Whatever happened to observation?

Photo: The National Archives

Anyone who has witnessed the problems highlighted in the Keogh Report first hand will have been appalled by the mud slinging in the Commons when the Health Secretary made his statement. The findings of "poor care, inadequate staffing and bad management" come as no surprise. See "Death by care" here and "NHS: Here we go again" here. This has been going on for decades.

That there is something wrong in the NHS has been obvious for years but being the sacred cow that it has become, criticism has been unacceptable even when watching a member of your own family die from an infection picked up in hospital where infection control was so lax that doctors and nurses had to be reminded to wash their hands.

Long gone are the days when the Ward Sister knew every patient, their diagnosis and recovery regime, when meals were supervised so it was obvious if a patient was not being properly nourished. When backs were rubbed to avoid bed sores, mouths kept clean and, of paramount importance, patients were observed by nurses training on the wards to care for patients. Nowadays it is not the ward but the nursing station that is the hive of activity. Is it any wonder that 'observation' has become a lost art?

NHS dementia

Photograph: Wpa Pool/Getty Images

All smiles but the reality is different. The latest depressing report illustrates the plight of patients in NHS hospitals with dementia. Can anyone be surprised? There have been endless reports of problems in the NHS and care homes where nurses don't care as they should followed by promises to do something about it but the chances are, unless you are one of the privileged few, you have a high chance of dying in misery in a care home or hospital, disorientated, dirty, dehydrated and thoroughly depressed. Yes, there are pockets of excellence which politicians and the fortunate praise as shining example of the modern NHS but they are far outweighed by reports of poor care by people who seem to regard patients as fodder simply to keep them employed with the minimum of effort. Read about it here, here, here, here, here, here, here, here.... . The reports are endless. In January 2010 Michael Parkinson in his role as the government's dignity ambassador condemned standards in care homes and hospitals as "downright unacceptable". In January 1999 a two-year campaign to improve "shocking levels of ill treatment" for elderly people in hospital began but we are still reading about it more than twelve years later.

This from a former dedicated nurse: "What has happened to basic nursing care, to observation, to humanity? Excuses citing undermanned wards, overworked staff simply will not do. If we were short staffed we worked twice as hard to ensure patient comfort. Nursing has never been an "easy job", working long hours without overtime pay, sacrificing a social life are just a few examples encountered but the rewards were so good, seeing patients get well and return home, which was surely why nursing was chosen by many, when vocation was an easily understood word."


There is nothing to smile about. The system has failed. Government ministers should stop talking it up and get back to basics. The old system worked so get nurses out of college and back on the wards to learn patient care, hands on.

Deficit Dave drops another one.

Deficit, deficit, deficit. No matter what the problem, the cause, the effect, the Prime Minister's response is unwavering: stick to the deficit reduction plan. When you are in a hole stop digging is generally good advice but such an analogy is unlikey to register. David Blanchflower has laid out the problem facing us in an article for the New Statesman in which he says: It is becoming increasingly apparent that Cameron is a) totally out of his depth when it comes to the economy; b) has no clue what to do to fix the problem; c) has little sympathy for those who are less fortunate than he is. He just doesn't care. But it is extremely unlikely that Deficit Dave will take any notice as illustrated in an earlier article for The Telegraph by Damian Thompson.  


Dave's latest gem to be dropped on the working classes is to advise parents to take their children to work during strikes. I can only assume he shot that one from the hip without giving any thought to child protection, health and safety or even the logistics of trying to work with an eye on the kids after possibly doubling the occupancy in the workplace - "when it is safe for them to do so" of course. A useful get out!  For people in a less privileged position struggling to make ends meet, life is not that simple especially for the elderly. 


Today's shocking report on care of the elderly at home illustrates how detached from reality politicians have become. 'Care' has been downgraded in hospitals and at home to the extent that many 'carers' just don't care any longer. Hospital nurses and District nurses have been elevated to the status of semi-medical professionals no longer soiling their hands on menial tasks yet it is precisely the intimate care that made 'nursing' what it was before accountants re-defined 'care'. Without proper care the entire system is in a state of collapse in hospitals, care homes and in people's own homes where 'home care' has become a 15 min visit. Today's carers are among the poorest paid with an undervalued status. This must change. If carers were better rewarded financially and in their status, genuine caring people may be attracted to what much of nursing care was all about. This is one deficit that cannot be ignored.

"It's not rocket science."

Regulator calls for better care for the elderly

Fifteen years after Ministers admitted that hospitals were failing the elderly, the Care Quality Commission has found that half of all hospitals that it looked at failed in standards of care for the elderly. The BBC website has documented stories.

From my own experience going back over 15 years I do not think anything would surprise me. Having witnessed the indignity of friends and relatives in soiled clothing, left exposed, unwashed, prescription drugs left on lockers, dry mouths - the list is endless - and the feeling of helplessness, wary of complaining for fear of making matters worse for the patient and leaving a lasting sense of guilt.

It is clear that there is a fundamental problem and as one of the new matrons said in a television interview, "It's not rocket science". The Health Secretary suggested nurses should blow the whistle on poor quality care but that raises the question of whether thy would understand when to blow it.

Another 15 years of excuses is unacceptable. I was accused in a comment on my previous entry of not coming up with constructive ideas. While that is not my primary purpose in blogging on this occasion I am happy to oblige. 

Apprenticeships are back in vogue. In nursing, learning on the job used to be the key to patient care but that changed when nursing degrees were introduced. I know many ex-senior nurses, none of whom thinks that the change has resulted in an improvement in the standard of nursing, quite the reverse. The faults highlighted in the CQC commission should be obvious to anyone with or without qualifications and that is the fundamental problem. What was a vocation has become just another career opportunity in which some care but many just don't. In this instance the old days certainly were better.

Carry on nursing

Newspapers are reporting today that nurses have been banned from wearing outfits showing “excessive cleavage” or too much leg. Coming on top of constant reports of poor hygiene among nurses and medical staff one has to ask what has gone wrong with the nursing profession. 

I confess that I found Susan Stephen sufficiently attractive in her regulation uniform without showing what was underneath but in my day, mystery had its own attraction. In my more advanced years I can also see that Joan Hickson, in her pre-Miss Marple days, had something about her in her starched apron and lace cap! Showing "excessive cleavage" would have been impossible in those regulation uniforms and the sight "too much leg" would certainly have been counter-balanced by the regulation black shoes nurses were obliged to wear. 

From 2013 nurses will need a degree in a move that is is "aimed at improving patient care". What absolute twaddle. That is an insult to the older generation of nurses who entered the profession with a vocation to nurse and care for the sick. I have not spoken to one State Registered Nurse who trained on the ward who thinks patient care has improved since the system was changed. More stories like this appear inevitable unless nurses carry on nursing as they used to.


Postscript

An interesting account from the Telegraph here. Some of the comments are as good if not better than the article in highlighting the problems faced. 

Don’t Care Hospitals

It is noticeable when driving in Britain today that our roads are unclean. I don’t throw litter out of my car window or drop it for others to pick up. I don’t know anyone who does but clearly there are many people who do. They don’t care and have little thought for others.

Even people paid to clean the roads no longer do the job properly now that they have been mechanised. Previously a man with brush and shovel cleaned the streets. Now street cleaning vehicles, probably air-conditioned, pick up litter just in passing, leaving behind what their brushes don’t reach.

The same attitude is evident in some of our hospitals where modern technology leaves patients wired to monitor everything but their general wellbeing. Wards have been left dirty causing serious, life-threatening infections while nurses and doctors have to be reminded to wash their hands.

In the worst cases patients have their food left out of reach with nobody to feed them, their prescribed drugs left on bedside lockers and their bedding in disarray resulting in undignified exposure. Having scraped congealed food from supposedly clean surfaces and excreta from under the finger nails of a “Barrier Nurse” patient – just a note on the door! - the findings of the independent inquiry into the Mid Staffordshire NHS Trust will come as no surprise to anyone who has been affected by the lack of care, especially of the elderly, in some British hospitals today.

Hospital Trusts may have become driven by targets and cost-cutting but as any ‘old-school’ nurse who was properly trained in nursing care on the wards rather than in college knows, many of the current problems are the result of changes in training and nursing practice.