Mary Dejevsky: Teamwork can't fix the NHS's troubles

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The Independent Online

When I collected my husband from a routine hospital stay 18 months ago, I knew instantly that he had lost weight. He had been in for only eight days and he hadn't had an operation, but he was markedly thinner. Well, he said, in response to my interrogation, he had hardly eaten anything. Either his tests coincided with meal times, or his disobedient hands couldn't handle the implements, or it all looked just too unappetising.

On Monday, on Channel 4's Dispatches, Mark Sparrow brought proof of the sad state of much hospital catering to our television screens, after photographing and blogging about what passed for nourishment during his 10-week stay. Last night, Heston Blumenthal became the latest celebrity chef to offer a recipe for NHS food. But I really wonder whether you need to go that far.

Sparrow found some obvious solutions: hospitals that cut out the money-making intermediaries, use their own kitchens and serve up the same decent food to patients and staff. He also showed experiments with tasty pureed food – so why not also soups and smoothies in spill-proof cups or finger-food, such as you find at party season in any supermarket? In many places, even much-maligned airline-style food would be an improvement.

In passing, Sparrow also divulged a dirty little secret of NHS hospitals: if you kick up enough of a fuss, you may get something better. Or, of course, as many patients fear, you may get victimised and determinedly neglected from then on. The gamble's yours.

Which brings me to compassion – or lack of it, as exposed in the health service Ombudsman's recent report. I, too, have observed that compassion can run short. But if nurses can't do compassion (not everyone can) surely they could manage efficiency and competence? Shudder if you enter a ward advertising "team nursing". In my experience, this is a euphemism for no one in charge and everyone doing their own thing as and when they choose.

Relying on a sense of personal responsibility and everyone treating everyone else as adults is all very well, but unfortunately not everyone deserves that trust – including nurses, or rather the multiple specialists who now staff hospital wards. Someone needs to be in charge: to make sure everyone on the rota has turned up, that nurses' conversation doesn't keep patients awake at night, that monitors and drips etc are checked like clockwork, and that vanishing into side-rooms for a chat or an extended break is noted.

This unfashionable concept is called supervision, and it is achieved not by managers in offices, not by wandering matrons conducting spot checks, but through a hierarchy of responsibility on the actual ward. How, in other words, it used to be done.







Oh no, not again! I see a Patten emerging



I'm sure Chris Patten is an estimable chap. No one who knows him seems to have a bad word to say about him. With the benefit of that slight distance that not knowing him confers, however, I would like to offer a cynical yawn in advance of his much-trailed appointment as chairman of the BBC Trust.

What a contest it was: Lord Patten, former Conservative Party chairman, ex-governor of Hong Kong, ex-EU commissioner and chancellor of Oxford University, and ... drum roll, please, for that other estimable chap, Sir Richard Lambert, formerly of the Financial Times, the Bank of England's Monetary Policy Committee, the CBI, and most recently appointed to the Bank's new Financial Policy Committee.

Is it any wonder women don't get a look in when the greatest number of top jobs go to the smallest number? I dare say a few men might also feel a bit left out of this tight circle. And the phenomenon is self-perpetuating. To be qualified, or rather seen as qualified, for one of these jobs, you don't need what most of us might call relevant experience.

I'm not aware of Lord Patten's particular expertise in broadcasting or Sir Richard's as a hands-on financier or businessman. No, you need only to be chosen for one of these noble sinecures, and then another, to the point where you become the obvious candidate for anything. Directorships, university chancellorships and Royal Commission appointments then roll in of their own accord.

Now look at the dog's dinner they are making about getting more women on to company boards. Lord Davies is expected to announce a "target" of 30 per cent within two years. You want to bet? Alas, they will say sorrowfully, there just aren't the qualified women around (under their own special definition of "qualified"), whereas there are hundreds of men. Actually, there aren't. While unpaid internships increasingly restrict access to the bottom rung of the gilded career ladder, a tiny old boys' network still doughtily guards the glittering prizes at the top.





'Moda Italia' that keeps protests in vogue



It pains me to say this, as I know I should have thoughts only of sisterly solidarity and the manifold sins against our gender allegedly committed by the Italian Prime Minister.

But, my goodness, have you seen the clothes? No, not Ruby the belly-dancer's attire – that would be in questionable taste whatever her age – but the coats and the jackets and the suits of Signor B and his posse of lawyers? Or the "smart casual" gear sported by the indignant ladies of Rome on their protest march?

Just a glance reminded me of the day many years ago (two days, in fact, as I missed the plane the first day) when I was flying from Milan to Moscow. It was autumn or spring, I forget which, but close enough to winter for Milan's travelling classes to have turned out in the most utterly gorgeous furs, suedes and woollens, as only Italians can style them. So, while I'm doing my best to share the fury of Italy's women, I'm finding it hard to have eyes for anything other than their clothes. Very green, very jealous eyes.



m.dejevsky@independent.co.uk

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