Rough NHS nurses

I knew my mother Norma's 81st birthday would be poignant. She had been diagnosed with lung cancer six months earlier - a terrible twist of fate considering she never smoked - and was not expected to survive the year. But at least, I reasoned, she was being treated at the world-renowned Royal Marsden Hospital in West London. There she would not only receive the best possible treatment but be cared for by dedicated nurses accustomed to looking after the terminally ill. Or so I thought.

But when I arrived on Horder Ward on the morning of my mother's birthday, she was distressed and disorientated. Instead of wearing the white linen pyjamas she had gone to bed in, she was wrapped in an NHS gown. Gradually it emerged that she had woken up in the middle of the night in a pool of blood, terrified she was haemorrhaging. She had rung the bell next to her bed but there was no response. Eventually a nurse turned up to discover my mother's cannula - a tube inserted into her vein and attached to a saline drip - had fallen out of her arm.

The nurse bustled around changing the sheets while my mother sat covered in blood, shivering beside the bed. When she asked for a blanket, the nurse told her to put on her flimsy cotton dressing gown, an offer she declined as she didn't want it covered in blood. Finally she was dressed in a hospital gown, put back into bed and left alone until I arrived in the morning. 'Where are her pyjamas?' I asked the nurse. 'I don't know,' she shrugged.

Not only was it a terrible start to my mother's birthday but an omen of things to come. For the next three weeks, our illusions about palliative care were shattered. We're all familiar with the problems facing the NHS: the chronic shortage of nurses, the drain on funding, target-orientated managers, government edicts. And earlier this year the Royal Marsden had to contend with an additional disaster, a fire that destroyed its top floor. But there's one question that cannot so easily be dismissed: when did hospital nurses stop caring?

My mother's battle against cancer began in January when she went to see a respiratory consultant at Cheltenham General, 15 miles from her home in Cirencester, Gloucestershire, and was diagnosed with cancer of the lower left lobe of her lung. 'A surprise and a shock,' she wrote in her diary, with typical understatement.

Until then she was fit and healthy. We'd spent New Year's Eve together at Somerset House in London, watching the fireworks and walking several miles back to my house in South-West London. Everybody had wished her Happy New Year - she was the oldest person on the streets.

Around 38,300 people are diagnosed with lung cancer each year - 90 per cent of them are smokers. My mother had adenocarcinoma, a cancer commonly found in non-smokers. But there were no signs it had spread. Determined to fight the disease, we asked for her to be referred to the Royal Marsden, a specialist cancer hospital and conveniently close to my home. There she underwent a six-week course of radiotherapy. Her consultant was sensitive and caring, and my mother handled the treatment well, walking a couple of miles to the hospital nearly every day. We were hopeful she would go into remission, and soon she was able to go back to her own home.

However, within a month, she began to get breathless and was taken by ambulance back to Cheltenham General. My brother Justin went with her and described the hospital as vile. Some nurses were disrespectful, unfriendly and unhelpful, others were downright aggressive. On a large mixed ward, my mother had to sleep next to the nurses' station, which was noisy all night. 'A terrible night due to nurses talking, laughing and searching records,' she wrote on July 3. The following night she recorded the name of a nurse who was 'frighteningly angry and shouting because I asked if it would be possible to be quieter'.

How terrible it was to see such a strong woman feeling so vulnerable. The next day I took her back to her home in Cirencester, vowing that when she had to return to hospital, we would get her into the Royal Marsden. Her condition deteriorated and my brother brought her back to London. First she went to the Royal Brompton where we had the most amazing experience of care in the NHS. The Brompton stood out as a beacon of hope. The ward was clean and modern, the consultant gave us his mobile number and the nurses were caring and cheerful. But they couldn't get her sickness under control and my mother was transferred to the Marsden.

Her three-week stay on Horder Ward began on July 25. Walking on to the ward, used for patients in palliative care, our faces fell. The contrast was incredible. Dark and gloomy, it hadn't been renovated for years. It was also incredibly stuffy. Despite a security buzzer, the door was constantly propped open to allow air into the ward. I had to buy my mother a fan on the hottest day of the year. When I complained, I was told she should have asked for one. Dozens of flies were buzzing around the ward but every time she mentioned them the nurses treated her as if she was being precious.

Apparently, Horder Ward had been next in line for renovation when the fire broke out. But why were dying patients being put on the worst ward in the hospital? Had they already been written off? Certainly, morale on the ward was low - on several days there were only three nurses for 13 patients - but that doesn't excuse unfriendliness or lack of caring. I had to remind the nurses repeatedly to call my mother Mrs Joseph, rather than Norma. Shouldn't that be automatic for a woman of 81?

One of the most disturbing things was their total lack of understanding that time is precious for terminally ill people. Staff took ages to come when bleeped - understandable when they were busy with other patients but not when they were in 'meetings' or during staff changeovers. One night my mother lay in agony in for two hours waiting for pain relief. Other nights the bed bells were out of reach and she had to wait until a nurse heard her cries.

During the days she became increasingly upset that nurses took so long to get her up and dressed. It was bad enough that the only bath on the ward was broken during her entire stay, but her showers got later every day. Sometimes she was not washed before lunch. Elderly people like routine, though this seemed to take second place to the nurses' convenience. Once my mother had to finish wrapping her own bandage, presumably because a nurse got distracted. Another day they forgot to give her a mouthwash. She was supposed to get one four times a day.

My mother wasn't the only patient being ignored. I fetched water for the woman in the bed opposite who was thirsty and a blanket for another woman who was freezing. My mother told me that, on one occasion, a male visitor had to help her when she was being sick.

One afternoon I finally lost my temper. A staff nurse had told my mother she had to keep her arm straight because the machine for her saline drip kept bleeping while she was asleep. When I argued that it was unreasonable to expect an 81-year-old woman with terminal lung cancer to sleep with her arm straight all night, she shrugged: 'What do you expect me to do?' 'I expect you to rectify it,' I said. 'It wasn't bleeping before you changed the saline.' Her response: 'She has to work with me.' But as my mother pointed out, she was the one doing all the work.

Another staff nurse, barely out of college, insisted on making my mother's bed the way she had been taught - even though she was not comfortable - due to health and safety rules, and bristled if I tried to help her lift my mother. She also had this infuriating habit of talking to patients in baby language saying things like: 'Let me lift your leggies.' My mother had lung cancer. She hadn't lost her mind.

We finally managed to take my mother back to my home on August 19. Her diary entry for that day says it all: 'At last I can come home to Claudia. A daughter does things far better!'

But that was not the end of our ordeal. In the early hours of August 30, my mother was taken by ambulance to Chelsea and Westminster Hospital because she had a ruptured bowel and was given only hours to live. Even then nurses did not make her a priority. Instead of allowing us to stay with her, they insisted we wait in the visitors' room while they settled her.

Finally we had to wait six hours for an ambulance to bring her home. Thankfully, the prediction was wrong. She did not die that day in hospital. She survived another week, dying on September 7 in my bedroom.

My mother came from a generation that believed hospital nurses were 'angels' ruled over by a strict but warm matron. Well, not any more. We met a few nurses who were brilliant, some who were passable but too many who just didn't seem to care at all. They may as well have been factory workers on a production line. We were hoping to make my mother's last birthday as special as we possibly could, yet the nurses managed to give her - and us - the worst one of her life.

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British mothers-to-be offered gift vouchers and beauty treatments to quit smoking

Rewarding bad behaviour? The NHS plans to offer treats to pregnant women who smoke so as to encourage them to quit. Pregnant women who smoke are to be offered gift vouchers and beauty treatments to encourage them to quit. The incentives, which also include baby goods, will go to those women who can prove they have kicked the habit.

Telford and Wrekin NHS Trust in Shropshire plans to begin a pilot scheme soon, having already agreed to the idea in principle. But it has been warned that the move could be seen as the Health Service rewarding bad behaviour.

Expectant mothers who agree to the trials will have various examinations, such as carbon monoxide monitoring, to show if they have recently smoked. Samples may also be taken to prove their bodies are free of nicotine and other harmful substances found in cigarettes.

Dr Kevin Lewis, director of Shropshire's Help 2 Quit service, said the plan could help improve live birth rates, result in better health for newborn babies and cut NHS treatment costs. He added: 'We are dealing with an addiction and we are dealing with human behaviour and we know from studies that people are often not as motivated by the benefits to future health as they are by the here and now.'

Last year, 466 women - equal to 23 per cent of maternities in Telford and Wrekin - were still smoking up to delivery.

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