Monday, August 31, 2009

The nightmare nurses of the NHS

By Minette Marrin

‘Dreadful, neglectful, demeaning, painful and sometimes downright cruel.” Those are the words used by Claire Rayner, herself a former nurse, to describe the way many nurses today treat elderly patients. Introducing a report by the Patients Association last week, she described shocking standards of nursing care in hospitals up and down the country.

The stories are horrifying — old people neglected, lying in their own faeces and urine, hungry, thirsty and afraid, while nurses chat callously at the nursing station, indifferent to the suffering around them.

Since the report was published the Patients Association has been flooded with hundreds of calls of support. “I am sickened,” Rayner said, “by what has happened to some parts of my profession, of which I was so proud.” One can only agree.

What is also particularly sickening is that none of this is remotely new. It has been a long time since anybody with any knowledge of National Health Service nurses could be that proud of them. For many years past, a significant number of them have been every bit as bad as this report now claims. I apologise, of course, to all those excellent nurses whose good name has been compromised by the bad and cruel nurses and also by those nurses who, although not bad, are badly trained and incompetent.

Recently I spent a lot of time over three weeks on a busy ward at the Gloucestershire Royal hospital, with several very sick old people, and the nursing care could not possibly have been better — highly professional, attentive and good-humoured and above all extremely kind. It can be done.

But there is no shortage of nightmare nurses. I know from many personal visits to hospitals over 20 years, and from many hundreds of heartbreaking readers’ letters over 15 years, that NHS nursing horror stories are legion. Whenever I’ve written an article about them, I get in response a collection of anecdotes that would disgrace a Third World country. And, as the Patients Association report points out, most of these stories are about old people. It is so late in the day for the country to sit up and take notice. Why has everyone been so determinedly deaf to the obvious truth?

Nearly 12 years ago I wrote an article for another newspaper headlined “The devil nurses of the health services”. I hated the sensational headline but it does make the point inescapably clearly that Britain’s quasi-religious belief that the NHS is the envy of the world and its nurses are angels was — and is — far from true.

Nurses’ personal standards would have horrified Florence Nightingale. It struck me forcibly how slovenly many nurses were, with loose hair trailing and hanging over patients’ wounds, with unkempt nails and hands all too rarely washed between patients. Many were just mean: they ignored and patronised the patients.

“They bring them to the operating table unwashed, leave them frightened and unfed, distressed by loud music, overflowing catheter bags and bed sores, by dirty sheets and filthy lavatories with blood in the sinks and excrement on the floor,” I wrote. “These are horrors caused not by shortage of money, but by personal laziness, indifference, lack of self-discipline or of any discipline at all.” And so on. There was total silence from the Royal College of Nursing and the General Nursing Council. Yet not only patients but also many nurses and doctors wrote to me in agreement, describing even worse things. So why didn’t nurses and doctors protest?

When Professor Lord Winston publicly complained about the terrible mistreatment of his elderly mother in hospital in 2000, I thought how late in the day it was for a distinguished and powerful doctor to bring this up. Surely he cannot have been the first consultant to notice the disgusting wards and vile treatment in many hospitals? Surely countless other top consultants knew about this scandalous state of affairs (or should have done), and should have brought it up?

Given the abysmal standards of nursing hygiene on many hospital wards, it is hardly surprising that we have had a growing number of scandals which no one can ignore. Poor basic hygiene was a factor in the recent disaster at the Mid Staffordshire NHS Foundation Trust hospital where at least 400 patients died needlessly; the official report of 2007 blamed “shocking and appalling” standards of care. But two years on, it emerged earlier this year that 10 NHS health trusts have even worse death rates than Mid Staffordshire had. As a spokesman for the Patients Association said at the time: “We are amazed that trusts could have these high mortality rates and yet not automatically face any action.” Quite.

To be fair, one ought to query the Patients Association’s figures in its new report. It says that its horror stories affect about 2% of patients which, it calculates, would mean 1m patients. But the total number of patients admitted to hospital each year is about 10m and 2% of 10m is 200,000. However, even 200,000 is far, far too many and I personally feel convinced that the real number — if people weren’t too terrified or exhausted or dead to complain — would be very much higher.

There are people far more knowledgeable than me, right across the health service, who know all about it, although not many of them seem to think clearly about what has caused this terrible cultural collapse in nursing. It is for them to speak out.

One of the problems is that the NHS is a monopoly — any patient knows there is nowhere else to be treated and any nurse or doctor brave enough to blow the whistle runs the risk of never working in medicine again; there is no alternative to the state medical monolith. Perversely, it is only for whistle-blowing that NHS staff are punished or dismissed; otherwise there seem to be no sanctions for bad practice. The unions have seen to that.

Another institutionalised error is the politically correct folly behind Nursing 2000, the so-called reform of nursing. In an attempt to give nurses professional status with a university degree, Nursing 2000 has all too often undermined their existing high standards of professionalism by taking students off the wards and belittling the status of old-fashioned bedside nursing care.

Yet another problem may, sadly, be a widespread fear and dislike of old people as a constant and unwelcome memento mori. But whatever the explanation, this bad and cruel nursing is completely unacceptable. Is there no one bold enough to do something?


NHS: Novices do nurses’ job after week’s training

HEALTHCARE assistants in the National Health Service with as little as one week’s training are performing technical nursing tasks on patients, including heart tests, blood checks and changing dripfeeding bags. The service is also relying on unqualified nursing staff to carry out basic duties such as washing patients and taking them to the toilet.

Despite being responsible for such intimate treatment, the 150,000 healthcare assistants and nursing auxiliaries working in the NHS are not registered with any professional body. The unregulated staff have been brought into hospitals partly to cut costs. However, criticism has also been levelled at ambitious nurses who perceive more menial tasks to be “beneath them”.

Peter Carter, general secretary of the Royal College of Nursing, said that supermarket shelf-stackers receive more instruction than healthcare assistants. Now he is demanding a substantial minimum training period, as well as the introduction of a code of conduct. “Hospitals take well-meaning people off the street, give them a uniform and put them on a ward,” said Carter. “Supermarkets give all of their staff training. They wouldn’t dream of taking someone on, not even someone stacking the shelves, by just saying ‘find your way around’.”

One healthcare assistant, who received only a week’s training before starting work at an Essex hospital, told The Sunday Times how unqualified nurses are being relied on to wash and feed patients. They are also used to adjust the amount of food that patients receive through a nasal tube and can even be asked to carry out echocardiograms (ECGs), which test the function of the heart.

The whistleblower, who did not want to be named, said she often felt inadequately trained for the tasks she performs. “You only get about a week’s training and that is to train you how to take blood pressure and to take blood sugar levels,” she said. “You are shown how to wash patients, how to manually handle the patients and how to use a hoist. “There are things I come up against that I am very unsure of. I did not get trained in how to carry out ECGs. “We are supposed to put the patients onto the ECG machine and get a [heart] tracing. The other day I was asked to do one and I wasn’t up to doing it because I haven’t been trained. I didn’t want to do it wrong.”

Last week the Patients Association published a report detailing the lack of basic nursing care received by NHS patients. It revealed how patients were often being left in soiled bedclothes, deprived of sufficient food and drink and having repeated falls.

Katherine Murphy, director of the association, said it had received calls from healthcare assistants and auxiliaries complaining that they are being left to carry out duties they are not qualified to perform. “Healthcare assistants are being asked to do a lot of the work that trained nurses should be doing,” she said. “We had healthcare assistants phoning us up who were put on a high-dependency unit with no introduction to the technology and no understanding of what they were meant to do.”

Unison, the public services union, claims the training of healthcare assistants and nursing auxiliaries is “patchy”. Many opt to complete national vocational qualifications, but this is not obligatory.

The union is concerned that nurses and healthcare assistants do not have standard uniforms across the NHS, leading to confusion among patients about whether or not they are being cared for by a qualified professional. One nurse, writing on the Nursing Times website, said that even she has found it difficult to distinguish between qualified and unqualified nurses. The nurse wrote: “I may be being cynical, but the reason why employers are going to resist this is so that they can continue to confuse patients and relatives about the true staffing levels on wards. “Even though I am a nurse, when I have visited relatives in hospital I have found it extremely difficult to identify the qualified from the unqualified staff.”

The healthcare assistant who spoke to The Sunday Times said qualified nurses fill out paperwork while healthcare assistants wash and feed patients. She explained that on one occasion, when a qualified nurse had been assisting with the washing of patients, she was called away to sign paperwork by another nurse who said: “Washing isn’t your job, that is not part of your job description.”

Claire Rayner, president of the Patients Association and a former nurse and newspaper agony aunt, admitted that such views were widely held by nurses. “It is an appalling attitude to say it is not your job to wash patients. I am afraid this is spreading widely and I disapprove of it strongly. Unfortunately, today’s nurses think it is too menial,” Rayner said.

Frank Field, the former Labour welfare reform minister, said: “It is a terrible indictment if the most qualified nurses on the ward are filling in the paperwork and the least qualified are doing the nursing. “Cleaning people is an essential nursing function. At the same time nurses are talking to the patients and finding out what the patients’ worries are.”

On his blog, Field recalls how he had resorted to feeding the patient in the bed next to his mother, who had had a stroke, because nurses had failed to help her. He wrote: “The woman was paralysed and unable to reach her food. It was regularly placed there at meal times and then simply taken away uneaten. The nurses commented how kind it was of me to feed the old lady. “I didn’t have the courage to tell them that it was their job; and that they had stood in a group gossiping, watching what I was doing. I was fearful that they would take it out on my mother if I did so.”

Department of Health spokesperson said: "The NHS is in a very healthy position regarding recruitment and retention, with supply broadly matching demand in most areas. Since 2007 we have seen a rise of 8,563 more qualified nurses. "Local NHS organisations need to plan and develop their workforce to deliver the right staff with the right skills to meet the needs of their local populations and ensure high quality care for patients." [Meaningless codswallop1]


What’s the Canadian word for ‘lousy care’?

By Jeremy Clarkson, writing from England. He thinks CanadaCare is even worse than the NHS. He regularly uses humorous exaggeration to enliven his writing but there is no mistaking his serious points. He is probably Britain's most popular TV personality

Some say America should follow Canada’s lead, where private care is effectively banned. But having experienced their procedures while on holiday in Quebec, I really don’t think that’s a good idea at all.

A friend’s 13-year-old son tripped while climbing off a speedboat and ripped his leg open. Things started well. The ambulance arrived promptly, the wound was bandaged and off he went in a big, exciting van.

Now, we are all used to a bit of a wait at the hospital. God knows, I’ve spent enough time in accident and emergency at Oxford’s John Radcliffe over the years, sitting with my sobbing children in a room full of people with swords in their eyes and their feet on back to front. But nothing can prepare you for the yawning chasm of time that passes in Canada before the healthcare system actually does any healthcare.

It didn’t seem desperately busy. One woman had lost her face somehow — probably a bear attack — and one kid appeared to have taken rather too much ecstasy, but there were no more than a dozen people in the waiting room. And no one was gouting arterial blood all over the walls.

After a couple of hours, I asked the receptionist how long it might be before a doctor came. In a Wal-Mart, it’s quite quaint to be served by a fat, gum-chewing teenager who claims not to understand what you’re saying, but in a hospital it’s annoying. Resisting the temptation to explain that the Marquis de Montcalm lost and that it’s time to get over it, I went back to the boy’s cubicle, which he was sharing with a young Muslim couple.

A doctor came in and said to them: “You’ve had a miscarriage,” and then turned to go. Understandably, the poor girl was very upset and asked if the doctor was sure. “Look, we’ve done a scan and there’s nothing in there,” she said, in perhaps the worst example of a bedside manner I’ve ever seen.

“Is anyone coming to look at my son?” asked my friend politely. “Quoi?” said the haughty doctor, who had suddenly forgotten how to speak English. “Je ne comprends pas.” And with that, she was gone.

At midnight, a young man who had been brought up on a diet of American music, American movies and very obviously American food, arrived to say, in French, that the doctors were changing shift and a new one would be along as soon as possible.

By then, it was one in the morning and my legs were becoming weary. This is because the hospital had no chairs for relatives and friends. It’s not a lack of funds, plainly. Because they had enough money to paint a yellow line on the road nine yards from the front door, beyond which you were able to smoke.

And they also had the cash to employ an army of people to slam the door in your face if you poked your head into the inner sanctum to ask how much longer the wait might be. Sixteen hours is apparently the norm. Unless you want a scan. Then it’s 22 months.

At about 1.30am a doctor arrived. Boy, he was a piece of work. He couldn’t have been more rude if I’d been General Wolfe. He removed the bandages like they were the packaging on a disposable razor, looked at the wound, which was horrific, and said to my friend: “Is it cash or credit card?”

This seemed odd in a country with no private care, but it turns out they charge non-Canadians precisely what they would charge the government if the patient were Céline Dion. The bill was C$300 (about £170).

The doctor vanished, but he hadn’t bothered to reapply the boy’s bandages, which meant the little lad was left with nothing to look at except his own thigh bone. An hour later, the painkillers arrived.

What the doctor was doing in between was going to a desk and sitting down. I watched him do it. He would go into a cubicle, be rude, cause the patient a bit of pain and then sit down again on the hospital’s only chair.

Seven hours after the accident, in a country widely touted to be the safest and best in the world, he applied 16 stitches that couldn’t have been less neat if he’d done them on a battlefield, with twigs. And then the anaesthetist arrived to wake the boy up. In French. This didn’t work, so she went away to sit on the doctor’s chair because he was in another cubicle bring rude and causing pain to someone else.

Now, I appreciate that any doctor who ends up working the night shift at a provincial hospital in Nowheresville is unlikely to be at the top of his game, and you can’t judge a country’s healthcare on his piss-poor performance. And nor should all of Canada be judged on Quebec, which is full of idealistic, language-Nazi lunatics.

But I can say this. If private treatment had been allowed, my friend would have paid for it. He would have received better service and in doing so, allowed Dr Useless to get to the woman with no face or ecstasy boy more quickly. Though I suspect he would have used our absence to spend more time sitting down.

The other thing I can say is that Britain’s National Health Service is a monster that we can barely afford. But in all the times I’ve ever used the big, flawed giant, no one has ever pretended to be French, no one has spent more time swiping my credit card than ordering painkillers and there are many chairs.


Australia: More public hospital negligence -- woman dies

Her dangerous condition was known but nobody cared

DAVID Cuthbertson cannot find the words to explain to his three-year-old daughter Alyssa why her mother was never able to hold her, and never will. In June 2006, having given birth by caesarean section at Nepean Hospital, Petah Kimm's blood pressure dropped suddenly. Staff failed to recognise the danger. Two hours later, at age 39, she was found dead in her hospital bed.

On Wednesday, Mr Cuthbertson will front an inquest in Sydney. ''I want this inquest to bring about change so nobody ever has to go through this again," he told The Sun-Herald. "I will not let the NSW Government sweep this under the carpet. I want them to own up."

Mr Cuthbertson and Ms Kimm were single parents when they met on the sidelines at Little Athletics near their home town of Mudgee in 2003. They became friends and gradually fell in love, creating a blended family with his son Luke and her children Steven and Nicole. "Initially I was against the idea of children because it involved IVF. But then one day I looked on as Petah nursed my brother's baby. The moment I saw the look on her face I melted. We pushed ahead with the IVF. She conceived straight away."

Alyssa was born without complication before Ms Kimm's blood pressure fell. A student midwife failed to inform senior medical staff. A Sydney West Area Health Service internal report later found that, during a changeover in nursing shifts, nobody flagged her as unwell. "Two hours passed before anyone on the next shift bothered to look. That was when Petah was found lying in bed dead," Mr Cuthbertson said.

"I've suffered with guilt. I was at the hospital until 9.30pm that night and then I went home thinking Petah was just tired. Had I stayed, maybe I could have changed this."

Last month, nurses at Nepean Hospital learnt 155 positions were being axed, including senior staff from the post-natal ward in which Ms Kimm died.

Fighting back tears, Mr Cuthbertson said: "Alyssa says 'goodnight mummy' and 'I love you' before going to bed each night." He said recently, after a family friend arrived ahead of them at their house, "I said to Alyssa, 'Guess who's going to be at our place when we get home?' She replied: 'Did you go to heaven and get mummy?' I hope one day she will understand.''

NSW Health made an out of court settlement but Mr Cuthbertson called their treatment of him during that process ''disgusting''. ''Petah and Alyssa should have been here today, playing in the park together. I want justice for them both."


Shattered Lives: 100 Victims of Government Health Care: Soon-to-Be Released Book Tells Dark Side of Public Health Care

A timely new book, Shattered Lives: 100 Victims of Government Health Care, abolishes the myths of public health care by telling the personal, real-life stories of 100 people who live in nations with government-run health care systems. Due to the topic's timeliness, an electronic (PDF) pre-release version of the complete book is being made available now for download to journalists, broadcast media, columnists, bloggers and the public at

Authors Amy Ridenour, president of the National Center for Public Policy Research, and Ryan Balis, a National Center policy analyst, tell 100 agonizing, real-life stories of victims in Great Britain, Canada, Australia, New Zealand, Sweden and elsewhere who struggled to access government health services and sometimes died stuck on long government waiting lists. "Some 16 years after Washington last attempted to nationalize health care, some politicians in Washington are at it again," said co-author Amy Ridenour. "But if Americans choose to adopt a public health care system, as the stories in this book attest, they will soon regret the decision."

Shattered Lives puts a face on frustrated citizens fed up with having surgeries repeatedly cancelled, medicines ruthlessly denied and patients herded like animals onto gigantic government waiting lists. In Shattered Lives, the grim reality of what proponents falsely bill as 'free health care for all' is told through the stories of actual victims of government health care programs.

Stories include:

* Lindsay McCreith, a 66-year old Canadian, crossed the border to a Buffalo hospital for diagnosis when he was told it would take over four months for the Canadian system to do an MRI brain scan to determine if the tumor was malignant. Once U.S. doctors confirmed the tumor was cancer, McCreith was told there would be an 8 month wait for treatment in Canada. Rather than risk his life, he returned to the U.S. and paid $40,000 of his own money for treatment.

* Britain's government managed National Health Service (NHS) withheld powerful anti-cancer drugs from Barbara Moss because of their cost but willingly paid for Tanya Bainbridge's 20,000 pound (about $33,000) sex-change operation and the removal of Bainbridge's unladylike forearm tattoo.

* Dunil Almeida, 42, was suffering from colon cancer but was told he was "imagining" the pain in his stomach over the course of over 50 examinations by the British NHS, which failed to test him for cancer for nearly two years. It was only when Almeida visited Sri Lanka that doctors told him he had cancer. By then, it was too late.

Among the other 97 outrageous stories Shattered Lives documents is a woman in labor castigated by a hospital nurse for not giving birth at home; numerous elderly patients losing their sight because cataract surgery or drugs were withheld; patients resorting to do-it-yourself dentistry and much more.

"Few disagree on the need for health care reform, but imitating failing health care systems abroad by adopting a so-called "public option" will bring Americans pain, misery, fear and death," said Ridenour. "Some government treatment lists are so long, getting on one is essentially a death sentence. This is no model for politicians in Washington to emulate."

Ridenour added, "Washington should be promoting a transparent and competitive market for health care, freeing Americans at the individual level to choose the insurance and medical services most appropriate for themselves and their families. There are ways to improve our health care system, but public health care isn't one of them."


Gaps in Obama's Rhetoric Start to Add Up

By Rich Lowry

The Obama team is saddled with a foundering health-care strategy. But it has a fallback plan - relying on the sheer dimwitted gullibility of the American public. How stupid do they think we are?

Stupid enough to think that a new $1 trillion health-care entitlement is just the thing to restore the country to fiscal health.

Stupid enough not to know that almost every entitlement known to man has cost more than originally estimated, with a congressional committee in 1967 underestimating by a factor of ten Medicare's cost by 1990.

Stupid enough not to realize that it is through budget trickery - the taxes begin immediately, the spending is put off for a few years - that the program in the House shows "only" a $239 billion deficit over the first ten years.

Stupid enough not to focus on how the gap between the House plan's revenue and spending steadily grows after the first ten years, making it a long-term budget buster.

Stupid enough to think increased preventive care will save the government money, just because Pres. Barack Obama constantly repeats it, despite all the independent studies to the contrary.

Stupid enough to believe that a program with no cost controls that can be discerned by the Congressional Budget Office will control costs.

Stupid enough not to worry that Obama's proposed superteam of technocrats operating outside normal political controls - the so-called Independent Medicare Advisory Council - will resort to rationing when costs continue to spiral upward.

Stupid enough to consider it wise to use several billion dollars in cuts from Medicare to create a new entitlement rather than to forestall Medicare's own looming insolvency, currently projected for 2017.

Stupid enough not to notice that the "public option" was explicitly designed by the Left as a stealthy path to single-payer, even as liberals continue to talk and write about its ultimate purpose openly.

Stupid enough to believe that we'll be able to keep our current health-care arrangements if we like them, even though the public option could throw tens of millions of people out of private insurance.

Stupid enough to trust the same people who came up with the public option as stealth single-payer to craft a co-op provision that isn't a stealth public option.

Stupid enough to credit Obama's assurances that the Democrats' reform isn't about government intervention in the health-care system when - even without the public option - it all-but-nationalizes health insurance.

Stupid enough not to see through Obama's sudden insistence on calling his plan "health-insurance reform" as empty poll-tested phrase-making.

Stupid enough to consider Obama's reform a good deal when its insurance regulations would increase premiums for most healthy people.

Stupid enough to think that the very real problem of people with pre-existing conditions locked out of the insurance market can't be alleviated short of a 1,000-page bill reordering the entire health-care system.

Stupid enough to buy Obama's cockamamie stories about unnecessary tonsillectomies and amputations - undertaken by greedy doctors to pad their profits - driving health-care costs.

Stupid enough to get gulled by rhetoric attacking special interests when almost all the special interests are backing Obama's plan for cowardly and self-interested reasons.

Stupid enough to consider new taxes on employment - imposed by the so-called employer mandate - a good idea during a weak economy with a 9.4 percent unemployment rate.

Stupid enough to condemn ordinary people angry and frightened enough to show up at town-hall meetings in every corner of the country as the product of an "astroturfing" conspiracy.

Stupid enough to blame nefarious Republicans for the faltering public support for an expensive, ungainly and contradictory health-care program passed out of four congressional committees on strict party-line votes.

Stupid enough to trust the good faith and public-spiritedness of an administration operating on Chief of Staff Rahm Emanuel's ram-it-through-now credo that a crisis should never go to waste.

And stupid enough not to be offended at how contemptibly stupid they think we are.


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