Melanie Phillips links to and comments extensively on this article about NHS nursing by Harriet Sergeant from last Saturday’s Telegraph, which flags up a publication also by Sergeant from the Centre for Policy Studies, entitled Managing Not To Manage (.pdf only). That’s about the management of the entire NHS, and not just the nurses, but the bit of the Telegraph article that particularly caught my attention concerns the way that the education of nurses is now heading:
The training of nurses has promoted them further and further away from the interests of their patients. In the late 1980s, nursing turned itself into an academic profession. Nurses desiring increased status and greater parity with doctors sought to transform their training into a graduate profession. The result is “a frigging mess”, according to a member of the King’s Fund, a charitable foundation concerned with health.
One senior staff nurse at a hospital in the West Country, who teaches at the local university, pointed out – logically enough – that the academic status of the qualification means “there has to be a lot of theory”. But there is too much theory, too much emphasis on social policy and communication skills – and not enough practical work.
At a London A&E department, a staff nurse who had recently qualified complained to me that her training had not prepared her at all. In 18 months of study, she had spent only one and a half hours learning how to take blood pressure and a patient’s temperature. On the other hand, a whole afternoon had been devoted to poverty in Russia. …
The usual assumption is that if there is a problem, it will take money to put it right, but that enough money will do it. But training nurses who knew how to nurse didn’t take any more money than teaching them about poverty in Russia costs now, surely. The problem will be forcing through the decision to teach nurses well instead of badly. My answer would be to phase out the NHS – gradually, no rush, say over a period of, I don’t know, three months – and thus allow a world to re-emerge in which good nurses get paid far more money than bad ones.
Melanie Phillips blames feminism. But why does feminism only seem to do damage to public sector institutions?
Brian – Ha ha ha! “… over a period of, say, three months”! Why the delay?
What mechanism would make good nurses get paid more than bad ones?
Zack,
The mechanism is called “the market”. I won’t normally predict outcomes in a free market, but I’ll bet there won’t be as much demand for a nurse who knows about poverty in Russia as there will be for a nurse who can sew up a wound.
’tis the problem with context free reporting. I am left wondering more and more about what the purpose of the poverty in Russia lecture was about in the context of nursing. I can think of a half dozen rather practical uses especially given the stories doctor friends are telling me about illness patterns in inner London hospitals.
Dave, I confess to be baffled by your asserted connection between knowing about poverty a thousand miles away and caring for a patient lying right in front of you. An example, please?
I would have thought recognising poverty would be even more essential training for a private nurse, after all, you don’t want to waste time sewing up the patient if they can’t pay you.
Dont be so silly, Ian, sewing patients up is a Doctor’s job, not a nurse.
What future have you got as a leftie activist if you cannot get even those little details right?
…find a couple of badly trained nurses, & suddenly the whole nursing profession’s up s**t creek. I don’t buy it. The people I’ve known who’ve trained (at university) as nurses did plenty of the whole wiping arses/taking care of people stuff. Sure, they did some academic stuff (possibly on poverty in Russia; who knows), but that didnt’ strike me as the dominant character of the course. Perhaps the nurse the Telegraph reporter spoke to went to a crap ‘university’.
I strongly feel you can’t teach compassion, and to try & do so would just arouse the “what’s this PC rubbish” mockery of the right anyway, so it’s unfortunate if uncaring people make their way into the nursing profession, but how do you propose to stop them? Have ‘compassion exams’? Tell me, how much scorn would most here feel for a ‘compassion examiner’, eh? No doubt advertised for in the Guardian jobs pages.
The NHS (for whatever reasons.. you have your theories, others have theirs) is not working well at the moment. We all know this. To suddenly blame nurses for the hospitals being understaffed, for refusing to help with some things, because they know that doing so will impact on other things they are going to be held responsible for, seems unfair.
One of the points in the article; the comment about the catering staff, is symptomatic of the current state of the NHS, where particular functions are contracted out, & the people employed to fulfil these functions are there for that particular purpose only; they are often specifically forbidden from doing much more than that, because their employer’s insurance wouldn’t cover it. In the past for instance, porters would have helped out with all sorts of tasks. Now their duties are defined quite tightly, & they are not permitted to deviate from the prescribed list. Again, it’s not training, not feminism, not any of these bugbears, just bad, rigid management, & a consequence of having several inflexible contractors with diverging interests engaged in one activity. This seems like one instance where a single monolithic entity, where staff were working in the interest of the hospital as a whole, and their manager understood if they spent a little time helping others, would probably be more efficient.
You have to also bear in mind that society as a whole has placed far more emphasis on individualism, & less on duty or caring of late. This can’t help but be reflected across the board.
…and suddenly a whole platoon of straw men came thundering over the hill…
You want to hear a blistering indictment of modern nursing training, ask a nurse who trained twenty years ago and is still working in the field. Hoo boy!
If you want to know the context in which nurses are being lectured about “poverty in Russia”, this article by Julia Magnet of Civitas gives you the sadly predictable answer:
I first heard Julia speaking about this on the BBC’s Today programme. Her thesis is that there has been a change in the culture of nursing in this country for the worse. A phasing out of the old ward system (matrons, sisters, staff nurses etc.) combined with a scramble for status through the attainment of worthless academic qualifications has led to system where no nurse is willing to take responsibility for the basic care of patients. In fact, in recent years the vocation has been heavily influence by the worst excesses of the modern academy:
I think Julia’s story is one of the most powerful indictments of Britain’s centralised healthcare system. It is a system that has managed, against all odds, to undermine nursing’s claim to the title of “the caring profession”.
“one of the most powerful indictments of Britain’s centralised healthcare system. ”
surely the opposite; if the hospital as a whole was centralised, & wards were permitted to share resources, rather than being run as semi-autonomous units with (presumably) their own pillow budgets which will suffer if any are lent, this wouldn’t even be an issue. Sounds like lack of money combined with shoddy management to me.
RC Dean,
Diseases of real poverty (i.e. not the stuff people think is poor in most industrial nations) are things that you are now likely to see in an Emergency Room in, for example, London and conventionally have never expected to see.
TB is a good example, plus a range of childhood and other infectious diseases which have been reduced and all but eliminated in the indiginous population but remain endemic in those of both legal and illegal immigrants.
A collegues girlfriend was telling me about a year or so ago but what she was seeing as a resident in a City of London hospital which also served the East End of the city. She had trained in Sweden but was suddenly seeing cases of diseases like TB for the first time in her life – she could have gone a career in Sweden without seeing them.
Knowing what to look for and the reasons behind would be, in my opinion, essential for A&E in a large city where you’ll have immigrants and something worth training people in rather than having them learn it on the job. This is especially true of highly infections conditions which you want to treat carefully even in an A&E.
That’s off the top of my head based on conversations with medically inclined friends. I could ask a nursing trainer I know and get a more detailed answer I suppose.
A_t: My wife works as a nurse in the NHS, and would echo many of the sentiments in Melanie’s and Brian’s piece. The general level of nursing care is terrible, and she blames the move from training in hospitals to training in lecture theatres. The gap is quite pronounced. Find nurses with 5-10 years worth of experience, and they are general compassionate, capable and kind. Nurses with less experience are surly, rude and lazy.
No-one is blaming nurses here – they are blaming the policy that produces nurses with a certain, inappropriate skill-set.
My wife hates the current system. To get promoted and earn more money, she has to attend a certain set of fairly useless courses, to teach her things that she already knows, or that aren’t relevant to nursing, rather than being a good and capable nurse/people-manager. It’s a sad system. She’d be the first to call for privatisation.
…Suffice it to say, my wife is an excellent nurse. She wasn’t trained in the UK either.
A_t,
Read the Prospect article. There are pointless internal markets in the NHS. These were an inadequate patch to a crumbling system. However, there is only one NHS and there is one training system for nurses. Both are poor. They are poor to the extent that, as the articles have demontrated, the profession as a whole no longer “cares” about patient’s basic needs. The NHS cannot get nurses from an alternative domestic source because there isn’t one.
If healthcare training was private and decentralised rather than a state-run monster, then nurses with true nursing skills (including empathy and efficiency) would be produced. Your excuse of “lack of money combined with shoddy management” simply won’t do.
“However, there is only one NHS and there is one training system for nurses. ”
hmm… so each university teaches according to a centralised syllabus, using standard national techniques, does it? Plus, there aren’t a great variety of paths into nursing, from full academic degree to training on the job. Nah… i’m just fooling myself.
“If healthcare training was private and decentralised rather than a state-run monster, then nurses with true nursing skills (including empathy and efficiency) would be produced.”
Yes, & bad nurses would also still be produced. That’s the nature of any market. Your argument would be more credible if you suggested that *more* good nurses would be produced under your proposed system.
Yes, ignore the evidence in favour of meaningless rhetoric. Typical…
A_t,
The kind of training on offer is monolithic. It is bascially the same at all Universities. It is heavily balanced in favour of “theory”, by which is meant “the usual mix of victimology, identity politics and class struggle” and against practice, that is dealing with patients.
The writer of the article I have quoted has looked at the course content and has seen that the ideas being taught have directly influenced the lack of care she recieved. Ideas have consequences.
Do you have any answers to this problem A_t? How would you reform the training system? I would let hospitals decide what a good nurse is. I would let patients decide what a good hospital is. I would let nurse training schemes respond to these decisions. This cannot happen under the current system. Could it happen under your system A_t? Do you even have any ideas beyond empty rhetoric?
Andrew & ‘anglosphere’
I’m not ignoring your evidence; just pointing out flaws in the argument, or nitpicking if you prefer. I’m listening quite attentively; i’m just not convinced yet. It’s easy to say “the system’s a mess. If we did X, everything would be better”. Andrew, your wife works in the NHS and believes greater privatisation would help. I have friends who work in the NHS & believe too much privatisation is the problem. Both sets of people have experience on the ground. Presumably they differ in their political affiliation, & this colours their interpretation of what they see around them. I know many of you here are rock-solid & certain of your beliefs, but I tend to believe that no one simple ideology holds all the answers, & that in human affairs there are usually several satisfactory (but flawed) solutions to any given problem. Believe me, i’m not ignoring you, & I apologise if that impression was given. I’m merely stating some of the opposing side’s case, & trying to point out that some of the things you call ‘obvious’ are not (at least to most people anyway).
Similarly, mr/ms anglosphere “the writer of the article I have quoted has looked at the course content and has seen that the ideas being taught have directly influenced the lack of care she recieved. Ideas have consequences. ”
I’m not dissing the author, but this is hardly a clear causal relationship. Certainly in the one case of the nurse who had little experience on the ground, but as i said, any system will have poor schools, or ones with misguided ideas; private training would still produce some rubbish nurses. If you want to argue a larger too much sociology->bad nursing case, I could probably just as easily take the rise of personal technology, draw a parallell in time between that & the decline of nursing, and conclude that greater selfishness stemming from the inherently non-communal walkmans/gameboys/mobile phones, and the expectations of privacy that these encourage, are breeding a more selfish generation, which impacts on the quality of nursing, as empathy & an unselfish nature are essential qualities for effective nursing.
I know the personal technology argument is spurious, but my point is, she’s observed one thing, observed another, & then her political likes & dislikes, along with one poorly trained nurse, have led her to associate one & the other. Anyone writing for Prospect magazine is unlikely to be well-disposed towards any kind of sociology etc. to begin with, so it will please them if they can make a connection beteween such teaching & an atmosphere of neglect in the NHS, in much the same way as an anti-globalista is pleased when they can spot some parallell between rising poverty & the rise of corporate multinationals. I don’t think any of the ‘evidence’ quoted in the article counts as such to anyone not already predisposed towards those beliefs.
Also, it’s interesting that you all look back to an era of ‘good nursing’, & then blame the change for the worse on centralisation, and believe a market-based system is the solution. During this era of good nurses, as far as I understand it the NHS was even more centralised than it is now, & there certainly wasn’t any kind of market operating which allowed patients to choose hospitals/nursing techniques. So would you put it all down to the pernicious effect of victim-obsessed sociology, formalizing the compassion out of caring people?
I’m not harking back to a time of better care and suggesting a market based system. Put the wider problems of the NHS to one side, and put politics (yours and mine) to one side. My wife is actually a fairly left-wing kind of person (she’s a nurse, of course she is…), but she can still see that the overall system doesn’t work. But that’s another issue.
My issue here is solely with the quality of nursing staff, which I can tell you is very poor. This isn’t an isolated incident, it is a combination of experience in several different areas within the NHS. My wife’s opinion, and experience backs this up, is that newer nurses are poorly trained, lacking motivation, initiative and common sense, and are unwilling to learn anyway. How do you solve that problem? I believe you can teach people to be compassionate and caring, and you do it by using the old-style of teaching nurses on the wards, and actively punishing their mistakes. Currently it is impossible to discipline staff, as their rights are too strong. Believe it or not, this leads to an atmosphere where a senior nurse can ask a junior nurse to do something and to get a sneering look in reply, and not doing it. How is this acceptable?
And yes, you can blame the rise in the me-culture all you like, but you can’t put the genie back in the bottle on technology. Do you propose banning mobile phones, Gameboys and Walkmans to prop up the NHS?
A_t,
Yes, people have different opinions. That is a fatuous point to make. However, there is truth. Yes, internal markets, NHS trusts, etc have been a failure. As my father says: “You can’t polish a turd”. This does not mean that real choice in healthcare (and by extension healthcare training) wouldn’t produce better nursing.
Yes your “personal technology argument” is spurious. People’s interpretation of cause and effect can be shaped by their political opinion. Another trivial point. There is still truth. Julia Magnet was in hospital for ten weeks. She has a chronic illness which means she has been in many hospitals. This was her first prolonged exposure to the British NHS. If you read the article you would know this. I have no reason to suspect that her experience of poor nursing is untypical. She also makes a convincing argument for the cause of this.
It was not increased centralisation of the NHS that has caused the problem of poor nursing, it was a failed attempt at reform combined with a Government initiative which redifined the role of nurses and completely changed the way they were trained (moving them into the Universities). In the Universities they were taught the voodoo sociology. The point is, in a private system, a Government minister would not be able to change the way all nurses were trained. One man would not be able to fuck up the whole system. Competing training methods would be tried and discarded.
“And yes, you can blame the rise in the me-culture all you like, but you can’t put the genie back in the bottle on technology. Do you propose banning mobile phones, Gameboys and Walkmans to prop up the NHS?”
🙂 no; not at all; i’m not saying I have a solution, just questioning the stated reasons for the decline in the quality of care. The fact is, most people feel less responsability towards others than they did say 50 years ago. This is true across society, and therefore I don’t think changed methods of nurse training necessarily have much to do with it. I utterly agree with you that the behaviour you describe, & that described in the article, is unacceptable. I’m just not sure a) why it’s happening, and b) what to do about it.
anglosphere,
I have no argument with the “quality of nursing has declined” argument, & I have read the article twice now, & am in no doubt that the author received poor care.
However, where we differ is on the “She also makes a convincing argument for the cause of this.” point; as I read the article, I could see potential connections between what she observed, but there’s hardly a clear causal connection to my mind. Just because she was on the receiving end of bad care doesn’t mean she is suddenly an authority on *why* the care was bad, & does not mean I have to accept her conclusions. I could point you to people who have worked in the NHS for years who have reached quite different conclusions.
I do however take your point about politicians not being able to experimentally ‘overhaul’ entire areas in hazardous ways; perhaps this is indeed a case for privatisation, although a person dedicated to the NHS in it’s current form might be able to argue for a better-shaped system permitting regional autonomy, and preventing political point-scoring.
(me, I don’t know… I can certainly see quite a good case for those who can afford it taking out private health insurance, with a safety net paid for out of general taxation for those who can’t afford insurance).
Dave, that’s all well and good about diseases of poverty, but what does studying the causes of poverty in Russia have to do with treating diseases of poverty in London? This sounds about as logical as studying the politics of Weimar Germany in order to repair BMWs.
Unless they can prove with a tax return that they have been paying into the system, immigrants should not be treated. Or they should be repatriated to be treated in their own countries, where they have presumably paid taxes. Or they should pay for private treatment. This free-for-all is an unconscionable abuse of the British taxpayer.
Verity, beyond your outrage, do you actually have any figures on how big the problem you’re talking about is?
How much of my tax money is actually spent on people who’ve just arrived, versus those who’ve been living here all their lives. Am I supposed to be getting outraged over 0.00001p a year, or is it a more significant problem than this?
Dave, that’s all well and good about diseases of poverty, but what does studying the causes of poverty in Russia have to do with treating diseases of poverty in London?
Because the diseases are not generally the diseases due to poverty in London – which, frankly, isn’t poverty in the sense of the word that most of the world uses.
What London hospitals are seeing more of is Eastern European immigrants coming from poor conditions across the former Soviet Union who haven’t had standard school immunisations and are suffering from diseases you’d never have seen in the UK a decade ago.
NB: This is just one possible explanation but context based learning makes a lot of sense for this.
This free-for-all is an unconscionable abuse of the British taxpayer.
As a British tax payer I can live with this myself Verity. Of course, the problem is we don’t let these people work legally so they can’t show a tax return.
I want to see immigrants working and paying taxes and making a net contribution and *not* getting benefits.
If they are doing that then let ’em stay (especially those with skills), if they’re not then they can have the first flight home that’s leaving Stansted.