Letter: Care on paper

As an ex-nurse of 18 years' experience, I know that Peter Fisher from the NHS Consultants' Association (letter, 29 January) is quite right about the culture clash in today's NHS.

For nurses, another problem is the stress caused by the mismatch between increasing responsibility and decreasing control. A common reaction is for nurses to retreat into the office, immersing themselves in paperwork while leaving patient care to untrained care assistants. This is actually the road to promotion, since the modern NHS manager is more impressed by documents than by real-life activity.

When I trained in the 1970s, nurse training was an apprenticeship. The modern training, being far more academic, invites unfavourable comparison with a degree, which would lead to a much higher starting salary.

PETER J LUCE.

Plymouth, Devon