Thursday 6 December 2012

Nurses have not stopped caring | Ellie Mae O'Hagan

Nurses have not stopped caring | Ellie Mae O'Hagan: It's politically expedient to blame substandard NHS care upon cold-hearted staff rather than disastrous health policies
I've always found it strange that when a privatised institution is accused of wrongdoing, the resulting conversation usually frames those involved as bad apples that must be disposed of in order for the institution to carry on as normal. But when the same happens to a public institution, the individuals involved are ignored in favour of ideas about institutional crisis and bad behaviour becoming routine.

It was evident again this week when the Labour MP Ann Clwyd revealed the appalling treatment her husband received as he was dying in the University Hospital of Wales, in Cardiff. Clwyd, the MP for Cynon Valley since 1984 and Tony Blair's former human rights envoy to Iraq, said her husband lay crushed "like a battery hen" against the bars of his hospital bed with an oxygen mask so small it cut into his face and pumped cold air into his infected eye. She suggested that a "normalisation of cruelty" is now rife among NHS nurses, and that her husband's treatment had become "commonplace".
Her story was published a day after the chief nursing officer for England, Jane Cummings, launched a three-year strategy to focus on "compassionate care". I am not interested in detracting from Ann Clwyd's experience, which sounds horrific. But I do think it's important that, if there is a decline in NHS care, we ask why it might have happened. It simply does not make sense that nurses have suddenly become cruel and lacking in compassion, if indeed they have, without any motivating factor or change in circumstances. As the Guardian reported on Wednesday, Jeremy Hunt has been admonished by the UK statistics authority for arguing that the NHS budget has increased, when the reality is the opposite. Do we really think that cuts to health spending and a decline in care are totally unrelated?
While writing this piece, I spoke to health professionals anonymously who wished to respond to the negative stories surrounding nurses this week. What they told me was so revealing and depressing, I feel that the remainder of this column could simply be notes from those conversations, and my arguments would be made. After I sent out a single tweet asking nurses to come forward with their opinions, my inbox was flooded within minutes. Nurses and their sympathetic colleagues were desperate, it seemed, for the public to understand that in many cases they are simply unable to fulfil their duties because the resources are not available.
One nurse told me that she worked a shift where there was no clean linen available in the entire hospital and patients had to lie in their beds naked: "I hated seeing my patients like that."
A trainee midwife talked about a patient who went into labour when there were no available beds for 125 miles: "She ended up having an antepartum haemorrhage. She wouldn't have made it if this had happened a few hours earlier in transit."
A mental health nurse emphasised the effect on morale: "We are struggling and distressed because we know our patients are not getting the support they should, and feel we aren't meeting our code of conduct as we can't provide care to the standard that we should. Colleagues are regularly in tears."
Doctors contacted me to support the nurses they work with. One explicitly blamed a perceived decline in compassion on cutbacks: "Compassion time is squeezed out of the day and sacrificed on the altar of efficiency."
We never hear this side of the story because NHS employees cannot speak to the press unsolicited – it is considered gross misconduct, the same charge as killing a patient. Those who approached me did so because their desperation had finally outweighed their fear. One nurse told me: "I am talking to you because I literally feel like banging my head against a brick wall every time I hear the government claim they're not cutting the NHS budget." She then listed the sweeping cuts being made at her trust, and concluded: "But no one is allowed to say this in the public domain for fear of affecting our reputation. It's infuriating to have to hear all the stories about poor patient care and not be able to explain why."
And yet, I'm not sure that the enforced silence of nurses is the only reason for their recent demonisation. Of course it's politically advantageous for the government to blame substandard care upon cold-hearted staff rather than their own disastrous policies – but it's hard to imagine doctors or NHS executives being treated in this way. Nursing is still a poorly paid, mostly female, lower middle class profession, with little social currency. Snobbery to nurses is obvious in responses to nursing professions having degree programmes: just as nursing assumed an academic hue, nurses were accused of being "too posh to wash" – the implicit suggestion being that lowly nurses should know their place.
Snobbery and caricaturing is even evident in the depiction of Florence Nightingale, who was likened more to a mother or an angel than an experienced professional. The Times wrote about her during the Crimean War: "She is a 'ministering angel' without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor, every poor fellow's face softens with gratitude at the sight of her."
When a government wants to dismantle a beloved institution, it is expedient to suggest that it is suffering from a malignancy. It is easier for the media to imagine nurses as the feckless bad mothers of the NHS, rather than dedicated professionals struggling to maintain standards in a system being gradually hollowed out. Awful experiences like Ann Clwyd's are given disproportionate focus by a political and media class that would like us to believe that things are simple: that nurses have just stopped caring. The reality is complicated, and – since we all need the care of a nurse sooner or later – it's time we started to acknowledge that. The Guardian

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