The de-moralisation of health care

By Melanie Phillips, writing from Britain

How in God's name have we come to this? In three hospitals in Kent, at least 90 patients have died from a superbug infection caused by filthy conditions with unwashed bedpans, staff `too busy' to clean their hands and - most appalling of all - nurses telling patients with diarrhoea to `go in their beds'. This unspeakable situation reveals not just callousness towards suffering and indifference to human dignity but a breakdown of some of our most basic civilised values.

Nor is this an isolated scandal. Last October, an internal memo warned the Government that virtually every NHS trust was reporting superbug infection. The health service, in other words, is institutionally polluted. The Government's response? To ignore this crisis, and then belatedly to bring forth Gordon Brown's pathetic commitment to a sporadic hospital `deep clean'. What has happened to the duty of care in our flagship public service? What has happened, indeed, to our sense of common humanity?

Two things have combined to cause this awful situation. The first is the Government's Stalinist control of the NHS which directly conflicts with patient care. The Kent hospitals focused on meeting waiting time targets to the exclusion of just about everything else; and the NHS management's byzantine structure ensures an almost total absence of accountability.

But that is far from the full explanation. Much more important is what has happened to the nursing profession, where there has simply been a collapse of that ethic of caring first promulgated by the inventor of modern nursing, Florence Nightingale. Of course, it must be said that there are still many dedicated and caring nurses of whom Nightingale would be proud. But in general, her ethic has been all but destroyed.

Nursing is not a job but a vocation. That means it is governed by a sense of moral duty to the patient rather than by the self-interest of the nurse. That sense of vocation lay at the heart of Nightingale's vision. It was no accident that in her seminal Notes On Nursing, published in 1860, she wrote that `the greater part of nursing consists in preserving cleanliness'. It was not just that cleanliness was essential for recovery and health. Keeping both hospital and patients clean meant the nurse needed to have the most elevated of motives to put the care and dignity of her patients first.

Accordingly, lowly functions such as washing, dressing and administering bedpans - where dignity was most fragile - were the functions that in nursing were invested with the highest possible significance. Simply, these were moral acts. Accordingly, wrote Nightingale, if a nurse declined to do these kinds of things for her patient because she was so concerned about her own status, nursing was not her calling. `Women who wait for the housemaid to do this, or for the charwoman to do that, when their patients are suffering, have not the making of a nurse in them.'

Florence Nightingale belongs in the first rank of pioneering Victorian feminists. But the tragedy is that modern feminism has all but destroyed what she stood for. In the 1980s, nursing underwent a revolution. Under the influence of feminist thinking, its leaders decided that nurses were treated like skivvies by doctors, who were mostly men. To achieve equality for women, therefore, nursing had to gain equal status with medicine. So nurse training was taken away from the hospitals and turned into an academic subject taught in universities.

This directly contradicted an explicit warning given by Florence Nightingale herself, that her 'sisters' should steer clear of the `jargon' about the `rights' of women, `which urges women to do all that men do, including the medical and other professions, merely because men do it, and without regard to whether this is the best that women can do.' That, however, was exactly what the nursing establishment proceeded to do. Since caring for patients was demeaning to women, it could no longer be the cardinal principle of nursing. Instead, the primary goal became to realise the potential of the nurse, to deliver equality with the male-dominated medical profession.

In her book The Project 2000 Nurse, Ann Bradshaw, a specialist in palliative care, described how this agenda removed caring, kindness, compassion and dedication from nurse training. Student nurses now studied courses such as sociology, gender studies, politics, psychology, microbiology and management. They were assessed for their communication, management, problem- solving and analytical skills. `Specific clinical nursing skills were not mentioned,' she wrote. In short, nursing ditched its core vocation to care.

I wouldn't have believed this possible had I not been forced to witness how my own mother was treated in a London teaching hospital a few years ago. She suffered under a wretched double burden of multiple sclerosis and Parkinson's disease. In that pitiable condition, which meant she could barely walk, she broke her hip and was admitted for surgery to a fracture ward. If I hadn't been on hand every day, she would have starved. After surgery, she was unable to move at all in her bed. Yet the nurses made no attempt to help her to eat; nor did they even deign to move her pillow to make her more comfortable. Yet when I protested, I was told by the senior nurse on duty the bare-faced lie that an hour previously my mother had been 'skipping round the ward'.

It was then that I realised that all the excuses about NHS failure being caused by lack of money were a lie. It was then that I understood that there was, instead, a lack of something infinitely more profound - conscience, kindness, a sense of duty to others - and that the image of the NHS as the embodiment of altruism was a grotesque illusion. If you were old and incapable, it was an encounter to be feared. The memory of my mother's terrible experience still makes me cry; and I weep also for all those poor souls who have died at the hands of the NHS in Kent, and all those other frail and powerless patients who are being treated so abominably in hospitals up and down the country.

What's happened in our hospitals surely reflects a still wider social breakdown. Our society seems to have turned into a Darwinian nightmare in which the fittest prosper mightily while the old and weak are tossed aside as of no value. That's why we starve and dehydrate some elderly people to death. That's why we turn a blind eye to the dreadful conditions in so many old people's homes. And that's why nurses become managers, and preen themselves as expert professionals in meetings and seminars and conferences and away- days while patients in their hospitals are left to die in their own filth.

And what about the Labour Party, for which the NHS is the ultimate symbol of its own superior social conscience? Are Labour MPs agitating about the filth in our hospitals and the deaths it is causing? Dream on. Labour MPs are currently wholly occupied with inspecting their own navel and analysing who is up or down in the Gordon Brown/David Cameron circus. And as for the Health Secretary, while patients are dying as the direct result of the system over which he presides, he appears to think that the biggest threat to the future of the very planet is that people are too fat.

Our NHS is now the symbol of a society that has lost its moral compass along with its heart and soul.

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One unfixable Australian public hospital

Despite huge pressures on the politicians, it is still a disaster zone

WHEN young mother Sara Claridge received a third phone call from Royal North Shore Hospital relaying the news that her urgent surgery had been postponed yet again, she broke down in tears. The 26-year-old was in line to have cervical surgery to remove pre-cancerous cells and relieve crippling pain from a gynaecological condition, but was told the hospital's theatres were closed. Ms Claridge - whose mother had a similar condition and had a hysterectomy at the age of 27 - had already had her operation cancelled once before she was moved up the priority list for surgery in October.

The incident is the latest in a string of alarming cases emerging from Royal North Shore Hospital following the case of 32-year-old Jana Horska, who miscarried in the hospital toilets last month. Following Mrs Horska's miscarriage tragedy, Associate Professor Bill Sears, a neurosurgeon at the hospital, spoke out, revealing operations are cancelled frequently at the last minute because of theatre closures.

Ms Claridge's setbacks now, sadly, catapult her into being a new symbol for Premier Morris Iemma's Government's failure to cope with the state's growing hospital crisis - a crisis that Health Minister Reba Meagher appears reluctant to admit, address or provide policy responses for. This latest case will increase pressure on the Government to explain how it intends to turnaround health care in NSW - it is another example of ordinary people being let down.

"But then she called and said the theatre was closed and we'd had to reschedule again to November. I was in tears, I just couldn't handle it any more," Ms Claridge said. "The pain knocks me sideways. Some days I can't get out of bed and I don't want to leave the house. "I'm 26, I shouldn't have to worry that when I have a shower my hair falls out in clumps. "I should be able to take my daughter to the park, or even be able to get up and make her breakfast without feeling like I have to go back to bed for the rest of the day."

An RNSH spokeswoman said the postponement of Ms Claridge's surgery was the decision of the doctor, who already had 21 patients on his waiting list. "(The) hospital has contacted Mrs Claridge and is investigating the possibility of an earlier date for surgery by transferring her care to another surgeon," the spokeswoman said.

Opposition health spokeswoman Jillian Skinner said yesterday it was a standard State Government defence to blame the doctors. "It is another example of the minister being at odds with doctors and their clinical decisions," she said. "She is in discomfort and she has a toddler to care for - it is cruel to delay the surgery."

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