More disconnected reflections on the past week’s news and experiences:
I’m no great admirer of Gordon Brown, but once again you have to feel sorry for him. His visit to New York for the UN General Assembly and the historic Security Council meeting chaired by President Obama was in many ways a personal triumph: he was widely hailed as the architect of the global response to the recession, “honoured as world statesman of the year at a VIP-packed gala dinner at which the award was presented … by the veteran US former secretary of state Henry Kissinger”; he earned international respect for a major speech to the General Assembly containing concrete initiatives on climate change, terrorism, nuclear proliferation, poverty and shared prosperity, and was a co-sponsor of the historic Security Council resolution, unanimously adopted, calling for a world without nuclear weapons. A few days ago he was in Berlin developing a new initiative on Afghanistan with the Chancellor, Angela Merkel.
Gordon Brown and Barack Obama in the Security Council
Yet he comes back from New York to be vilified by the media because there wasn’t time for a formal bilateral meeting with President Obama — whom Brown sat next to (or only one seat away) in the Council. Obama inevitably took advantage of the presence in New York for the UNGA of numerous world leaders to talk privately to those with whom his contacts are rare. He and the UK prime minister meet often and talk on the secure telephone even more often. Yet even the Guardian treats us to a banner headline proclaiming that Obama has snubbed the unfortunate Gordon. Truly, no man is a prophet in his own country. Fair enough to take Brown as we find him, warts and all: but the UK media never seem to notice anything but the warts.
* * * * *
Earlier in the week I was stopped and searched by an extremely courteous police sergeant under the infamous Article 44 of the Terrorism Act 2000. I had just emerged, with my wife, from Green Park tube station; we were walking through the park on our way to have lunch with some old friends from university, all of us septuagenarians. Under section (3) of Article 44, authority to stop and search anyone “may be given only if the person giving it considers it expedient for the prevention of acts of terrorism“. The sergeant smiled drily at my speculation that I had been singled out for this treatment because of my beard, presumably an almost infallible pointer to terrorist proclivities. A search of my back-pack failed to reveal a bomb, but the sergeant was pretty suspicious of my sachets of powdered sweeteners (“Splenda“, actually: strongly recommended). I suppose any copper must hope to have hit pay-dirt when coming across white powder in a beardie’s rucksack. He took my wife’s word for it that it was only sweetener, and refrained from tasting it. There followed a fairly lengthy ritual of identification, the policeman laboriously copying details of my driving licence, the time and location of the search, and the provision of the Terrorism Act under which he was acting, onto elaborate forms. He gave me faint, barely legible copies of these, “in case you wish to lodge a complaint against my conduct or against the system, Sir”. I assured him that I had no complaint against him personally: his conduct had been impeccable. As for the system, I had already made vociferous public complaints against it ever since the enactment of the pernicious law in question. I assured him that I would continue to do so. So I must assume that my name and details are now irrevocably recorded in some police database under the heading of ‘terrorist suspects’. Not really funny, I suppose.
* * * * *
I was glad to see a letter in the Guardian on 22 September (I can’t find it on the website) making the points, not to my knowledge made elsewhere in the media, (1) that the ‘fine’ of £5,000 imposed on Baroness Scotland, the Attorney-General, by a government body called the UK Border Agency for her failure to make a photocopy of the passport of her Tongan housekeeper was ludicrously and disproportionately severe considering the laughably trivial nature of her ‘offence’ (it’s not even a crime); and (2) that things have come to a pretty pass when British citizens can be arbitrarily fined to the tune of thousands of pounds by a government department without any vestige of due process. Another unpleasant feature of this non-event has been the opportunistic rush by the Tory shadow home secretary and his LibDem counterpart to demand that Patricia Scotland should “consider her position” — mealy-mouthed Westminsterese for “resign as Attorney-General”. And yet another unpalatable aspect is the fact that the law imposes on all of us this mad duty to photocopy the passport and other documents of any foreign person whom we employ, in a brazen attempt to make us do the UK Border Agency’s work for it.
The UK Border Agency has acknowledged that Lady Scotland had not “knowingly” employed an illegal worker, and had “taken steps” to check her housekeeper’s documents, so her sole offence was the failure to photocopy them. Did the opposition spokespersons hollering for her resignation raise any objection to this barmy and oppressive provision of the Immigration, Nationality and Asylum Act 2006 when it was scrutinised by parliament? If not, they should shut up. It’s especially sad that all this should cast a shadow over Patricia Scotland’s distinguished career (thanks to the Daily Mail, needless to say) when hers has been such an inspiring example of sheer talent and hard work, taking a girl from Dominica in the West Indies, the tenth of a family of 12 children, to Britain as a young black immigrant, to a starry career as a barrister, to ministerial appointments and a seat in the House of Lords, and then on to the position of the government’s principal legal adviser with the right to attend Cabinet. The Daily Mail and those demanding her resignation must feel very proud of themselves.
* * * * *
Continuing down through Green Park after my brush with the law, we cut through to Pall Mall via the passageway leading past Bridgewater House, one of the magnificent buildings lining the side of the park. Designed by Barry in 1847 for the Earl of Ellesmere, the house is still privately owned, unoccupied most of the year other than by a caretaker and his wife. This week, however, it was the centre of vigorous activity, as dozens of workmen dismantled a gigantic stage, supported by extensive scaffolding, over the grounds between the house and the park, and laboured to remove the massive cantilevered steel canopy that had been erected over it. The stage and canopy had been built, so we gathered, for a party last weekend for some 400 people, given by an unnamed host who was staying at the time at the Ritz, just at the top of the park. It had taken more than two weeks to build these massive structures, and seemd likely to take at least another two weeks to dismantle them and take them away. No doubt some restoration of the grounds underneath will also be necessary. I just thought you’d like to know. It must have been some party.
Brian
Try to stifle that yawn at the prospect of yet another discussion of cuts: if we’re not careful, that’s what the general election is going to be about. What it should be about is mass unemployment — already the UK total is nearing 2.5 million, expected to hit 3 million soon — and the other hardships inflicted on the most vulnerable people by the recession: how to start getting unemployment down and a durable recovery from the recession under way: at what point the mountain of public debt incurred in the battle to contain the recession can and should start to be reduced: and how much damage will need to be done to those public services on which the most vulnerable people in society depend when the time comes to cut government spending and step up government revenues in order to bring the public finances back under control.
On all these issues, which are mirrored in almost all the world’s major economies as a result of the global recession, there is a general global consensus among governments and economists about what needs to be done, and when: in other words, about the priorities. But within Britain there is no such consensus. On almost all the issues listed, there are sharp differences of approach between Labour and the Conservatives. At present the Conservatives are setting the agenda: it’s all about cuts. The Tories are obsessed to the exclusion of all else with the problem of the debt. Almost all areas of public expenditure should be slashed, say Messrs Cameron and Osborne, with immediate effect, in order to restore the public finances. Increasingly it becomes clear that the public sector is their number one target: public services, public service pay and pensions. Whether the Labour party goes down to ignominious defeat or takes the election to a fighting finish will depend on its success or failure in seizing control of the political agenda and presenting a more credible, honourable and practical set of aims and priorities than those currently being peddled by the Tories.
So here’s a questionnaire for undecided voters to fill in before election day:
1. Which are the main causes of the recession (tick as many as you think apply):
(a) Gordon Brown’s reckless, spendthrift mismanagement of the UK economy in the years before the recession.
(b) Labour’s waste of huge sums of public money spent on bailing out the failed banks.
(c) The development of trading in sub-prime mortgages and other toxic assets, mainly in the United States, bundled up in increasingly opaque derivatives whose real value or degree of risk eventually no-one could calculate, confidence in which suddenly collapsed, leading to massive bank failures, the collapse of the credit system, resulting in a sharp drop in economic activity and a sharp increase in bankruptcies, business failures, unemployment, house repossessions, and government spending on bank rescues and unemployment and other benefits, aggravated by a corresponding fall in revenue from income and other taxes.
(d) The massive global trading and fiscal imbalances caused by the immense scale of public and private borrowing by the United States to finance a huge trade deficit, financed mainly by the purchase of US debt by China and Japan and used to sustain an unsustainably high level of government spending and consumer credit unmatched by earnings.
(e) Global warming.
2. Which country’s government first adopted policies to contain and eventually to reverse the recession based on bailing out the biggest of the failed banks (including taking the worst affected temporarily into public ownership) and providing a massive fiscal stimulus to the economy designed to sustain and revive a level of demand that would lead to a resumption of investment and production and thus eventually to recovery from the recession? Tick just one of the following: (a) The US, (b) Germany, (c) France, (d) China, (e) Brazil, (f) Spain, (g) the United Kingdom, or (h) Zimbabwe. (Actually everyone knows the answer to this one.)
3. When the anti-recession measures described in (2) were later adopted by most of the rest of the world with the broad approval of almost all reputable international economists, which UK political party attacked them as fiscally irresponsible and a reversion to old-fashioned socialism? Tick one of the following: (a) the Labour party, (b) the Conservative party, (c) the LibDems, (d) the Greens, (e) the BNP, or (f) the Official Monster Raving Loony Party.
4. Which country’s gross national debt amounted to 94% of its GDP in 1950 and is expected to reach 101.1% of its GDP in 2011? (a) The United Kingdom, (b) the United States, (c) Germany, (d) France, (e) Greece, (f) Rwanda
(Tick one. The answer is in footnote 1.)
5. How many, if any, of the following 13 countries had a higher level of public debt as a percentage of their GDP than the UK in the last full calendar year: Japan, Singapore, Italy, Greece, Belgium, India, France, Portugal, Germany, Canada, USA, Austria, Cyprus? [For the correct answer, see footnote 2.]
6. Which is the most urgent, highest-priority policy objective: (a) bringing down the UK’s high level of public and private debt, or (b) persisting with measures to sustain and stimulate demand in the economy so that the recovery, when it comes, will be early and durable? (Only one may be ticked.)
7. In the view of the majority of international economists, which approach is likeliest to encourage and sustain recovery from the recession: (a) immediately cutting government expenditures across the board, even before recovery is securely established, regardless of the consequences for unemployment levels and for the level of demand in the economy, so as to make an immediate start on reducing the national debt; or (b) continuing existing policies of stimulating demand by pumping money into the economy, targeting as the highest priority those likeliest to stoke up demand levels by spending all additional income received, i.e. the poorest, the disabled, and pensioners? (Only one may be ticked.)
8. When it is safe to start rebalancing the country’s finances in order to begin to pay off the unsustainably high level of debt incurred as a result of bailing out the banks and fiscally stimulating the economy [oo-er, that's a clue to the answer to question (1) -- do not go back and change your answer], which of the following measures for that purpose will be most likely to be effective: (a) slashing public services and imposing pay cuts and pension reductions on members of the public services — mainly e.g. nurses, local government employees, policemen, postmen, teachers, firemen, dustmen, schools inspectors, social workers, prison officers, probation officers, etc.; (b) concentrating on continuing to reduce unemployment, thus repairing government revenues from income and other taxes such as VAT and reducing government expenditure on unemployment benefit and other welfare payments to help the hardest-hit victims of the recession; (c) increasing taxes on those best able to pay more, including senior executives receiving bonuses and salaries exceeding £100,000 a year; (d) re-evaluating all major government expenditure programmes in order of priority in terms of protecting the neediest victims of the recession, ensuring that the recovery continues undamaged, and applying the criterion of fairness (those best able to pay more do so, the poorest and most vulnerable receive more support) — and deferring or cancelling the programmes evaluated as being of the lowest priority, even if intrinsically desirable; (e) substantially reducing government expenditures by: very early withdrawal from Afghanistan, reducing the prison population by 50%, and abandoning as unaffordable (whether or not desirable) Trident, ID cards and their supporting database, new aircraft carriers, new fighter-bombers to equip the aircraft carriers, and the new prison building programme. (Tick all that you think likeliest to be effective for the purpose defined.)
9. The figure of £1.457 trillion is the UK’s amount of: (a) government borrowing for measures to beat the recession? (b) the government’s estimated budget deficit in the current financial year? (c) current personal, private borrowing by individuals? (c) government spending so far on the wars in Iraq and Afghanistan? (d) MPs’ and peers’ expenses claimed and disallowed? (Only one may be ticked. The answer is in Footnote 3.)
10. Which of the following UK political parties, i.e. those theoretically capable of forming a government after next year’s general election, is likeliest to have got the answers to the nine preceding questions right? — (a) The Labour Party; (b) the Conservative Party. (Only one may be ticked; please vote for the one you have selected.)
And, less seriously, question 11: please identify the author of each of the following quotations and the newspaper in which each one appeared (answers in Footnote 4):
A:
According to [the independent Institute for Fiscal Studies], Mr Cameron would have to cut £54bn of spending in today’s money just to meet the Labour government’s deficit-cutting plans – plans which he says are too timid. Even if he scrapped the police, the Foreign Office, transport spending and six other government departments, it would not be enough.
B:
A good Keynesian would respond to a call for cuts by saying that, whatever we do, we should maintain demand. That means maintaining cash benefits to the old and poor, who spend rather than save.
C:
Necessary as these efforts to give the world economy stronger foundations are, the more immediate priority is not to stop the recovery in its tracks. Domestic public finances will be the most urgent challenge for many leaders as they return from Pittsburgh. With publics nervous about soaring government debt levels, the danger is that fiscal stimulus will be withdrawn too soon. That will hurt not only those who tighten but also their trading partners. As leaders agree to rebalance the world, they must continue to push it upward.
D:
The government should lop 5% off every budget and every public salary for a year, no exceptions and no argument. It would be crude but fair, the price paid by a public sector that has done well over the past decade at the expense of the productive sector of the national economy. It is an expense that the nation cannot at present sustain.
Footnote 1: (The answer to question 4): the United States.
Footnote 2: The answer is that all thirteen of those listed, as well as numerous other countries, had a higher level of public debt as a percentage of their GDP than the UK in 2008. The percentages were: Japan 170.4, Singapore 113.7, Italy 103.7, Greece 90.1, Belgium 80.8, India 78, France 67, Portugal 64.2, Germany 62.6, Canada 62.3, USA 60.8, Austria 58.8, Cyprus 49, UK 47.2. Other countries whose public debt exceeded 40% included Switzerland, the Netherlands, Poland and Brazil. (http://en.wikipedia.org/wiki/List_of_countries_by_public_debt)
Footnote 3: £1.457 trillion is the total amount currently owed by UK private individuals. It has recently begun to diminish for the first time since records began in 1993. (http://news.bbc.co.uk/1/hi/business/8231135.stm)
Footnote 4: A, George Parker, Financial Times, 19 Sept 09
http://www.ft.com/cms/s/0/29a25f00-a482-11de-92d4-00144feabdc0.html.
B, Simon Jenkins, the Guardian, 16 September 2009 (http://www.guardian.co.uk/commentisfree/2009/sep/15/labour-public-spending-cuts). C, The Editor of the Financial Times, in a first leader, 18 Sept 09 (http://bit.ly/3m0w6V). D, Simon Jenkins, the Guardian, 16 September 2009 (as B).
Brian
On the always stimulating Our Kingdom website (“a conversation on the future of the United Kingdom“, part of the City University‘s[1] OpenDemocracy network) there’s an interesting if somewhat academic debate in progress about the implications for the whole of the UK of a referendum in Scotland on Scottish independence (whatever its result), and the disintegration of the United Kingdom which Scottish independence would entail. This stems from a post by Gerry Hassan, “The long march to Scotland’s independence referendum“. Gerry Hassan is a writer, researcher, policy analyst and associate at the think-tank Demos. What follows is based on my comments contributed to the debate at Our Kingdom.
For many of us the destruction by Scottish secession of the United Kingdom, or at any rate Britain, the country which for all its faults claims our loyalty and in my case, anyway, my affection, would be a tragedy for all the people of all its four constituent parts. I am English, of English, German Lutheran and Polish Jewish ancestry, but for me Scotland and Wales (and equally but in a different way Northern Ireland) are just as much part of my national heritage, ingredients in my national history and culture, as England is. Scots, Irish people and Welshmen simply aren’t foreigners in my book, and never can be, whatever constitutional changes might occur, any more than Queenslanders can be foreigners to the people of New South Wales when they are all Australians, any more than Californians can be foreigners to Vermont people when they are all Americans.
What this signifies to me is that it is now quite urgently necessary to consider possible alternatives to the break-up of the UK into its component nations, in ways that would meet most of the legitimate aspirations (and grievances) of the people of all four nations. It’s fairly clear that the distinctive identities of England, Scotland, Wales and Northern Ireland, plus their common ownership of the United Kingdom, need to be translated into a new constitutional dispensation under which each of the four nations governs itself by democratic right (i.e. not by kind permission of some authority in Westminster, or anywhere else) in all their internal domestic affairs, from the criminal law to education to taxation, each – necessarily including England — with its own separate elected parliament and government (which three of the four of course already have). The four entrust to a single elected authority, comprising a separate central government and legislature, those things which they agree are best run collectively on behalf of all of them: mainly foreign affairs and defence, with collaborative arrangements for revenue allocation and some transfer of resources from the richer to the poorer areas of the kingdom. The division of powers between the four self-governing nations and the upwardly-devolved centre would be defined in a written constitution administered by a central supreme court. The dominance of England as by far the biggest and richest of the four nations, now almost unfettered except by convention, would need to be formally limited, probably by turning the House of Lords as the second chamber of the all-UK parliament into an elected ‘house of the nations’ — call it a Senate — in which all four nations have equal representation, so that English representatives on their own can never out-vote those of the other three nations.
We could call this novel arrangement “a federation“. The Australians, Germans, Americans, Canadians, Swiss and several other nationals of functioning democracies might even agree to offer us some useful tips on how to make our federation work, if we asked them nicely. It would, by the way, give Scotland virtually all the advantages of full independence with none of the disadvantages; it would answer the West Lothian question, although not in quite the way that Tam Dalyell, its distinguished author, would approve; it would cure the whole of the UK of its congenital over-centralism; it would complete the half-finished process of devolution while reversing its top-down power trajectory, and remove its present inchoate[2] anomalies. It would take at least 20 years to complete the transformation. It would be a bumpy but exhilarating ride. It would be worth the wait and the effort.
It’s hard to be sure about the reasons for the extreme reluctance of the political and media establishments even to discuss the possibility of moving to a fully federal system, despite the fact that it would solve so many problems and that the availability of a better alternative to the disintegration of our country is daily becoming more urgent. With devolution we are half-way into a federation already, and most of the serious anomalies that have resulted (encapsulated in the West Lothian question) are due to our failure to complete the process.
I suspect that a large part of the resistance to the idea of federation stems from dislike of the idea of England having its own elected parliament and government, separate from the existing Westminster parliament and government. These would automatically become the new federal institutions, much smaller and with greatly reduced powers (mainly over foreign affairs and defence). A separate English government would inevitably wield more real power, although only in England, than the downsized federal government at Westminster, not an attractive proposition for current Westminster politicians with their romantic fantasy of a Westminster parliament and executive with unlimited ‘sovereign’ powers. Persuading politicians to give up some of their powers and status is always going to be an uphill task. They should, though, take heart from the reality that the federal governments and legislatures of existing democratic federations, such as the President and Congress of the United States, enjoy far more international and even national prestige, despite their limited powers, than those of the component states that comprise their federations.
I surmise that there are at least four other major obstacles to the required all-party consensus in favour of movement to an eventual federation: (1) It’s too radical for our timid politicos; (2) It would take at least a couple of decades to complete the process, and our political leaders’ congenital short-termism prevents them from looking that far ahead; (3) There’s a cosmic ignorance in the Westminster village and among its attendant media clowns of other democratic countries’ constitutional arrangements, and a deeply ingrained reluctance to learn from them, so every problem that crops up in the course of change requires us laboriously to re-invent the wheel; and (4) The federal idea requires a capacity for a vision of a different way for the nations of the UK to govern themselves — moreover in a new and unfamiliar democratic relationship with each other; and our politicians (with a few rare exceptions) don’t do vision.
Time to wake up before it’s too late.
[1] See correction in Anthony Barnett’s comment below.
[2] Inchoate: “Recently started but not fully formed yet; just begun; only elementary or immature.” Unconnected with ‘incoherent‘ or ‘chaotic‘, except in (frequent) error.
Update (13 September 2009): (1) This has now been re-posted at LabourList — see http://bit.ly/4a3rr9. Comments on it posted there will no doubt be more widely read than those here. (2) By coincidence Vince Cable MP, perhaps the most widely respected politician in Britain, has just published an article in the Daily Mail (at http://bit.ly/3lalbH) sounding the alarm at the possible break-up of the UK and suggesting that a federation “like the US, Canada or Germany” would be the best solution [actually Australia is probably the best model of all]. Might this be the start of something big?
The standard of nursing in many (not all, but many) NHS hospitals is appalling. Almost everyone has experienced, or knows friends and relatives who have experienced, atrocious and negligent treatment by nurses in NHS hospitals, including especially agency nurses. For years open discussion of this calamitous reality has been taboo. We value the NHS, as widespread resentment of recent attacks on it by American right-wing opponents of US healthcare reform has shown. Hardly anyone in Britain wants to abandon the National Health Service’s core principle: medical treatment available to all, regardless of income, free at the point of delivery, whether at the local GP doctors’ practice or in NHS hospitals and clinics. Much NHS treatment and many, probably most, NHS staff are first-class. But far too many nurses are indifferent to their patients’ needs, indolent, arrogant and domineering, sometimes downright cruel. Basic aspects of patient care are often neglected because the more basic forms of treatment are regarded by qualified nurses as beneath them. Beds and whole wards are allowed to remain filthy for days; patients sometimes go unfed and unwashed; appeals for help in emergencies or at times of urgent need go unanswered. Care of the old seems to be especially bad, but the old are by no means the only victims of this scandalous neglect.
One recent example of disgraceful standards of nursing in a famous London NHS teaching hospital is documented in a searing letter of outraged complaint to the relevant hospital trust from a young woman friend, a qualified psychoanalytical psychotherapist and mother, who has kindly allowed me to put the text of her letter on this website: you can read it here. This is an outstandingly conscientious and observant person and I can vouch without a qualm for the truth of every horrifying detail of her narrative. Indeed I know that some of the things she witnessed and experienced in hospital were even more horrendous than those described in her letter.
There is ample evidence that this is by no means an isolated case. A recent report on nursing care by the Patients’ Association (PA) has aroused huge concern and received massive support from around the country:
The Patients Association has been overwhelmed by the huge number of responses we’ve had to the heart-rending accounts of inadequate patient care that we’ve published today. We’ve been inundated by hundreds of emails and calls from patients across the country contacting us to offer their support and relate their own experiences of poor care. … Newspapers, radio stations and television channels are telling us that they are being flooded with supportive comments from members of the public.
It is very clear, that whilst still representing a small proportion of the care being given by the NHS the numbers of people receiving substandard care are not small. … We feel the immense response we have had from the public is the best answer to continual rebuttals by NHS leaders and the Department of Health as they insist on ignoring the scale of the problem.
We do not wish to attack the nursing profession as a whole and we know the vast majority of nurses do an excellent job but this doesn’t mean incidences of appalling treatment can be ignored or treated as one-offs. Those nurses lacking the caring attitude vital to their role should not be allowed to undermine the work of the rest. We are pleased to see nursing leaders acknowledge this today.
The PA press release accompanying publication of the report demonstrated the largely unacknowledged scale of the problem:
The Patients Association has campaigned for many years to improve the quality of care provided by the NHS and throughout that time our efforts have been fuelled by the accounts we receive from patients and their relatives through our HelpLine on a daily basis. As a consistent pattern of shocking standards of care has emerged we have decided to publish a number of these accounts to highlight the unacceptable experiences facing patients up and down the country on a regular basis. The Patients Association calls on Government and the Care Quality Commission to conduct an urgent review of the standards of basic care being received by patients in hospital and demands stricter supervision and regulation of hospital care. …
Director of the Patients Association Katherine Murphy said: “….Very often these [accounts concern] the most vulnerable elderly and terminally ill patients — it’s a sad indictment of the care they receive.
“These accounts reveal patients being denied basic dignity in their care — often left in soiled bed clothes, being given inadequate food and drink, having repeated falls, suffering from late diagnosis, cancelled operations, bungled referrals and misplaced notes. There are also worrying instances of cruel and callous attitudes from staff towards vulnerable and sometimes terminally ill patients. We hope this report is a wake up call for the Department of Health and the Care Quality Commission — we’ve made a number of recommendations to try and prevent these kinds of things happening to other patients. We hope this report also encourages other people to get in touch with us and tell their stories — we plan to continue publishing accounts until we can be confident that every patient is secured dignity in their care. The people that have come forward for this report are incredibly brave and had one thing in common — they want it stopped.”
Writing in the (London) Sunday Times on 30 August, Minette Marrin, whose column has often addressed the scandal of bad nursing, confirmed the evidence that the problem is not confined to a tiny minority of nurses and nursing assistants in a tiny minority of hospitals:
…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?…
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?
Minette Marrin makes an important point here about the failure of hospital doctors to take effective action to stamp out disgracefully sub-standard nursing. Part of the problem, perhaps indeed at the root of it, is that most doctors spend far too little time in hospital wards, talking to patients and nurses, just watching and listening. Of course they are busy and often over-worked, but this is an absolutely essential part of the jobs for which consultants in particular are handsomely paid. Some consultants and other doctors do it: why can’t others? Often the only time a patient sees the consultant supposedly responsible for his or her care is when the great man (or, occasionally, woman) does the ‘hospital round’, accompanied by a small flock of obsequious and anxious junior doctors, often spending no more than three or four bland minutes with each patient. These royal visits may occur as rarely as once a week. The nurses know when a visitation is due and clean up the patients, the beds and the wards in preparation for it. It’s often said that the Queen must assume that every building in the land smells of fresh paint. Hospital consultants who never visit, unannounced, the wards where their patients lie in squalor no doubt believe similarly that all wards are clean and tidy, in the tender care of attentive and diligent nursing staff, at all times of the day and night. Even junior doctors and registrars commonly appear to be in a great hurry to get away from the wards lest they be waylaid by distressed and neglected patients: they are often more frightened of the nurses than by the likely consequences of the neglect suffered by their patients. Surprise snap visits by hospital managers, especially Chief Executives, also seem as rare as hens’ teeth. Do these great personages have any idea of what’s going on under their noses, or how the staff for whom they are responsible are failing to do their jobs to even minimally acceptable standards, with sickening consequences for the patients to whom they have an overriding duty of care? If so, why do they not do anything about it, individually and collectively?
As the Patients’ Association says, remedial action is now long overdue. “We hope this report is a wake up call for the Department of Health and the Care Quality Commission.” When will the Department and the Commission stir themselves from their long slumber?
Brian
