In our hard-pressed NHS, must sympathy be rationed too?

A toxic mixture of cost-cutting and ideology seems to have put a limit on tea and sympathy

2 August 2014

9:00 AM

2 August 2014

9:00 AM

Sometimes I have a quiet time as a voluntary hospital visitor. But recently I’ve witnessed a lot of distress from people of all ages and types. The other week I saw an elderly Middle Eastern man bent over a bin in a ward corridor, crying almost uncontrollably. I asked him the problem and he stuttered out that he had been watching his daughter sleeping, and he believed she was going to die.

I went off to find a nurse as I felt I didn’t know enough about his situation or hers to help. The nurse wouldn’t tell me anything due to patient confidentiality. I returned alone to the man and tried to sympathise. He managed to say that his daughter had food poisoning. I didn’t think that sounded too bad, but he added that his wife had died of it. It seemed complicated, but there was no one to ask, no one came to calm him down and there was no place we could go for privacy.

The same day I met a young Muslim from Southall, west London, with a chest infection aggravated by alcohol abuse. He’d been sent here as a child to live with his grandmother; his mother stayed in Pakistan. He qualified as an accountant, but depression and drink had left him jobless and homeless. ‘If I leave here,’ he told me, ‘I have nowhere to go.’

I asked a nurse about him. She said he had ‘plenty of relatives in Southall’, which he did. From what he’d told me he didn’t like any of them much. She said they’d ‘offered him their support’ so ‘the housing department is not interested’. And neither was she.

We are constantly told that the NHS is wrestling with its budgets. We all know that there is no money left for any extras for patients, such as toothpaste, bed socks, chiropodists and good food. But it often seems to me that tea and sympathy are also rationed.

Last week I met an old lady, very intelligent and well spoken, who has developed a bad skin condition on her legs. She found herself hardly able to walk, a very scary thing for old people who live alone. While she’s been in hospital her landlord has decided to sell her rented home and given her notice to quit. Her son wants her to find a care home near him, in Hastings, but before that she has to recover in a care home locally, in Acton. It’s all a great upheaval and she is naturally anxious.

The day I saw her, the offer of a place in a local home had been cancelled. She had no idea why, or where she was going. I went off to make her tea, trying to remember the code for the kitchen door — the catering women are often bad-tempered — and to try to root out some facts for her.

‘She’s going to be assessed today,’ the nursing sister told me crossly. ‘I’ve already told her once, so you don’t need to tell her again.’ The nurse had the attitude that she should be quiet and stop fussing. There was no time to attend to her fears. Opposite an old Irish lady was sitting in her chair, ready as she thought to go home and waiting to be collected. I inquired and found she was not due to go anywhere. The nurses were exasperated at her stupid confusion.

I moved on to a ward where there are a lot of old ladies, demented and sane mixed together. I’ve visited one lady several times but as she is almost stone deaf I can’t do anything except make her tea and hold her hand.  She has a hearing aid at home; a friend of hers visits and could bring it in. Twice I have asked a nurse to pass on the message. I know it’s never going to happen. The nurses won’t have the time or the will.

In the same ward I was surprised to see a girl, 17 at most, sitting on her bed with her iPod in her ears. She didn’t want tea, but was pleased to chat. I asked why she was stuck with the old dears. She didn’t know but said it was pretty bad, especially at night, when a lot of demented people get loquacious. ‘They all talk out loud to themselves,’ she said.

Just then a nurse and a woman doctor appeared at the end of her bed. I asked them if she might go to a side room. The doctor didn’t look up at me, but gave a glance at the nurse and slightly shook her head.

‘Side wards are for infection only,’ said the nurse, sounding like a robot. As I left I asked another nurse the same question. She was quite charming as she smiled and shook her head.  ‘Not a good situation,’ she said, ‘but nothing we can do.’

I just hoped they gave the girl some extra support, but I doubt it. In hospital these days, your only company comes in digital form, which you bring in with you.

I realise that a lot of this uncaring attitude is to do with lack of staff. Recently Unison, the UK’s largest trade union, warned that cuts could soon risk patient safety. Of 3,000 nurses questioned, 65 per cent said they didn’t have enough time with patients and 55 per cent that care was ‘left undone’ as a result.

But nursing has always been a very tough profession. I know that the study of history has been largely sidelined in our schools, but a quick glance at it tells us something about changing expectations. Unison is worried that 45 per cent of staff have to look after eight or more patients at once during their shift. Florence Nightingale went to nurse the wounded in the Crimea with 38 volunteer nurses, including her Auntie Mai. They tended approximately 18,000 grievously injured men. There were few beds, a shortage of supplies, no anaesthetics, epidemics were rife and a rotting horse was stuck in one of the drains. But I do not believe that ‘the lady with the lamp’ or her nurses were callous and indifferent towards their patients.

For a more recent view of nursing under pressure, take a glance at ‘Civilian Nursing in Lambeth Hospital during the Blitz’, by Doreen M. Abrahams. She describes incredible privation, danger and courage. Of course things were different then — nursing was like a cross between a military campaign and belonging to a religious order — but human beings and their needs are the same now.

As a hospital visitor I parachute in. I am not there to see how hard the nurses work. I don’t witness the stresses and strains that make them unkind. Some of them plainly see me as interfering, which I am. But appearing out of nowhere does allow me to hear directly from the patients how they are feeling. It only takes a few minutes of listening attentively to do this, and to befriend them.

The biggest change has been in our culture. The women Florence Nightingale sent into battle against disease and degradation, once known as angels, have been replaced, at least on general wards, by mechanistic bureaucrats. A toxic mixture of cost-cutting and spurious ideology has taken qualified nurses away from basic nursing and replaced them with overworked, underpaid nursing assistants. The outcome is clear for any hospital visitor to see — there is simply no one left on the wards to make a cup of tea or offer sympathy. Florence would be the lady with the hump if she ever got to hear about it.

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Show comments
  • Sean Grainger

    Toxic has become meaningless, subs please note.

  • rtj1211

    The reality of every human endeavour is that it goes through cycles of entrepreneurial zeal, systemisation, cost cutting and decline, at which point it either dies or reinvents itself.

    Medicine has created its own Sword of Damocles: by conquering so many diseases, it now has enormous numbers of incurable conditions on its hands, many of which are really a result of people not dying off due to other things first.

    What I also think people have forgotten is that human beings are essentially social and many illnesses come from social isolation, ostracism or neglect. Not all, of course, but many.

    The difficulty is that you get the two extreme positions (God can cure everything (he can’t) and ‘if you can’t treat it with medical intervention, it’s incurable’ (which is twaddle in a lot of cases too).

    As always, the cause of the difficulties is the societal settlement currently in place and a refusal of society to face up to the implications of the settlement that it has made, subconsciously or consciously.

  • Damaris Tighe

    Very sad & I agree with your analysis Jane. But isn’t it interesting that the more society witters on about ‘caring’ & ‘compassion’ the less caring & compassionate it becomes.

  • Binding&Hoche

    They are the LIverpool care pathway generation of nursing staff and quacks…there was an Aktion T4 generation in Germany..they get used to ‘processing’ patients, rather than treating them.

  • Picquet

    I have no doubt at all that there are Advanced Management Systems (ie: fashionable business-consultant-led methodologies) behind much of the change in relationship between patient and doctor/nurse. These can be detected by the exudation of bullshit from their ‘Mission Statements’ and ‘Vision Statements’. I experienced this during my last brief visit to a London hospital, where I was called by my Christian name and referred to as a ‘customer’.

    • Damaris Tighe

      Exactly the same in the police force, sorry, service. All this business bullsh*t applied to public services which are not businesses.

  • Gwangi

    My experience is mixed: on one occasion, excellent emergency care which was life-saving. However, on another, in a general ward for the elderly, I was appalled by the lack of care, the way buzzers were routinely ignored, the way messages were never passed on to patients or vice versa to relatives at home, the way a nutritionist didn’t turn up for almost a week to see why my elderly relative wasn’t eating, the way no nurse ever seemed to be monitoring the level of water consumption of elderly patients or their meals. I think the nurses think old people are almost dead anyway, so better to let them starve and dehydrate to death. Bottom line: if I hadn’t been around to go in every day, my relative would have got dehydrated and malnourished, caught an infection and been dead in a couple of weeks.

  • Latimer Alder

    My late mother was so badly treated by the staff at Falkirk General and its successor Forth Valley Royal Hospitals that she was frightened of calling the doctor lest she be sent there again.

    It wasn’t lack of money or ideology or any resource shortage that caused the problems. It was the basic ‘couldn’t give a s*it’ attitude of most of the frontline staff.

    Mum died almost exactly a year ago – at home. It was clear that – knowing she was very ill – she took steps to ensure that nobody would find her and drag her off again for further poor treatment.

    I have to agree that she made the right decision.

    RIP Mum.

    • Terry Field

      My dying father was appallingly treated by this bastard system.

  • Terry Field

    It is a great feeling to have left Britain and escaped its many miseries, the murderous NHS being at the very top of the list.

  • Rob in Madison

    I used to nurse in US hospitals, civilian and Army. The initial insult to the ability of nurses to care is unreasonable patient loads. Let that situation continue for long enough, and a culture of dismissal and disengagement grows. And if, by some miracle funding were restored, allowing better nurse/patient ratios, reversing the cultural adaptations would take a particular effort.

    Hugely implicated in this horrible problem is the role of hospital management, whose chief concerns are directed toward their bosses, rather than to the needs of the staffs they manage.

  • Penny Stewart

    This is completely in keeping with the heartless treatment I received in hospital