Leading article: What can and should be done about nursing


The National Health Service is one of the biggest employers in the world, and it would be unrealistic to expect everything to run perfectly everywhere all the time. Nor was there an age, except in folk memory perhaps, when all nurses were both supremely competent and kind. Scandals have punctuated the history of nursing, even as the image of ministering angel has gained hold. Whether it is comparison with a non-existent past or simply the higher expectations of today, however, reports of inadequate, neglectful and even callous care by those paid to look after the sick have proliferated in recent years.

It would have been consoling to believe that the desperate experience of some elderly patients at Mid Staffordshire NHS Foundation Trust, where visitors notoriously reported relatives so parched that they had resorted to drinking water out of flower vases, was an isolated example of a badly run institution. Instead, those revelations brought forth a torrent of horror stories. Mid Staffs, it seemed, was not so unusual after all.

Around the same time, The Independent's Christina Patterson was gaining her own distinctly mixed experience of NHS hospitals, where the nursing care veered from the compassionate and excellent to the ignorant and downright cruel. In the past few months, she has set out to try to find out how far there was a crisis in NHS nursing; and if there was, why it had come about and what could be, and was being, done about it. Today, and the rest of the week, we are printing her reports and conclusions from the front line of nursing.

As she writes, a common response to patients' poor experience of nursing care has been to call for the clocks to be turned back to a time when matron and starch-ed caps and aprons ruled. But this is too simplistic a remedy. Times have changed, and nursing has had to change with them. Nurses need far more knowledge and technical expertise than they once did. The requirement for them to have a more academic education is not, in itself, misplaced, but the concentration on this aspect may have had knock-on effects elsewhere. Nor is this all that may have contributed to the shortcomings so widely observed. There have been changes in society, in education and in job opportunities for women, all of which play a part.

We try to pinpoint here not just what has been going so wrong – about which there is, when it comes down to it, much agreement – but what is going right, and how the best experience can be replicated. For all the distressing complaints about bad practice, there are many excellent nurses and many inspirational examples. And because the picture is so varied, so must be the solutions. This is not a problem where a single lever can be adjusted and everything rectifies itself overnight.

Much is already being done to try to address the most glaring deficiencies. Some poor hospitals have turned themselves round with spectacular success. Good leadership is crucial to nursing, as it is to so many other institutions. So, too, though is consistency. And while the very many good nurses may find it insulting that so much focus in official reports and in the media is on the bad, it is only by identifying what is wrong that more will be made to go right.

Special report: A crisis in nursing
* Day One: Six operations, six stays in hospital – and six first-hand experiences of the care that doesn't care enough
* Christina Patterson: More nurses, better paid than ever – so why are standards going down?
* Leading article: What can and should be done about nursing
* Day Two: Reforms in the 1990s were supposed to make nursing care better. Instead, there's a widely shared sense that this was how today's compassion deficit began. How did we come to this?
* Day Three: How can a profession whose raison d'être is caring attract so much criticism for its perceived callousness? Does nursing need to be managed differently? Or is the answer to develop a new culture of compassion?
* Day Four: The nurses who taught an ailing hospital how to care