It’s almost every day. Yesterday, it was the nurse who phoned the wrong family five times to tell them that their mother, who was sitting up in her hospital bed, had died. On Sunday, it was the survey which showed that fewer than 10 per cent of nurses thought they usually gave their patients good care. And today it’s the report that people who work in the NHS, and people who have been treated by the NHS, although “treated” doesn’t always seem like quite the word, have been awaiting for years.
“There was blood everywhere,” said Julie Bailey on Newsnight on Monday night. “We had to pick patients off the floor and patch them up and hunt for staff. But it wouldn’t have mattered some days, because the staff, I’d say 60 per cent of them, shouldn’t have been on the wards.” There were, she said, often no clean sheets. There was, she said, “screaming and chaos” on the wards. “We believed,” she said, of her 86-year-old mother, Bella, “she was going somewhere safe.”
“My mother was screaming,” said Deb Hazeldine. “She was half on a commode, and half on the floor. She said ‘please, Deb, don’t let me die in here’.” But she did. Deb Hazeldine’s mother did. And so did hundreds of other people, who were drenched in their own urine, and caked in their own faeces, and who were so thirsty they were having to drink from vases. Up to 1,200 people, according to the first report into Mid Staffordshire NHS Foundation Trust, which came out three years ago, died because the people who were meant to be looking after them let them down.
The report was written by Robert Francis, who has also written the report that’s out today. When it came out, lots of people couldn’t believe that such terrible things had happened in a hospital. I was recovering from a big operation, and could. When I’d first gone into hospital, seven years before, I’d thought the nurses would be kind. It turned out I was wrong. Some of the nurses were kind, and seemed to like their jobs, but an awful lot of them weren’t, and didn’t. An awful lot of the nurses who looked after me, after the six operations I’ve had in the past 10 years, seemed to think patients were a nuisance.
I made a vow, on my hospital bed, to try to find out what had gone wrong with nursing, and to do what I could to make things better. I’ve talked to nurses, trainee nurses, doctors, managers, and, of course, patients. I made a Four Thought for Radio 4, which is now being used as a teaching tool for nurses, and visited hospitals for a longer documentary, to follow it up. I did a week-long “special report” on nursing in The Independent, which ran last April. I’ve taken part in panels, at universities, and conferences, and medical associations, and I’ve made a short film about nursing for The One Show, which will be on TV tomorrow night. And what I’ve learnt is this:
There is a problem with nursing in this country. The Care Quality Commission says one in five hospitals it inspected last year didn’t meet basic care standards. The NHS’s own survey says one in 10 patients aren’t happy with the care. One in 10 is a lot, but it’s just the tip of an iceberg. Most patients don’t complain. They’re too scared, as I was, that if they do, things will get worse.
When things go wrong, as they often do, it’s never for one reason alone. It isn’t because nurses are “too posh to wash”, because washing patients, and helping them eat, and making sure they’re comfortable, is, or ought to be, a central part of the job. It isn’t because nurses have degrees. Nursing is much more complicated than it used to be. You need to be able to process data and use complicated equipment. Nurses probably need degrees. There’s no reason why you can’t have a degree and also feed and wash.
It isn’t because of targets. When public money is being spent on people’s health and lives, there should be targets. There should be a target, for example, as one guest said in that report on Newsnight, of “zero harm”. NHS trusts shouldn’t aim to have 95 per cent of their patients not getting infections. The airline industry doesn’t aim to have 95 per cent of their passengers land at an airport alive. It should aim for 100 per cent. That’s a target, and you don’t reach targets if you don’t set them first.
It isn’t because of understaffing, though if you don’t have enough staff, you’ll find it very, very hard to look after your patients well. You should have minimum ratios of staff to patients, and you should stick to them, because that’s what good managers do. But you can’t say that poor nursing is always due to understaffing. You can have plenty of staff and still have bad care, as those of us who have watched nurses ignoring buzzers to chat to each other know.
When things go wrong, as they often do, it’s because there’s a culture of things going wrong, and it’s a culture that’s been set at the top. When things go wrong, it’s because there are bad managers, and bad communication, and bad relations between different levels in the organisation, and between different types of staff. When things go wrong, it’s because managers haven’t been talking to their staff, or watching what they do, or making sure they’re doing everything they can to help them do their jobs better. When things go wrong, it’s because they’re not listening to patients’ bad experiences, and they’re not doing everything they can to make sure they never happen again.
Good hospitals have clear management structures, clear communication with staff and with patients, and make it very clear to everyone who’s responsible for what. Good hospitals publish and display their patient feedback and don’t make excuses when things go wrong. Good hospitals inspire their managers to inspire their staff to do their jobs better. They reward them when they do well, and hold them to account when they don’t.
At Mid Staffordshire it is clear there was a culture of bullying and fear. There’s never an excuse for cruelty on a ward. There’s never an excuse for leaving patients covered in ulcers and lying on dirty sheets. Any nurse who did this, and any manager who oversaw this, should be named and shamed. But people behave badly when they’re treated badly. If you want them to do a good job, you have to treat them well. We’ve had enough reports. Please, let’s not commission more reports. We know what works, and we certainly know what doesn’t. Managers, nurses, and chief executives, it’s over to you.
Christina Patterson’s film about nursing on The One Show can be seen on BBC iPlayer here.