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Saturday 17 May 2008

The retreat from Scutari

Last week, I wrote a column in the Daily Mail about the scandal of dirty hospital wards which were killing patients through the superbugs they were breeding. While I said the way the NHS was run had much to do with this problem, I pinned much of the blame on the profound change that had taken place over the past two decades in the training of nurses, who were no longer taught Florence Nightingale’s dictum that the core of good nursing was maintaining patient and ward cleanliness.

*My 93 year-old grandmother, broke her femur and was taken into hospital for treatment. She was otherwise in good health as far as we were aware. The operation was a success. However, following the operation, she contracted an infection in the wound and had to be put on antibiotics. As the infection cleared up, she contracted bronchopneumonia. Again, she was given antibiotics for the pneumonia, but then contracted C.diff. To get rid of the C. diff, her pneumonia treatment was stopped and she was put on a course of different antibiotics. This caused her pneumonia to return. At this point, my grandmother begged for all treatment to be stopped. She said she would either get better herself or die – but that she could not stand the torturous treatment inflicted on her any further. (Believe me, kindness was distinctly lacking on that ward!) All treatment was stopped and my Grandmother died on 9^th April 2003 – approximately 6 weeks after having entered the hospital.

It should be noted that during part of her treatment, my Grandmother was placed in a private room which was filthy. The walls and floor were dirty. Yesterday’s dinner was often left on the table alongside that morning’s breakfast and we once found her false teeth under the bed. My grandmother was unable to feed herself and would not eat the food provided for her anyway as the kitchens liquefied everything. She was slowly starving. The only time she showed decent appetite was when we provided bacon sandwiches for her from home and, on one occasion, when she ravenously consumed a battered fish from the hospital kitchens. (We had to argue at length for this piece of fish as we were told by the food orderly that she had ‘not ordered it’.) Painkillers were often left in a plastic cup at the end of her bed where she could not reach them.

We saw displays of temper against other elderly or confused women which could only be described as outright cruelty. We would have reported this to their families, but had to be very careful. We did not want these people to victimise my Grandmother and other visitors had reported being ‘banned’ from the wards when complaining of cruelty and lack of cleanliness. (Not all the hospital staff were cruel, but as with most situations, the bullies were left to inflict their misery without check.)

The slow and harrowing death of my Grandmother occurred as a direct result of the appalling aftercare and filthy conditions at this Hospital, which caused her to contract various infections, including C. diff. We still believe that, had we taken my grandmother away from the hospital, she would have recovered. The memories of that nightmare time will haunt us forever.

 

*I was also horrified when my sister in law told me of her experience which was within the last month. She had to spend a couple of days in hospital recently because some sort of inner ear problem had rendered her incapable of being anything other than horizontal. She was plumbed into a drip, and at some point during her stay, denied the use of a bedpan by the nurse on duty who ordered her to ‘go in your bed.’ Eventually she had no other option.

She had been traumatised by filthy hospitals and medical incompetence during my brother's terminal illness 6 years ago. And now this! Work all your life, pay mucho taxes, do civic duty and this is your reward ! She is 69 years old and has been a Justice of the Peace for the last 14 years. It is scandalous. It is monstrous! It beggars belief. Billions have been spent and even the basics are no better. New Labour is THE most morally bankrupt shower there has ever been.

 

*I have been a Biomedical Scientist(BMS) for over 40 years and your observation on nurses was spot on. Yes, nurses are now graduates and, as such, probably regard menial tasks as below them. Those tasks are sometimes done by Healthcare Assistants (old name auxiliary nurses) and/ or cleaners. Cleaners, in my experience recently, are almost always ‘outsourced’ (agency) and may not even work in the same hospital regularly. I expect that they have not been medically trained and to them s**t is s**t!

I worked in a small private hospital for a number of years and patient infections were scrupulously observed. The Microbiology BMS reported the infections, the Control of Infection nurse collated them and reported to Matron, or the Microbiology Consultant if necessary. On one occasion, all members of staff were swabbed, including Consultants, to find the source of a hospital based infection.

My father was admitted to a hospital 6 years ago and picked up MRSA while on a high dependency ward. When he recovered enough, he was transferred to a single room as I was told that he was still infected. He was in that solitary room for 4 weeks until his death. When I asked on occasions why he was not being transferred to the main ward, where he could at least have company, I was told he was still infected. I asked when he was last tested for MRSA and was told by a named nurse that they did not have the funds to test! That fact was denied by the Chief Executive when I wrote complaining about my father's treatment.

Because I lived 500 miles away, I was not able to visit as often as I wanted, so depended on information given to me by nurses because I could not speak to my father. I phoned every day and was reassured that he was quite well. It was only because a family friend phoned me on a Sunday to tell me that I ought to fly up to see him that I actually got to speak to him before he died three days later. I had been told lies about his condition.

You will not be surprised to learn that letters to the Chief Executive, his MP, his MSP all replied with platitudes - in fact, because he died during Parliament’s recess, my letter to his MP and then his MSP were replied to as being ‘too late to investigate any mistreatment of his condition’.

 

*Unfortunately, 30 months ago I was diagnosed with bowel cancer and had my bowel removed. On arriving at the hospital the day prior to the operation, I went to the toilet. No soap or hand-wash. Spoke to nurse. Yes we know we will get some tomorrow when the cleaner is back!!!!! The patient in the next bed informed me he had said the same the day before. Basic hygiene. After the operation, excrement from a spill from a colostomy bag was left on the floor for 2 days until the next bed patient’s daughter brought in disinfectant to clean up.

I have always been supportive of nurses. Not any more. They were lazy and did not have any basic knowledge of hygiene. They were just not interested. You could hear the night staff talking all night about what they had done that day. You ask them to help you empty your colostomy bag. You would think you were talking to a brick wall. Ask them to wear rubber gloves or wash their hands between patients? You are joking.

My next bed patient and I watched after each other. When we came out we both wrote to our MPs, the hospital the trust etc. We received letters back that were lies. Unfortunately, we were both having chemo and did not have the energy to follow up the reply letters. I wished I had. Why should older people be treated with such disdain? On the other hand I am under the Royal Marsden Sutton for my actual cancer treatment. The treatment is unbelievably good. The hospital is spotless and nurses seem to care. Why the difference? I spoke to one nurse at the Marsden who told me they could not even wear their nurses’ uniform when they were coming to or from work!!!! They would be sacked if caught.

*About three years ago a very close friend of mine aged 39 developed leukaemia. Whilst he was undergoing treatment for this in hospital he then developed a perforated bowel from the chemotherapy which then had to be suspended whilst a decision was made. Two days after this suspension of treatment he suffered two severe strokes. Until this point no-one had any complaints about his treatment.

From the day he suffered the strokes it was obvious there would be only one outcome. Thus realistically his quality of life became important for the time he had left. Bearing in mind he was left-handed and suffered a stroke of his left side which meant he was unable to write, he was also unable to speak (as a result of the stroke) and he was receiving constant painkilling medication for the leukaemia, it then seemed odd that he should be placed immediately into a side room on his own. From this point I feel he was forgotten by many of the nursing staff. I visited him daily until he died. Some days I would go in and the call button was lying out of his reach on the top of his pillow where he could not see it. Some days it was lying on his bed near his left (paralysed) side! Very rarely was this either within his reach or within his vision. Because of this he was unable to call nurses when needed, as he had lost the power of speech he could not shout, and as he was alone in a side room he could not attract anyone's attention. I always placed it where he could both see and reach it.

Many days I watched the nursing auxiliaries bring his food in and place it temptingly on his table at the foot of his bed, often out of reach. After what seemed a relatively short time they returned and noticing the full dishes commented that he must not be hungry! He couldn't reach the food. When I complained they left it there but no-one came to feed him so I and his friends fed him. On very few occasions did any of the nursing staff attempt to feed him (they may have when I was at work. I visited him every evening for 3-4 hours). Had it not been for myself and his large group of friends visiting and feeding him I believe he would have received little or no food at all. As a result he didn't last very long. It was possible to communicate with him, he could respond with nods or shakes of the head or by waving his right hand when he was coherent. If the nursing staff who brought the food in didn't realise he couldn't cope on his own then they are incompetent or this seemed to be a deliberate policy to starve him to death but in a tortuous way. If the staff nurses didn't pass this information on to the auxiliaries then they are incompetent for not communicating.

On one memorable occasion I visited him and the bed stank of pee, he was crying in pain and his stomach was obviously swollen - I could physically see this and he was holding his stomach with his good hand. When I called the nurses, initially an auxiliary came and I asked her to get me a staff nurse. The staff nurse could not see what the problem was even when I pointed it out to her. She stated that he could not have peed the bed as he had a catheter in despite the fact that the pee stank because it had leaked into the bed somehow (I don't know how I did not look under the sheets). My own thoughts are that the catheter had become blocked under the sheets which was preventing his urine draining causing him pain. This is very basic patient management. After I complained again two sisters came and ushered me out of the room and changed his sheets, cleaned him up and sorted the problem. I was allowed in after they had cleaned him up and he was not in any pain then. Why didn't the nursing staff spot this? How many other times was he in this state and wasn't picked up by the nursing staff?

I just hope that I never finish up in the same situation - I would rather die in harness then be neglected and maltreated by incompetent nursing staff.

*I am a nurse of some forty years experience, most of which has been spent in community nursing and working with elderly people. Nurses are no longer encouraged to nurse (care) for their patients. Instead they are directed to learn abstract concepts and highly technical procedures from the beginning of their training. Long gone are the days of bed bath, bed pan and temperature rounds. These rounds generated the time for nurses to share confidences with patients and to observe ways in which their patients' comfort and progress could be monitored and improved.

Although I deplore the passing of such basic care concepts, one cannot blame the nurses themselves. As you point out, the various revolutions within nurse training have given us the nurses who run our wards today. With the demise of the Enrolled Nurse grade and the ever increasing emphasis on targets, there is no-one in our health service who has both the knowledge and the time to spend with individuals in order to achieve holistic care.

In defence of the nurses, the career paths offered to these trainees does not allow them to develop such diverse skills. In order to earn a living wage, (over £20,000) they have no option but to follow the career pathway that the training dictates. Should they decide to go into the private sector, the majority of available posts are in nursing homes which takes them away from acute nursing and into elderly care, thus backing them into a cul-de-sac from which it is difficult to return.

 

 

* I'm horrified at the situation in the NHS hospitals today. I honestly believe that if the truth were known, there would be a national outcry. But sadly the real victims, often the elderly, don't always have anyone to speak up for them. The standard of care on medical and elderly ‘care’ wards is outrageous. I don't really understand why there isn't more of an outcry.

Although there are many complex factors involved, in my experience, the most crucial is the lack of discipline within the nursing profession. There does have to be a degree of ‘fear’ for some nurses or laziness and sloppiness creeps in. The biggest myth is that all nurses are angels, drawn to the profession by compassion and vocation. Oh no, never believe that. It's nonsense. The second reason (and they inter-relate) is the state of nurse education. On this, I must resist the temptation to ramble on as I'm sure you don't have time to read this. Suffice to say, in nurse education the lunatics really have taken over the asylum.

I really do speak from experience having been a nurse, nurse lecturer and now a nurse manager working for GPs. I've also seen from a relative's perspective what happens to elderly people on NHS wards today and I can tell you I truly fear my old age if I stay in this country.

 

*At last someone has had the courage to voice what many of us who work within the NHS have known for years, that nursing training and the type of person going into nursing is at the heart of the scandal of filth and neglect in our hospitals.

The root of the problem in dirty hospitals was sown in the 60s and 70s when unions had employers at their mercy and managers had an impossible task of trying to get people to do what they were paid to do without the unions on their backs should they criticize standards or levels of sick leave etc. The whole problem was solved or so it was thought by handing these tasks over to contractors with all the attendant employment issues. The new army of cleaners were answerable to no-one as they were working often without surveillance and without protocols, and any complaints from clinical staff had to go down the tortuous route of procedure.

The problem of dirt is so easily solved. Cleaners should be recruited by each hospital. Properly trained, properly paid and put to work on their own areas of the hospital ie, they should have ownership of those areas, be answerable for the cleanliness and be encouraged to take pride in their work. Cleaners should be available around the clock for continuous cleaning with certain jobs done every day at the same times. Ample supplies of linen, dressings, bed clothes, paper products, soap etc should be available.

Nurses haven't time to clean floors and walls etc but I have been ranting for years about nurses training and attitudes even when it was considered completely out of order to criticize these angels. Political correctness did away with the authority of doctors on wards. They were repeatedly told that they were no one, just part of the team and so they are unable to complain when patients they have laboured over in the operating theatre are condemned to almost certain death on wards where they are left in their own filth, left unfed and often times missing medication if they haven't the strength to remind staff or lift cups of water to their lips. This is not the workings of my imagination. I have seen this many times. It must be totally soul destroying to be a doctor in the NHS.

Nurses have a loud voice these days with none of the responsibility. I have seen the very worst type of women, women who you wouldn't accept a cup of tea off in their own homes go into nursing and quickly become puffed up with their own sense of importance, I have also seen women who would make ideal nurses be driven out by the sheer pointlessness of the stuff they are learning and the fact they are discouraged from physically helping patients.

The government defends itself with the talk of the billions that has gone into the NHS since they came into power and they are talking of billions more. What they don't say is that the bulk of it goes into computer systems and managers. I am a manager in an NHS practice and the speed and scale of computerization is overwhelming. My job has changed beyond recognition from one that had the patient at the heart of my day to one spent pulling out data and running audits for the Department of Health. We are subject to massive propaganda from turkeys who are obviously not going to vote for Christmas, that it is going to revolutionize patient care. It is actually about control, about spying on people, about manipulation, about trying to kid people that they have a new and modern service. You don't put gold taps in a bathroom that has no running water or electricity supply. The government holds the most peculiar view that doctors send patients to hospitals unnecessarily. They couldn't be more wrong, GPs labour to keep their patients out of hospital because they don't want them to die. I have even begun to wonder whether the problems are deliberately unsolved in order to achieve this end!

I believe that any government that hasn't the intelligence, the will, the courage to make massive changes which may upset vested interests isn't fit to govern. The NHS isn't the envy of the world. Some third world countries have cleaner, safer hospitals than ours now. We are a rich country and our tax payers invest massively in the infrastructure and have a right to clean safe hospitals and caring, dedicated staff.

 

*My father was senior pathologist at the Kent and Sussex Hospital in Tunbridge Wells during the late 1930s and early 40s - one of the three involved in the present scandal of course - and I particularly remember the high standards that prevailed at the time throughout the hospital with a daily inspection of every ward by the Matron, feared by everyone, nurses and patients alike. Woe betide the Ward Sister should any spot of dust or dirt be found. The nurses were trained up in a hierarchy with incentive to move into more responsible posts higher up, but the sense of duty and vocation was never lost. The aim of the nursing profession was to help the patient to recover. Hospital food certainly was not brilliant but it was at least nutritious and no patient was left to feed themselves if they were unable to do so, and it was the responsibility of the nurses to keep the wards spotless. As a result there was no MRSA nor Clostridium Difficile.

During my National Service in the late 1940s I volunteered for nursing in the RAF and was trained accordingly. Despite the Service ambiance, we were expected to behave in the same way towards patients as our confreres in civilian life and similar regimes were applied to us. It was obligatory to keep patients clean and comfortable in accordance with the principles established in the last century by Florence Nightingale. This was held to be the basis of the nursing care of patients.

However, many years later, as a Principal Lecturer in philosophy, I found myself involved in setting up the new BSc in Nursing. It quickly became obvious to me that through its dependence upon the attitudes of the feminism of the time it would inevitably lead to a collapse in patient care. Vocation was out - as demeaning to nurses. No more were nurses to be involved in keeping patients clean, in helping them to avoid bedsores, in seeing that they were adequately fed, and especially, a task required to fight infection, to keep the wards and beds clean and sterile. Instead nurses would be quasi professionals, steeped in silly and irrelevant subjects and with only a half-baked and book-learnt understanding of arbitrarily chosen 'scientific' subjects. Nursing as such was to disappear - and so it inevitably turned out. But who was to be left to look after the patients? Nobody was interested in that because it was beneath the 'professionals'.

A little later my wife and I were involved in helping a neighbour - an old man who had been a professional artist of some importance. His wife had died and he had no-one else to whom he could turn, so when he had to go into hospital it was we who visited him and gave him some contact with the outside world. On one occasion we happened to be visiting at the time the midday meals were being given to patients. He was incapable of getting the food into his mouth by himself as his hands were shaking too much and he could not locate his mouth for himself. Some 'nurses' were passing by the foot of his bed so we pointed out to one of them that he was not able to feed himself. The response was - 'well you feed him then!' We were shocked because it was only by chance that we happened to be there at that time - and we found out from him that he frequently went without food, his plate being later removed at the appointed time whether he had eaten anything or not.

The position has now become serious. The NHS culture is rotten - and is made worse by the huge numbers of drones carried in the so called management echelons. It now takes a highly paid 'Bed Manager' for example, equipped with a suitable clipboard and with an office of her own, to go round the hospital recording how many beds are vacant when the Ward Sisters can report that number in a few seconds. Only a tiny example of the massive waste of course. Nor are things made better by the employment of thousands of foreign nurses with hardly any English, nor it seems much in the way of qualifications to assume the responsibilities they undertake. But of course one cannot say much in that connection for fear of prosecution for racism - or 'nursism'?! In short, as you yourself are very much aware, the problems go much wider and are symptomatic of the implosion of our entire cultural values and attitudes.

And finally, a nurse who has a very different perspective:

I think this nurse is in a state of denial. I also think that the crisis in nursing is part of a much broader de-moralisation of the NHS and our wider culture. We have to restore to our public services and general society a sense of duty and obligation to others. This cannot be achieved by a top-down, massive state bureaucracy set up to deliver unrealisable demand. That means accepting that the NHS is bust, and replacing it with a European-style system of social insurance embodying and promoting individual, professional and social responsibility. Much of the public already gets this. How long will it take our politicians to wake up?

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