been fleeced in its costs in training foreign nationals.
The corporate state appears to have a global system in place through which they are happily using immigrants of all nations and in all nations to deplete the native representation in all institutions, enough to allow what this report is all about.
Balfour Beaty own Blackburn Royal and Balfour Beaty is Blair Atholl
There’s a piece featured in the Independent today about a “Bulgarian midwife”, who works here only as a nursing ‘auxillary’. She supposedly became very impatient with old people. It did cross my mind that she wasn’t very happy about having to work at the opposite end of life’s journey.
Anyone know how Linda Birch’s career is progressing these days?
http://www.dailymail.co.uk/news/article-2240228/NHS-matron-Linda-Birch-blasts-rude-midwives-worrying-trend-inadequate-care.html#axzz2KJvhOpHP
Mr belinus,
What have immigrants to do with it? If it were left to the natives matters might be a good deal worse.
People respond to the influences that descend from the top and permeate an institution. If the bosses are horrible the staff usually reflect that.
There is an awful culture of impersonal managerialism that pervades the NHS which seems to be intrinsic to it.
It’s a bit like telling the truth about Scousedom, the slightest word of criticism brings down howls of unrighteous self-pitying indignation on anyone who dares to utter it. The cow is sacred, end of. And you are a wicked person who hates the poor, the disadvantaged, the halt, the blind and the lame.
I just pray that if I fall ill it will be on one of my many trips to France, and before the whole French state collapses under the weight of its marvellous unsustainable public services.
An example of French humanity.
This week i happened upon a restaurant in Nice (as one does). The patron not only recommended what i should eat because he’d just eaten it, but he also advised me which wine should accompany it (vetoing the dearer bottle I had chosen). No effort to give me pleasure was spared.
Little amuses bouche appeared while I was waiting, and the staff unostentatiously looked after me, genuinely wanting me to enjoy the experience and doing everything they could to give me what they would have wanted had the roles been reversed.
I find this more often in France than nearly anywhere else I go (Italy is nearly as good) so long as it has not been infected by le vice Anglo-Saxon of only doing the bare minimum necessary to justify the size of the bill.
This kind of humanity seems to be part of French culture (diminishing I fear); has it ever been part of British culture?
I suppose it depends what side of the Englishman one aspired to as a child, I have to say the example that was my grandfather sufficed to show the English gent, but then in the background was a severe racism due of course to the two wars.
Though I strayed from the gent aspect while a teenager onto adulthood, i can safely say today, i have re-found the English Gent side of myself and am happy to remain that way.
As a northerner, the French attitude of which you speak was absolutely the case until the legacy of Thatcher drove the Southern isolation existence and the drab town centre architecture, up north. So I believe the south has forced its mind onto the rest of the country, and do covet that old fashioned healthy north south divide, it kept you saxons off the garden.
As for the immigrant question take a peek at a later post by me above yours to which this is a reply…
As long as the politicians demand that there is incontrovertible ‘evidence’ that everything has been done ‘properly’ so that they can justify themselves (that’s not to be confused with those doing the work), on the occasions that something, as it inevitably will, goes wrong, and are prepared to beat up the management with sticks, as they do – you have to have worked in this environment to know just what does happen – then don’t expect anyone to put their heads above the parapet to stop it.
All the political parties indulge in this, although the more byzantine aspects of the ”performance management’ culture information information systems and related bureaucracy were mainly Labour administration innovations
None of this will go away, there will be no reversion to former attitudes and conditions (not all of which were better anyway) because those ultimately in charge, the politicians, blue, red, orange, or chameleon, only care about themselves.
My experience of Portuguese medical system, and that includes a death, is that it is caring, kindly and compassionate .
I enjoyed reading this thoughtful and well written post. Your description of the attitude of French health service staff reminds of my stay in an NHS hospital back the late fifties. The NHS was only some ten years old at the time so I guess its been going downhill with age.
The NHS was set up for different era where the post war health care requirements were totally different from today.
The NHS is not Britain’s best loved institution, its a decrepit old jalopy which needs to be scrapped and replaced by a modern service focused on modern health care needs.
Dear God, looking quickly at some of these comments, it’s frightening how many otherwise sensible sounding people havent got a clue what it takes to run some of these enterprises, given their size and complexity, the breadth and scope of the services provided, their financing, nor the relative extent of their overall efficiency and management cost levels, as compared to those of other developed economies and healthcare systems
I spent almost all my life dealing with those in one form or other. There have been improvements in many areas that are beyond recognition from when I started, some things that are maybe not so great, but unfortunately the level of external cluelessness, and the average whelk stall manager’s certainty that they could do better, remains the same
On the evidence of the Mid Staffs report, a whelk stall manager could have done better. Neither, sadly, does the problem seem to be limited to Mid Staffs. Something, somewhere, has gone seriously awray.
I know it was intended as a joke, but what could a person running a small retail business with perhaps two or three employees open 6 days a week during the daytime bring to running an organization with hundreds of employees open 24 hours a day and 365 days a year and a budget of many millions that would open the eyes of those who have spent their entire working lives in such an environment?
For example how can you compare the legal compliance requirements of a whelk stall (perhaps refrigeration and handling and packaging of merchandise) with something as complex as an operating theatre?
I have a vague feeling that if a person running a small retail business was given charge of an operating theatre, they may be tempted to see the asset used to best effect and not left idle when there is a waiting list of people needing it.
Look, I’m not trying to be smartarse, but it’s quite obvious that something is not right with the NHS. It’s blindingly obvious to anybody who has had any contact with it over the last few years that in some quarters, the patients are the last consideration. Not being an insider, I don’t know where the problem lies, but I suspect it may be linked to too much management and not enough doing.
As for legal compliance requirements, I do know a bit about those, as I earned my living as a professional design engineer in an industry in which safety was a very high priority. It’s really about ensuring that properly qualified and experienced people are doing the critical jobs, ensuring they have the resources they need, and letting them get on with it – supporting them without constantly bothering them. It’s also important to have rigorous systems of work in place, preferably set up by the people doing the job – if they have something forced on them, they’ll just resent it. It’s also important to listen and act positively when people highlight problems; it seems that in some NHS trusts this last one was forgotten.
” It’s really about ensuring that properly qualified and experienced people are doing the critical jobs, ensuring they have the resources they need, and letting them get on with it…”
Very much the same applies, or should apply, in the health care industry. When we hear these anecdotes about patients being dropped on the floor or having bed sores, then the first question I would want to ask is whether the staff have been properly trained in lifting people and whether they have the necessary devices such as mechanical hoists for lifting or alternating pressure beds for bedsore prevention.
Of course, if the staff are just bad or out of control, then that is another matter altogether. I haven’t read the whole of the report on Mid Stafford, but would be interested to know what their stats were like for absenteeism and staff sickness. I would suspect they would have poor performance ratings in those areas too.
What you say may be so but, and it is a big but, this is a government run enterprise with all the failings of all government run enterprises and no advantages found in private enterprise.
I’m not saying the NHS should be privatised but I am saying it needs a clean out of ALL the dead wood and excess management. Your average whelk stall manager would be just the type of person needed for that task. Operating theatres, scanners and other high cost equipment should be working on a 24 hour schedule 7 days a week. That way the return on investment is maximised and the waiting lists would become a thing of the past. Unfortunately, that will never happen with the present climate of public service managers gold plating everything they do and their making sure that non of then can be sacked for incompetence unless they get a golden handshake. That is NOT the way to run a business and, lets face it, the NHS is a business no matter how you look at it.
I agree ivan… There is a major problem with nationalised industry in that its management becomes just a statistical exercise and a total disregard for something that the free market understands very well, namely ‘DEMAND’…
Nationalised organisations cannot react quickly enough to every (if any) situation in a timely manner, so the order is to design, build and manage the given system by ‘COMMAND’, which never works well.
An example within my local NHS would be that in the area around where the recent crass decision regarding Lewisham Hospital was made, there were more than 25 hospitals before the inception of the NHS, now they are trying to keep two and a half open due to bad “planning” and overspending. Before the NHS, in that area, those 25 hospitals were all well used, and as each one closed there was plenty of protest (to no avail).
It could be better, the actual provision could easily be taken back to its original model… i.e. some local council, church or charity, some local business think it might be profitable, or otherwise needed/useful in a given area to open a service and then aim to keep it running, even if it is thought better that funding should be state managed (that’s a dubious concept itself!).
You have instantly turned a command based system into a demand based system, and the demands will only be met by the paymaster, if they are employed by the discerning patients… instant, free management!
I would love to see how you would finance the staffing costs of doing that. I’d also be interested where you think the extra staff required would come from in the first place, anyway
You could of course get a bit closer to that by closing a heap of hospitals to do it, leaving just a few regional mega facilities, but the political cost of doing that is such that it won’t happen in my lifetime, and probably not yours either
And do you know anything of the management cost control regimes that have been operated for the last 25 years or so? Or have any idea of the hours the senior managers in these places work?
And don’t forget that whelk stall managers tangible end product is empty shells
Dear me, looking quickly at some of these comments, it’s frightening how many otherwise sensible sounding people havent got a clue what it really takes to run some of these enterprises, given their size and complexity, the breadth and scope of the services provided, their financing, nor do thry know anything of the relative extent of their overall efficiency and management cost levels, as compared to those of other developed economies and healthcare systems
I spent almost all my life dealing with those in one form or other. There have been improvements in many areas that are beyond recognition from when I started, some things that are maybe not so great, but unfortunately the level of external cluelessness, and the average whelk stall manager’s certainty that they could do better, remains the same.
Sorry for the double comment. For some reason I am getting ‘publication failed’ responses on my phone……
could be because you are very naughty….
Ok, full disclosure. I am a male nurse who, after a previous career, trained in a London teaching hospital (long enough ago that Florence was still a girl). I have worked in Admissions, A&E, ITU, HDU, Respiratory specialist areas, general medical, surgical and elderley wards in most of Londons teaching hospitals. Just over ten years ago I, for family reasons, moved (with a drop of three grades) to a small regional hospital (admissions ward). As such I have twenty-mumble years within a varied selection of areas. I have multiple degrees (two PhDs) and I’ve lost count of the professional qualifications I’ve collected over the years.
None of the ‘uncaring’, unprofessional or lack of compassion evident in the report (not having worked at North Staffordshire I cannot comment on how widespread or common it was there) WAS evident in any area I had experience of. Yes, there were individuals who did, but they were swiftly noted and ‘encouraged’ to find alternative careers (or at least employment in another hospital). That includes the busiest A&E in the country, areas with completely dependant patients, massive turnovers and/or long stay patients – care was paramount.
On moving to the smaller regional unit things were very different! Practices were out of date (positively Jurassic in some cases), staffing levels were laughable, the division of labour risible (qualified staff standing at the desk chatting whilst healthcare assistants struggled on with care they did not understand). I am not unexperienced in new posts, so kept my mouth shut and tried to ‘do the job’. I never saw ‘the desk’ (paperwork was completed, as most areas, at the bedside of whomever it dealt with), I delivered care (feeding, washing, explaining) with assistance from a HCA. The result? I faced constant ‘reprimands’ for ‘undermining’ colleagues (their HCAs would approach me to help with procedures, knowledge, etc.). I was ‘disciplined’ for ‘getting down on my knees and cleaning up a spilt bedpan that someone had simply walked away from’, as it was the HCAs job. I was verbally attacked in public (with staff, patients and visitors present) because I humidified oxygen (as is required by standard protocol) ‘without a prescription’ (the consultant was called and a demand made for him to complain – his response? ‘About bloody time someone did things properly’). I was ‘sent to Coventry’ by all the qualified staff. Then my patients medications started disappearing, infusions were ‘accidentally’ disconnected and tucked into bandages so as not to be obvious….. I complained (fearing for my registration and patients well-being, if not their lives), supplied evidence/documentation (which was ‘conveniently’ lost). Doctors (whose patients were getting prescribed therapies), patients (18 letters of support and 27 in four months in gratitude, that in itself should show how unusual basic care had become) and HCAs all lined up to support me, without avail. I was ‘encouraged’ to leave, receiving an abysmal reference (‘lacks social skills’) effectively destroying my career.
I left nursing, obviously, for some time. I, it being the only job I am qualified for, returned as an agency nurse, and thankfully found areas which still act with professionalism and compassion. I believe the ward I previously worked at was ‘audited’ no less than three times due to complaints and ‘poor outcomes’ (deaths, unnecessary deteriorations, patients on soiled linen, etc.) – and given a ‘clean bill of health’ each time!
My opinion? I believe there are many, even most, nurses in the NHS who remain caring, compassionate and professional. Those who use the excuses of shortages/paperwork/etc. for poor care do a massive disservice to the majority who work extra hours (staying back after a shift to do that paperwork as an afterthought and seeing staff work 12/14 hour shifts without a break is not unusual. I have had to call staffs partners in to ‘force’ them to go home, sent staff to A&E, etc.). Yes there are units and staff like NS is ‘alleged’ to have but the salient point is if you actively not only cover up such behaviour, protect and support them and promote those based on ideology rather than competence, then that is exactly what will flourish.
Only when those responsible (not only the politicians and managers but ask yourself just how many of the nurses and doctors either acted in this way, or stood by quietly and allowed it, have been sacked, struck off and face criminal proceedings? Not one, all of whom should have been) face punishment will I have any trust in the system rekindled.
For me the NHS is patently, as the perfect example of a bureaucracy run wild, unfit for purpose. (It makes British Leyland, British Rail and The Post Office look ‘well managed’)
(Oh, and ‘paying based on compassion’ will become yet another tick-box item, as well as another method that those in power use to provide for their supporters whilst punishing any detractors. Care and compassion will be unaffected in any way other than driving those who act in such a manner naturally away more quickly)
Just Sayin’
I recall that quite some years back there was a whistle-blower TV show where a midwife/nurse secretly video-taped behaviours in hospital. The programme was broadcast to the usual initial response and then quickly forgotten about again. Some time later I was astounded to read that the woman had been disbarred by the Nurses union (I have a feeling it was the Midwives Section) and the reason was a doozy! By filming the aforesaid negligence she had perforce allowed the negligence to occur and because of HER negligent behaviour…. so she lost her *license*. Perhaps even more astounding was the lack of any interest from the press in kicking up a stink about this ridiculous response from the “Professionals”.
Another one I recall was another TV expose where a carer for old folks was filmed being derogatory about them, but not in front of them, only in the car between visits. In fact, so far as could be seen, her patients liked her and she did a good job. However her filmed “gallows humour” asides led inevitably to her being sacked. I think she was from Brighton.
“I was verbally attacked in public (with staff, patients and visitors present) because I humidified oxygen (as is required by standard protocol) ‘without a prescription’”.
With respect, there is a lack of clinical evidence that running oxygen bubbles through water makes any difference to the patient’s hydration. If the patient becomes dehydrated, assessment should consider other possible reasons.
Since it involves the extra cost of a disposable humidifier chamber and sterile water, my guess is that the hospital required a doctor’s order for it so as to allow doctors freedom of clinical practice, but to make the cheaper option the default.
However if that was the standard protocol in that hospital, then nursing management should have communicated that to the nurses via memos and written protocols.
http://www.nursingtimes.net/nursing-practice/clinical-zones/respiratory/does-oxygen-need-humidification/5009649.article
The world.
Is going.
To hell.
In the uniquitous.
Hand cart.
Claire Rayner famously wanted her last words to be:
‘Tell David Cameron that if he screws up my beloved NHS I’ll come back and bloody haunt him.’
I wonder if Tony Blair and Gordon Brown are feeling her ghostly presence?
Is this why Cameroon was often caricatured as having a head like a condom?
http://www.guardian.co.uk/global/2011/oct/07/simon-hoggart-week-conservatives-conference
my beloved NHS
Therein lies a problem. It’s not the NHS you are supposed to be in love with. It’s healthcare, the duty to help the patient, the ideal of healing. Rayner made an idol out of a state bureaucracy and so anyone who suggest that actually, it’s not a god and the NHS isn’t the point, is instantly attacked as a heretic.
In another place, statisticians have calculated that in Britain you have a 2,200 times greater chance of being killed by the NHS than by Al-Quaida.
Maybe we should just give that £100bn a year of NHS budget to Al-Q and then we’ll all live longer.
Unless we have some professional role in or close to the nhs, we can only comment based on our direct experience.
I was impressed with the care my dying sister received in France a few years ago. When I telephoned the hospital from England I had no trouble speaking to her. When I visited, she was in a comfortable room, not a ward, and care was evident. That was at a small town hospital to the west of Limoges.
Back to England.
My late wife spent a lot of time in or visiting local hospitals over the last 15 years of her life. I had a few day visits myself, too.
There are some very caring and hardworking frontline staff in those nhs hospitals.
There are others that appear to be there just waiting for the end of their shift. Possibly enough engagement for factory farming. This can only happen in the absence of leadership/management, call it what you will. The same applies with the hostility and rudeness we sometimes encountered.
Spending a lot of time visiting you see the way things are done, the joke cleaning routines on the wall charts, the mystery of just when a doctor will be available, or some feedback on what’s happening. And weekends?
I know nothing of healthcare except as a recipient.
I have managed people, professionals, skilled and unskilled, and not always English speaking.
Even if we can assume that all front line staff have the necessary technical competence, and I’m not convinced of that, the present situation can only exist because the culture is wrong. That’s not in my experience an issue of pay, resources, or even organisation, except in extreme situations.
It’s to do with the leadership of those staff, and dealing with those who can’t or won’t do the job the way that’s needed.
Targets are not standards.
And yes I know they’re not all like that. The point is none of them should be.
We’ve been doing this since 1948. They nearly killed me then.
One picture that sticks in my memory is that which I saw during my incarceration in a wonderful hospital in Bordeaux. An elderly patient was sitting up in bed being spoon-fed by one nurse whilst another wiped her chin. Truly dedicated and caring professionals Poor Britain.
Your post links with Annas, about my point. So YOU are the victim (
)
I recently left my Government job, as they decided to make us all “pay by results”. (which, in our “line” is basically bloody impossible!).
So. I am now mid way through a “Praktikum”…. (where you work for no money, but just to gain experience, and add to your schooling…. in English???)
I am training to be a “Demenzkrakbegleiter” which is NEARLY like a nurse, but we can not give medication.
We work VERY closely with the Nurses. And I must say, here in Berlin, I have heard horror storys. BUT, from what I have seen, they are all EXTREEMLY proffesional and, above all, they are FRIENDS to the patient.
I do not doubt that most of the nurses in Britain are the same. But as I say, you get the “horror stories”. Others are not “News”.
NOW! We have the same problem here as in the U.K. UNDERSTAFFING.
ONE Nurse for 18 Patients on late sghift. When they mustr all be fed, “cleaned” and put to bed??!!??
Yet they remain friendly to the patients.
The anger is directed at the bosses. And maybe THAT is the difference??
I too have a strong memory of two nights in the hospital in Bordeaux where I shared a room with a 91 year old who patently had Alzheimer’s in addition to her cancer…
She was convinced that anybody bald and of my height had to be a man and no one could convince her otherwise. Every time I so much as twitched in my bed alongside her, she started screaming and hollering that ‘the man’ was getting out of bed and would the nurses please protect her…
By day break I was ready to throttle her…
The night nurses however, after 30 or so such interruptions to their work, remained as calm, patient and excruciatingly polite to her as ever. She was routinely ‘Madame’ and ‘how can we help you Madame’; they would settle her back down again and then turn to me to apologise and beg my understanding.
There was never the slightest hint of irritation in their tone.
They were saints.
Exactly as I heve witnessed it.
One thought though, an Alzheimers patient in the “general ward” would never happen here…..in THEORY (given). But normally they are cared for by family, OR they are in a “Wohngemeinschaft”…. NOW my English fails me!
Where many people live, but they are like a family. They shere the kitchen, they have a laundry, etc. But they also have their private rooms, where we, as carers/nurses, must first knock, then ask if we can go in.
It appears to work.
My sister’s surprise at the healthcare her daughter received in France, provincial facility near Marseille, was just how much she had to do that in the UK would have been done by the nursing staff. Her impression was they actually did very little
I think most people of my generation (born 1927) would agree that the NHS was fine during its early years. The decline in the behaviour of some (by no means all, of course) of its staff surely reflects the decline in personal standards which is so noticeable, to people of my age, in our wider society. I guess this is often due to bad parenting, by people who for example have habitually parked their offspring in front of the television as a substitute for personal engagement with them. It’s no wonder if people brought up like that, without the right role models and little association with other children, sometimes fail to exhibit imagination and show no wish to alleviate suffering. Will Mr Cameron’s fine words make the slightest bit of difference? Somehow I doubt it. This once wonderful country is going down the drain.
On the very, very rare occasion I vaguely think about returning to UK, when I am very much older, I think to myself that if I am not ill then I will be fine just the way I am. And if I am ill then UK is the last place I want to be. So I dump that idea toute de bloody suite.
In twenty years everything I have ever seen of Care in The Community is marvellous, and everything I have ever heard about French hospitals is more than excellent.
The mere thought of UK hospitals leaves me rigid with fear, while I have no such fear of French hospitals. And on the two occasions that I have been to my Doctor he has known exactly what was wrong with me despite not speaking a word of English, and my French being nothing to write home about either.
And the Old people’s Home up the road a bit is very nice as well. And they won’t force me to sell my house until after I am dead. But that will be for my children to deal with, and they will have a choice.
There have been some interesting and astute comments made here (it must be the better class of visitors).
That the NHS, as a microcosm of society as a whole, is now reflecting the changes in that society is hardly a surprise and should be generally worrying, considering just what is being seen (Griffin)
That we only ever hear of the ‘wrongs’ (and portrayed in as lurid a manner as possible) is also not surprising considering the biases of the MSM (FT)
I do still believe (based on personal knowledge and experience) that you can, and most in fact still do, receive some of the best therapies and care in the world here in our benighted hospitals. Yet delivering that care is now harder and harder to do, and it is done despite as opposed to because of the ‘reforms’, culture and management.
In my first post, as a ‘D’ grade newly qualified nurse, I had four layers of management above me (up to and including the chief executive). The last post, again as a ’5′ a ‘D’ due to stepping down, I had eleven layers, and that does not include the increased layers lying between a hospital and the Department of Health. In each case the increase has massively increased costs, necessitating cuts in staff doing the actual job, and provided another layer acting to protect and expand their bailiwick (both my own experience and those intimated by Moor Larkin show what their priorities really are, and care delivery is the last amongst them). It is hardly a unique situation reflecting exactly the same problems evident in our ‘education’ system and even the police does it not? The bureaucracy has grown to think of itself as the raison d’etre of the organisations.
To an extent I agree with binao that management ‘should’ make a difference (having been fortunate enough to work some areas where being led by example was the norm) but I simply cannot believe that so many ‘professionals’ would simply ignore the basic tenets of their roles because of ‘bad management’ (in most areas professionals deliver quality care ‘despite’ as opposed to ‘because of’ management – and it has always been thus although now it is the norm instead of a rarity).
Elena mentioned ‘Care in the community’. As someone within the system I view its rise as the beginning of the end for the NHS (similar to mental health services). The idea of providing support for a person to live in their own home is entirely laudable and already existed in ‘reasonable’ cases with DNs, community hospitals, cottage hospitals and CNs. However, where did the money for it all come from? Why from the same budget that was already suffering from the increasing management and PC boon-dongle encroachment. We now see people discharged much too quickly, to inadequate support – directly home since community/cottage hospitals were ‘rationalised’ and consequently re-admitted soon afterwards, assuming they survive (figures massaged of course to show it as different admission of course). Did it save money though? Of course not! It appears as if the NHS budget saved some small amounts, but a multiple of that is then spent funding the uncountable numbers of community carers, assessors (not too many actual nurses though) and not forgetting managers (and diversity outreach equality staff).
As I said before – broken beyond repair, no longer fit for purpose!
Elderly people in France who require care in their own homes and cannot afford to pay for it up front are also subject to repayment to The State after their death. This is collected from their Estate. If they have no Estate then there is nothing to be collected from. This does not prevent them from receiving care in whatever shape or form is best for them.
All children in France inherit absolutely, and are therefor expected to care for their old people, sooner or later. And perfectly right and proper too.
If there is no Estate and no children then no one is abandoned. I have seen it happen, and it works. And if someone is totally alone then people in the village rally round. A large number of District Nurses are men, and would need to be to deal with the fat old lady that befriended me when I needed a friend. I still miss the rotten old besome. Climbing her apple trees and killing her bloody chickens, which even The District Nurses aren’t prepared to do. But I didn’t half learn a lot.
I just can’t believe it takes about 1,5 million people to provide our healthcare. (if I’ve got that right) One worker in 20.
It’s so big how can anyone ever get a grip on it?
I always thought in my industrial working days that leading a team of 12 was about the practical maximum; in an organisation of about 200 you can know and be aware of most people fairly well; above that you need some very good people to make it work. I’ve been there.
So I guess we might be better with smaller units.
Never was convinced by economies of scale.
XX I just can’t believe it takes about 1,5 million people to provide our healthcare. (if I’ve got that right) One worker in 20.
It’s so big how can anyone ever get a grip on it? XX
And, yet, we are permenantly understaffed.
Go work it out…..
I agree with bring back Matron, not selected because she ticks sodding diversity boxes but because she is a long servicing nurse of the old school who runs her hosptal with an iron fist in a velvet glove, the sort who puts managers and accountants and other such inhuman beings in their place…back in the office fiddling the books and where they can do no harm ie nowhere near the recruitment training and promotion of nursing cleaning catering portering or any other aspect of the real running of a hospital.
Cameron would come up with money as a sweetener, what else do you expect from the likes of him and others who can be bought cheaply, they expect everyone else to have their own shallow base view of life and cut price tag.
Regards
Judd
I agree with bring back Matron, not selected because she ticks sodding diversity boxes but because she is a long servicing nurse of the old school who runs her hospital with an iron fist in a velvet glove, the sort who puts managers and accountants and other such inhuman beings in their place…
Right, but does this kind of matron exist outside Doctor In The House, Carry On Doctor or Carry On Matron Ealing comedies, and did she ever exist in reality? A woman who might have seemed all powerful to the youthful eyes of Richard Gordon as a medical student at St. Bartholomew’s circa 1940 might appear very different to modern eyes.
Yes matrons in the pre-1967 NHS were in charge of nursing and housekeeping services, but they never had strategic power to make changes at board level.
Medicine has simply changed over the decades.
Modern medicine is essentially applied biochemistry. Blood tests are performed in computerized labs and doctors read the results and prescribe corrective measures to be administered via pharmacists and nurses.
A measure of how this has changed is that I was over 40 years of age before I EVER had a blood test. My baby daughter had one the other day at less than 4 months old as she was off her feed, and was diagnosed with a slight anemia and prescribed some vitamins and a diet change.
When I was 7 I had a severe case of pneumonia and the doctor came to my house and gave me an injection of penicillin from a glass syringe and long steel needle. At that time there were no oral forms of penicillin like tablets or syrups available. Nor were there disposable syringes and needes. The glass syringes and steel needles were autoclaved and used again.
Things like computerized blood tests were impossible 60 years ago when I was a babe in arms, so hospitals focused on things like strict routines, beds in neat lines all made up the same way, lining up patients for a military type inspection by the doctors, instead of lab work, medications, intravenous infusions, intravenous drugs and so on.
The hospitals floors and walls may have been cleaner in those days. I don’t remember this personally, but I will accept it was so.However knowledge of infection control mechanisms has improved beyond all recognition in terms of knowledge of hand-washing techniques, availability of cheap sterile gloves, methods of handling bed linens, disposable single-use equipment, and so on. MRSA was a big problem, but it wasn’t caused by dirty floors, so much as development of strains of bacteria resistant to various types of penicillin and a large number of patients with compromised immune systems.
Today’s hospitals may indeed lack compassion, but I think one’s chances of survival to an older age are still much greater than they would have been in the heyday of the omnipotent matron. I was recently in hospital in the Dominican Republic and some of the nurses were brutal with the IV needles, but at least I got the medication, survived and went home, which I regard as a desirable result.
Jonathon
You are right to point to the huge progress made through technology and biochemistry.
I remember the gentian violet and iodine.
Does that really excuse the distancing of frontline staff from the patient?
It may be that tough but effective treatment gets the job done, but we’re not just talking about sick people whimpering, we’re talking about people dying.
Not because of rare errors in surgery or treatment, but from neglect and lack of care.
In a hospital.
Together with Able’s astute comment above, about the insidious impact of the MSM’s portrayal of the NHS, this ranks as about the most perceptive comment made here
“Cameron would come up with money as a sweetener”. I think that you have missed the fact that this all happened under a Labour government, which literally threw money the country did not have at the NHS.
I used the Cameron word because he’s supposedly in charge at the moment, i make no differential between him or any other of the current cabal of politicians of the three-cheeks-of-the-same-arse party, they are (nearly with a few notable exceptions) all complicite in the destruction of our country in all its forms, but no more culpable than the blinkered brainwashed and bribed electorate who voted for them/this and continue to do so.
But what went wrong? The NHS was a good idea. And so were Pensions. Or were we all supposed to die five minutes after we retired? They got that wrong. Too many of us survived The War on a near starvation diet, and healthier for it.
And then there were the people who went to the Doctor for a free Asprin and a Knee Bandage when the likes of me avoided the Doctor like the plague and kept on walking. Too many people looking for a free handout. And I don’t mean people who are really sick. But The Health Service was and is abused.
This does not excuse bad care and lack of compassion. I don’t know what to do about that, but I can’t see Degrees helping. You can’t get a Degree in Compassion. Fortunately, I don’t need to worry about it. But I do have to pay a sizable amount for my health care here. Perhaps that is the answer.
As Jonathon says “Medicine has simply changed over the decades” but much of ‘nursing’ hasn’t.
Yes many of the diagnostic tools and interventions (and outcomes) have developed/improved to such an amount that I’d disagree with Elena (misquoting I admit) and state that degrees are needed (a nursing degree is far from an esoteric science, most covering the most basic anatomy and physiology, basic pharmacology and psychology the bulk covering nursing models, evidence based basic care and procedures. For myself I have further degrees, one a ‘Clinical Sciences’ BSc from Kings which is basically a medical degree without ward time or status change. Do I ‘need it’? No. Does it help me, and my patients? I believe it does in that I can understand the diagnosis, question decisions, explain to my patients and better monitor their progress rather than waiting for a ‘convenient doctor passing by’, and I am far from unusual in level of knowledge). Whilst degrees are not essential and “You can’t get a Degree in Compassion” neither does getting a degree negate or preclude compassion. The people involved here will be both degree and diploma qualified (and possibly older non-diploma qualified as well) so not having a degree evidently does not equate any better with having compassion either.
Most of ‘nursing’ even as practiced today is exactly that practiced for centuries, feeding, dressing, toileting, monitoring of condition, etc. Whilst the case in question may appear to those outside the profession as purely one in which compassion and basic care were dispensed with, it is simply impossible for the supposed professional staff to have had ‘any’ contact with these patients (could you practice ‘high-tech’ monitoring and management/prevention of decubitus ulcers (a statutory requirement) without noticing that the person was lying on soiled linen? Can you administer medications, therapies or even monitor basic signs without noticing your patient is dying of dehydration?!!!)), which is perhaps why I feel that they should be struck-off from the register since literally none of their role was, even in pretence, undertaken.
The fact remains that whilst we can debate whether ‘society’, management, culture or fear for career motivated them, they either refused care or stood and watched silently and as such every last one should face the consequences and never be allowed near a patient again. Too tough? Ask yourself honestly if you could stand and over days/weeks/months watch person after person suffer and die for such ‘petty’ reasons, I know I could not!
@Able
Yes, medicine has changed since the days of the dragon-matron, and so has the population served, because due to the successes of medicine the people in hospital today are much older and much sicker than the hospital population of the early days of the NHS and there is a large population of patients with dementia of various types, not to mention that older people often suffer from periods of confusion after surgery, or due to poor oxygenation of the brain if they have respiratory complaints. Many such patients ideally require round the clock 1:1 care from a Health Care Assistant.
Nursing can basically be broken down into 2 groups of components:
1. Support of activities of daily living where the person cannot do for themselves in the areas of feeding, toileting, dressing, ambulating (walking), and grooming and personal hygiene. A useful, though tasteless, mnemonic is DEATH: dressing, eating, ambulating, toileting, hygiene.
2. Providing skilled delivery of medical treatments and medications, pre- and post-surgery care, vital signs and daily or shift assessments, communication with doctors, education of patients and families about their care, assisting doctors with other more esoteric treatments that are not done alone by nurses or consent forms, making appointments and coordinating with other departments such as medical imaging and X-ray, physiotherapy, dietary, arranging transportation, ordering special equipment, record keeping, responding to medical emergencies, and so on.
This can be pretty tough work on its own as the nurse has to maintain a mental database of everything that is going on with x number of constantly changing patients who are assigned to her/him.
I have read some of the Mid Stafford report–but not all, as it is three volumes–especially vol. iii, Chapter 23 on nursing in which the author(s) go into these issues of care delivery in considerable detail.
It seems that the issue is not, as the public thinks, that nurses don’t need degree level education, but that under the old apprentice system of training nurses, nurses spent a great deal of their three years of training working as part of the workforce on the wards and providing the activities of daily living care to patients while they learned about the more technical aspects of nursing by osmosis and familiarity. Them days are gone and they aren’t coming back, but it seems that there were problems with the skill mix of registered nurses and assistive staff and that Mid Staffordshire got into a downward spiral of absenteeism and poor morale in which standards of care declined, particularly on certain wards such as the notorious Ward 11.
Quite!
The changing demographic is to an extent a ‘red herring’. It has always been thus (a gross oversimplification but for most of the population their entire lifelong contact with health services will be immunisations/checks, a few scattered minor ailments and a final ‘fairwell tour’ at age >70). That there are now both more older people and a greater percentage of the population should not in itself alter anything.
Part of the increasing problem comes back, as in everything, to money. The massive reorganisation and reductions in inpatient beds following Tomlinson was the beginning of difficulties. In the ‘old days’ it was not unusual to have beds empty until a suitable patient for whichever speciality was admitted. Today there is ‘hot bedding’ with not a single bed left empty for even a second (constant ward transfers to ‘create’ spaces, early and inappropriate discharges, etc.) and bed numbers set for ‘the average’ at best (a minor ‘event’ can necessitate, and regularly does, calling in consultants to decide which of their patients can be discharged even earlier to create beds. The most basic logic would indicate scaling for the ‘average’ bed requirement means that 50% of the time there are too few beds).
Staffing is still, allegedly, as always based on both bed numbers and patient dependencies. Again in the ‘old days’ I would be allocated perhaps five patients with mixed dependencies (depending on area) allowing for direct involvement in all aspects of all their care (basic care, more high-tech interventions, education/information, cleaning, liaison with the multidisciplinary team, etc.). Now? In a similar environment I usually have at least double, and sometimes more (and often more dependant and requiring more therapies and complicated and time-consuming liaison for discharge etc.). I have a HCA to assist me so to all appearances the staffing remains the same, yet my workload has more than doubled. (As an aside ‘keeping track’ is simply a skill developed with practice literally no more complicated than remembering your shopping list whilst dealing with getting your children ready for school, calling to book your holiday, doing the ironing and talking to both your bank about an overdraft and the plumber about putting in a new bathroom all at the same time – Oh OK a little complicated then).
The issue of a disconnect between those who manage (and hold the purse strings) is valid. Most ‘managers’ I have had any contact with last worked clinically (when they’ve had any clinical experience at all) some many years ago – I have lost count of the times of ‘when I worked the wards’ has been used to force through some untenable reorganisation when they have no idea what the result actually means.
Morale may be constantly low (and it is). Staff absenteeism and crucially their willingness to both work longer (unpaid overtime has always been the thing the NHS has relied upon to operate) and come in ‘at short notice’ to help in an ‘emergency’ (of which there always seems to be one at least monthly) has all but disappeared (use and abuse someone enough and the result is predictable).
However! From personal experience, whatever the reason, when patient care is threatened either more staff (having called in senior ‘supposedly’ clinical staff to work as ward assistants as well as the more regular ‘can you come in for an extra shift’ calls to staff), more beds (having opened outpatient areas as temporary wards) or closure to admissions (not always possible when, as here, the nearest alternative hospitals, excluding the local satellite unit, are either 60 or 75 miles away). All these ‘issues’ are common across almost every hospital, what therefore is unique about NS? The point being, and telling on a number of levels, that the staff at NS did not do any of those things. The question is why?
I thought losing the role of State Enrolled Nurses was a big mistake, the two year course was ideal for good practical nurses who were perhaps not academically inclined but excellent nurses. Now it is hard to tell who is qualified at all unless you look at the badge, most are minimally trained Healthcare Assistants. I realised that last time I was in hospital, I thought the ward was well staffed until I asked a question the HCA’s couldn’t answer and I had to find one of the very few qualified nurses. This downgrading seems to be well established, Community Support Officers instead of police, HCA’s instead of nurses, Practice nurses instead of doctors, it is just a matter of time until the stewards are flying the planes! The last time I saw a real policeman on the street was in 1996. My personal experience of the NHS has been generally good but a lot depends on how articulate and persistent you are and where you live and that should not be the case. I just wish we could get politicians out of healthcare and stop using as a political football, having lived in Germany for a few years the system was better and much quicker and France sounds fine too. I can’t see any changes until the people responsible are charged with manslaughter and neglect from the top down, instead they are paid off or promoted. In any other business they would be arrested so why not the NHS? as someone said it was a system for 1948 and should have been updated decades ago.
Herein a core argument: do you admit a professional managerial class, knowing that they will always be able, at the last instance, to use the wriggle: “I wasn’t the nurse”, or do you make managers of your professional nurses, such as Able, taking them off the wards but telling him that he’s got the authority to boss people around but if he gets it wrong, he will be held both professionally and criminally liable?
So far we have done the first. I’m not impressed with the results but I’m also familiar with the argument that medical staff ultimately make very poor managers. I do not know which is correct.
Rather than a *correct* method, I’d prefer a method that *worked*. For the most part they obviously do because my experience of hospitals and GP Practices has been a good one. I suspect much of what went wrong at Staffs could be traced to a very few individuals who were not managed at all, by anyone. It’s not so much *management* at patient level, but more like *supervision*. Managers in offices are not going to make staff on the shop floor behave any differently – only the other staff in those wards can do that.
As an aside I recall that traditionally the most qualified person on the wards (the “Sister”) was often the least empathic to patients and the warmest were the *auxillaries* who primped our accomodations and kept us fed and watered.
WoaR
An interesting point! I have heard, possibly apocryphally, that in a certain foreign country there are two clinical ‘tracks’ to promotion. All nurses train, qualify and are expected to gain experience across multiple specialities (as here) before promotion. However, should one be interested and capable in management areas one chooses the ‘management’ track. Interest and ability in clinical aspects? One chooses the clinical track.
The result would be that ward administration is dealt with by one, clinical care by the other. Potentially you could have a situation where the most senior and experienced/qualified person worked clinically whilst the ward was ‘managed’ by a junior (Management opposition is guaranteed with ‘why should we pay a 7/8 to wipe bums?’ being the politest response I can think of. The multiple regradings show exactly what they think about paying for experienced staff, whilst of course expanding the numbers of managers exponentially)
The opposite situation exists here, with anyone wishing to gain promotion (and justified rewards for years of work and study especially when comparing incomes with other, shall we say, ‘less caring opportunities’ even within the NHS) will automatically be dragged away from clinical input and forced into management. Perhaps keeping, and rewarding, clinical excellence will have an effect on care delivery?
“I thought losing the role of State Enrolled Nurses was a big mistake, the two year course was ideal for good practical nurses who were perhaps not academically inclined but excellent nurses.”
Yes, but under the old system a lot of the two years was just unpaid labour on the wards and was not really two years of study. In the US Licensed Practical Nurses are used a great deal including for administration of medications. The LPN course is one year in a technical college with some short supernumerary placements for practical experience, however the usual admission requirement to an LPN course is that they must have completed a 90-day course as a Certified Nursing Assistant plus a year’s experience as a CNA, so they should already have the knowledge and experience of supporting patient’s activities of daily living and are now ready to learn about delivery of medications and treatments.
I agree with carol42 about the loss of the Assistant nurse training and grade. My experience of NHS goes back to 1953, when I started as a cadet nurse. At 18 I was taught how to apply koalin poultices and give turpentine enemas etc. Our matron WAS a DRAGON. Other matrons I worked under, while training were pussy cats, matron at the TB sanatorium we were seconded to was a wonderful lady. The 2 midder superintendents during my training were fantastic managers with devoted staff. They were single ladies and could dedicate themselves to their units. That is one of the big changes. I mostly worked with girls from Northern Ireland, only a few local lassies. The community was less formal. At the local midder unit the protocol books were added too almost daily in the early nineties. I got fed up with it all in 1992 and retired at 57. Some mothers were getting verbally abusive, which was difficult to cope with. I found another job none nursing job a few weeks after I retired, which lasted till state pension. My conclusion is that there should be a basic care level qualification that takes at least a year. That ward/ unit management should demand a diploma specific to that skill, taken after initial training. Degrees could be sought later, if possible with some sabbatical leave. The NHS always stirs the passions. In the last year we have both had a big helping of NHS care. It varies from wonderful care, to infuriating waits, due to minor errors and protocols which make one feel utterly helpless, abandoned and furious.
Given the focus on professionalising the nursing profession, all graduates and a target driven culture it perhaps isn’t suprising that compassion for patients wasn’t considered a worthy concept to retain. What is utterly shocking is that the NHS appears to have attracted people who have no natural compassion of their own, or the common sense to realise that compassion is a worthwhile thing to have for someone in your care. My own personal experience of our local hospital would tend to support the contention that there are many nurses in the profession for whom a callous detachment (albeit thoroughly professioal at the same time) is the status quo. Like the nurse whose solution to my adverse reaction to an epidural (could not ‘pee’ for love nor money) was to urge/force me to drink more water until… an emergency catheter was required and she got a thorough drenching from my grossly overdistended bladder in the process. Natural justice.
I was in hospital as a child and teenager and remember being so spolit by the nurses that I did not want to go home so readily when the time came fdor discharge. Doctors were the arrogant / uncaring ones with bad bedside manners then.
Today as a pensioner the thought of going into hospital is so scary that even the thought of dying to avoid t is preferable to me, having witnessed aged parent neglected and made worse than on arrival as an inpatient, on a ward for the most vulnerable, I met only one person who I would describe as caring enough to ‘care’ about the person to touch them with kindness- not a nurse. A few nurses only seem to actually like any people they administer care to on their watch. Most just badly fill out charts which are always incorrect. Some actually complain they have to do any work- I have heard it all.
Nurses had vocation once now they have a career ladder as a ‘profession’ The same too with social work. Vocation = care and profession = indifference/ career ladder so Cameron will only help people climb the rungs of a ladder created by successive governments who seem not to know what exactly makes people care for others- not laws and micromanagement of society.by politicians..
The simple answer is to give patient choice. And not some fake choice, but real I-will-go-elsewhere-and-you-will-not-get-paid choice.
Compare this with the horsemeat situation. For all the “private sector is evil”, well, the private sector cleaned out their stables, didn’t they? No cover-up, no attempt to blame someone else. Tesco apologised, took Findus off the shelves, and have brought in procedures. And they did this in days, not years.
Why doesn’t the NHS do this? Well, because sod you, that’s why. Where else are you going to go? Private? Thanks, we still get paid.
You need people to own these hospitals. People who care about the hospital’s reputation because they have their own personal wealth involved in it. That’s why Tesco fixed their problems PDQ.
Well said Tim!
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