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What direction now for NHS nursing care?

The recommendation by Robert Francis QC in his report into the Mid Staffordshire Trust, that nurses need better training to ensure they can deliver compassionate care, and trainee nurses should be assessed for the aptitude to deliver care, is a damning indictment of how far nursing has fallen from its exalted position in the public’s consciousness.

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Frances Swaine is Leigh Day's first managing partner and remains a partner in the human rights department. She specialises in human rights law and is an experienced clinical negligence claims lawyer. Follow Frances on @FrancesSwaine
The literate public in 1834 was much entertained by the caricature of the dissolute, drunken nurse, Sarah Gamp, whose appearance in Dickens’ Martin Chuzzlewit, paved the way for Victorian nursing reforms.

It is 157 years since perhaps the greatest of those reformers, Florence Nightingale, was described in The London Times, as ” a ministering angel”, and 120 years since the Nightingale Pledge for nurses containing the words ” I will do all in my power to maintain and elevate the standards of my profession.”

Nursing continued as an honourable profession with its own monitoring body, first in 1887 the British Nurses Association, then in 1919 the College of Nursing.  We now have the Nursing and Midwifery Council (NMC) regulating nursing standards throughout Britain, with over 660,000 nurses and midwives registered to work in the UK

When a National Health Service emerged from the cataclysm of the Second World War, amongst the reasons for its introduction in 1948 was a view that access to healthcare for British citizens was a ‘right’.  and nursing was in the forefront of the NHS’ ability to deliver that healthcare.

Early nursing care in the NHS, in post war austerity Britain, did not have the resources of today’s modern medicine.  The Florence Nightingale image may well have given way to the no nonsense Matron, first popularised by Hattie Jacques in 1959’s Carry On Doctor, but no visitor to the cinema would ever have been in any doubt that their lives would have been as safe as it could be in her hands.

So what has changed?

There are still many, many hospitals up and down the country whose nursing staff deliver a truly professional standard of care to their patients, but then again there are those that do not, and awareness of these failing institutions is growing.

Over the past two years my firm has been successfully pursuing hospitals on behalf of client families, under the Human Rights Act, receiving settlements for those families whose eldest family member has died.  Damages settlements have either been successful because it has been accepted that their loved one has not had their life protected by the NHS, or, more commonly, where the nursing care they received violates Article 3 of the Human Rights Act, and it is accepted (by way of settlement), that those hospital patients suffered inhuman or degrading treatment.

Inhuman and degrading treatment by nurses in an NHS hospital?  What has gone wrong?

Life expectation has changed dramatically, with those going into geriatric nursing in the 1950s mostly dealing with patients whose life expectation was closer to 60 years of age, and whose care needs were often non invasive and palliative.

Is geriatric nursing in the 21st century some way to be avoided by those going into the nursing profession? Is care of the elderly the bottom of the pile, with little involvement with life saving care and a greater likelihood of having to spend time with those whose physical and mental faculties have gone, never to return?  Does such lack of care reflect a change in social mores with regard to respect of the elderly in general?

For all the money spent, all the regulatory bodies set to monitor nursing care or exhort by way of Trades union leadership, for all the aspirations of a National Health Service, the current medical and nursing profession is letting itself down by not addressing these questions and not ensuring the basic standards of care are met that underline the delivery of a hospital service.

Courtesy, civility, cleanliness, listening skills, family liaison, kindness.  In some hospitals these seem to be in short supply especially in services delivered to the most vulnerable.

However, it is still the nation’s NHS.  The ethos in which it was set up, as access to healthcare for all, must be one, which to be effective, inspires a universality of care across the nation.  Not only those named and shamed should be apologising for their hospitals shortcomings.

It is the nation’s right for all services to be delivered in an appropriate way.  Let’s see the nursing courses, the regulatory councils, the RCN and the BMA and those right at the top of the whole service, calling for basic, acceptable standards across the board and then enforcing them with disciplinary measures which keep the delivery of decent, kindly patient care as a pre -requisite to entering and remaining in the profession.

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