The Sunday Times

September 25th, 2011

Speak up, or nurses will carry on with their woeful care

It is one of life’s many mysteries that the British are so astonishingly patient at times when they ought to be very angry. Take nursing. It seems there is no need for anyone in charge of nursing to beware the anger of the patient British patient because it never comes. Grumbles and lamentations there may be — I have had thousands of letters over many years from people horrified by the nastiness of their nursing care — and the Patients Association does its best, but a critical mass of righteous fury is missing. I cannot understand why.

For more than 15 years I have been writing diatribes against the low and falling standards of nursing in this country. I don’t mean all nurses, of course, but recently there have been enough horrifying hospital scandals to prove the point that disgracefully bad nursing is widespread. My views are not just based on my own observations of visiting many hospitals and patients. They have been formed by conversations with nurses themselves — good nurses who are increasingly frustrated and shamed by their profession and by some of their colleagues — and by countless heartbreaking testimonies from patients themselves or their relations, often in grief-stricken handwriting.

Before long it became clear to me, as many nurses themselves pointed out, that the problem lies mainly with training. Nursing training was leaving nurses unfit for nursing and still is. In the late 1980s the nursing establishment became obsessed with the idea that all nurses, like doctors, should have degrees — the national obsession with professional status — and be trained not in hospitals but in a university setting. This turned nearly 20 years ago into Project 2000, which was not opposed by Conservative governments, and promoted by their Labour successors and the Royal College of Nursing; all nurses were to have degrees by 2013.

That sounds fine, until one examines the consequences. Of course lots of nurses need degrees, and some have always been graduates. Nursing has become ever more complex and academically demanding at the higher levels. But it remains much what it always was, at what one might call the less academic levels, for which good training is essential but a university degree is not. In fact the intellectual demands of a university degree, and getting a place to study for one, have on the one hand turned many young people away from nursing altogether, when with a different training they might have become excellent bedside nurses. I can remember one trainee nurse in Greater London telling me how others on her course struggled hopelessly with Foucault’s theories of sexuality when they wanted only to look after sick people in practical ways.

Such nurses used to exist, in the bad old days before Project 2000. They were called state enrolled nurses (SENs) and were trained on the wards by matrons and senior nurses, and also had some academic training and exams. They were not nearly as highly trained as state registered nurses, but they were integral to the nursing team, part of a chain of responsibility with their essential clinical observations and expertise in routine issues — dealing with everything from bedsores to specimens, routine tests, bed washes, bedpans and reassurance.

They gave the NHS much of its worldwide reputation for bedside care. But they no longer exist. SENs have long since disappeared, victims of the nursing establishment’s pursuit of higher status and equality (an illogical combination, you might think). SENs’ work has been taken over by untrained, low-paid, unregistered, uninvolved nursing auxiliaries, with the results we have seen — too many patients left in their own filth, ignored, unfed and unwashed and begging nurses in vain for anaesthetics or a bedpan.

Meanwhile, Project 2000 has produced all too many graduate nurses who are too posh to wash patients and too qualified to care, without actually being of much use. “Unable to take blood pressure or give an injection, and a liability on the wards” was how one hospital trust executive put it to me nearly 15 years ago. At the same time complaints have been denied and whistleblowers punished. I cannot count the number of times I’ve written about it, to be ignored by the establishment and ferociously attacked by thousands of nurses. The Times writer Camilla Cavendish has recently produced several excellent reports about nursing. It is clear things have been getting worse.

Now, to my intense fury, all this has suddenly been admitted, without a hint of an apology, by one of the organisations that made it happen. Last week the chief executive of the Royal College of Nursing, Peter Carter, had the gall to announce that many new nurses arrive in hospital incapable of caring for patients because they have spent too much time in the classroom and not enough on the wards. Too many of them, he said, “are not up to the mark”. How dare he announce this now, unforgivably late in the day? It was the predictable result of taking all trainee nurses out of hospitals and forcing them to do degrees. Equally shocking was the response of the Nursing and Midwifery Council (NMC), the body responsible for setting standards for nurses. It merely commented that “the balance between theory and practice hasn’t changed. It’s 50-50, as it’s been for many years”.

Carter remarked that the way hospitals now depended on untrained, unregulated healthcare assistants was a “disgrace”. Of course it is, in the absence of the trained SENs who were part of the nursing team. His solution is to call for the registration and training of auxiliary workers. This defies belief. They would be SENs by another name, bringing the whole thing full circle. That is the real disgrace.

Where, all these years, have been the organisations and the people responsible for this prolonged disaster? Where were the quangos, the health ministers, the NMC, the unions, the nurses themselves and the doctors? Why were they silent about the suffering of so many patients? In 2000 Lord Winston was horrified by the treatment of his elderly mother on an NHS ward, and made a public fuss about it. But my response (after bitterly reflecting that my own mother was treated even worse in an NHS hospital) was to wonder why he was the first to do so.

Doctors and nurses must have known about such things for years — especially the many good and compassionate people among them. They should have joined together in mass outrage. They should do so now, apologising at the same time. But putting up with things one shouldn’t put up with seems to be the British way.