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The NHS’s sympathy deficit

1 August 2014

Sometimes I have a quiet time as a voluntary hospital visitor. But recently I’ve witnessed a lot of distress from people of all ages and types. The other week I saw an elderly Middle Eastern man bent over a bin in a ward corridor, crying almost uncontrollably. I asked him the problem and he stuttered out that he had been watching his daughter sleeping, and he believed she was going to die.

I went off to find a nurse as I felt I didn’t know enough about his situation or hers to help. The nurse wouldn’t tell me anything due to patient confidentiality. I returned alone to the man and tried to sympathise. He managed to say that his daughter had food poisoning. I didn’t think that sounded too bad, but he added that his wife had died of it. It seemed complicated, but there was no one to ask, no one came to calm him down and there was no place we could go for privacy.

The same day I met a young Muslim from Southall, west London, with a chest infection aggravated by alcohol abuse. He’d been sent here as a child to live with his grandmother; his mother stayed in Pakistan. He qualified as an accountant, but depression and drink had left him jobless and homeless. ‘If I leave here,’ he told me, ‘I have nowhere to go.’

I asked a nurse about him. She said he had ‘plenty of relatives in Southall’, which he did. From what he’d told me he didn’t like any of them much. She said they’d ‘offered him their support’ so ‘the housing department is not interested’. And neither was she.

We are constantly told that the NHS is wrestling with its budgets. We all know that there is no money left for any extras for patients, such as toothpaste, bed socks, chiropodists and good food. But it often seems to me that tea and sympathy are also rationed.

Last week I met an old lady, very intelligent and well spoken, who has developed a bad skin condition on her legs. She found herself hardly able to walk, a very scary thing for old people who live alone. While she’s been in hospital her landlord has decided to sell her rented home and given her notice to quit. Her son wants her to find a care home near him, in Hastings, but before that she has to recover in a care home locally, in Acton. It’s all a great upheaval and she is naturally anxious.

The day I saw her, the offer of a place in a local home had been cancelled. She had no idea why, or where she was going. I went off to make her tea, trying to remember the code for the kitchen door — the catering women are often bad-tempered — and to try to root out some facts for her.


‘She’s going to be assessed today,’ the nursing sister told me crossly. ‘I’ve already told her once, so you don’t need to tell her again.’ The nurse had the attitude that she should be quiet and stop fussing. There was no time to attend to her fears. Opposite an old Irish lady was sitting in her chair, ready as she thought to go home and waiting to be collected. I inquired and found she was not due to go anywhere. The nurses were exasperated at her stupid confusion.

I moved on to a ward where there are a lot of old ladies, demented and sane mixed together. I’ve visited one lady several times but as she is almost stone deaf I can’t do anything except make her tea and hold her hand.  She has a hearing aid at home; a friend of hers visits and could bring it in. Twice I have asked a nurse to pass on the message. I know it’s never going to happen. The nurses won’t have the time or the will.

In the same ward I was surprised to see a girl, 17 at most, sitting on her bed with her iPod in her ears. She didn’t want tea, but was pleased to chat. I asked why she was stuck with the old dears. She didn’t know but said it was pretty bad, especially at night, when a lot of demented people get loquacious. ‘They all talk out loud to themselves,’ she said.

Just then a nurse and a woman doctor appeared at the end of her bed. I asked them if she might go to a side room. The doctor didn’t look up at me, but gave a glance at the nurse and slightly shook her head.

‘Side wards are for infection only,’ said the nurse, sounding like a robot. As I left I asked another nurse the same question. She was quite charming as she smiled and shook her head.  ‘Not a good situation,’ she said, ‘but nothing we can do.’

I just hoped they gave the girl some extra support, but I doubt it. In hospital these days, your only company comes in digital form, which you bring in with you.

I realise that a lot of this uncaring attitude is to do with lack of staff. Recently Unison, the UK’s largest trade union, warned that cuts could soon risk patient safety. Of 3,000 nurses questioned, 65 per cent said they didn’t have enough time with patients and 55 per cent that care was ‘left undone’ as a result.

But nursing has always been a very tough profession. I know that the study of history has been largely sidelined in our schools, but a quick glance at it tells us something about changing expectations. Unison is worried that 45 per cent of staff have to look after eight or more patients at once during their shift. Florence Nightingale went to nurse the wounded in the Crimea with 38 volunteer nurses, including her Auntie Mai. They tended approximately 18,000 grievously injured men. There were few beds, a shortage of supplies, no anaesthetics, epidemics were rife and a rotting horse was stuck in one of the drains. But I do not believe that ‘the lady with the lamp’ or her nurses were callous and indifferent towards their patients.

For a more recent view of nursing under pressure, take a glance at ‘Civilian Nursing in Lambeth Hospital during the Blitz’, by Doreen M. Abrahams. She describes incredible privation, danger and courage. Of course things were different then — nursing was like a cross between a military campaign and belonging to a religious order — but human beings and their needs are the same now.

As a hospital visitor I parachute in. I am not there to see how hard the nurses work. I don’t witness the stresses and strains that make them unkind. Some of them plainly see me as interfering, which I am. But appearing out of nowhere does allow me to hear directly from the patients how they are feeling. It only takes a few minutes of listening attentively to do this, and to befriend them.

The biggest change has been in our culture. The women Florence Nightingale sent into battle against disease and degradation, once known as angels, have been replaced, at least on general wards, by mechanistic bureaucrats. A toxic mixture of cost-cutting and spurious ideology has taken qualified nurses away from basic nursing and replaced them with overworked, underpaid nursing assistants. The outcome is clear for any hospital visitor to see — there is simply no one left on the wards to make a cup of tea or offer sympathy. Florence would be the lady with the hump if she ever got to hear about it.

This article first appeared in the print edition of The Spectator magazine, dated 2 August 2014

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  • JimHHalpert

    Some figures and a calculation.

    Number of nurses employed by NHS: 371,777
    Number of hours worked per week by nurses: 37.5
    Number of beds in NHS: 136,895
    Average occupancy: 87.4%

    Therefore, the average number of nursing hours per bed patient per week is:
    371,777 * 37.5 / (136,895 * 87.4%) = 116.5

    I.e. there are enough nurses employed by the NHS to give each patient a dedicated nurse for 16.6 hours every day, 7 days a week. This number will be reduced slightly to allow for annual leave, training, etc., for nurses. Does anyone think patients get anywhere near this amount of care? Where is all this nursing manpower going if it isn’t being expended on patients?


  • saffrin

    Idiot politicians and their placement CEO’s.
    Too many chiefs, not enough Indian’s.

  • anyfool

    When Labour told people they had 24 hours to save the NHS from the Tories.

    There was no mention of MRSA and other now rampant diseases.
    There was no mention of filthy wards,
    There was no mention of uncaring carers,
    There was no mention of patients lying in their own excrement.
    There was no mention of patients starving to death.
    There was no mention of thousands of avoidable deaths.
    There was no mention of deliberate killing of patients through the aptly named Liverpool Care Pathway.

    All this and the witless electorate still think Labour is to trusted on the NHS, you really have to give Labour a round of applause for their success in the dumbing down of education, a resounding victory in a slew of failure.

  • redrum

    1. A welfare system which wasn’t intended for what we are now using it for. Beveridge must be turning in his grave when he sees what it has become today;
    2. A breakdown of families, both emotionally and geographically, resulting in none of the historic support systems which patched up the gaps.

    I don’t advocate an increase in NHS expenditure; rather, an increase in educational expenditure and a reduction in benefits, so that everyone has the same opportunities to learn and earn. Once one has been provided with the opportunity, then if you don’t seize it, caveat emptor.

    • Inverted Meniscus

      We cannot have sensible ideas like this which would encourage self reliance. I mean, what would happen to Labour’s client vote?

  • Rhoda Klapp8

    I know a senior nurse, from the US and married to an English man, who has worked in the NHS for three or four years. Recently after a holiday in the US she was taken aside by immigration at heathrow for not having a valid work permit. The NHS hadn’t renewed it, by neglect. She was sent back, no appeal, a week to set her affairs in order. and no right to take her daughter. Now she is lost to the NHS. She is pretty pissed off at this treatment, and now all three of them are going to live in the US. There is no problem finding a nursing post there.

    Now how was that a good idea?

  • HJ777

    This shortage of nurses thing.

    International comparisons show that although we have fewer medics per head of population, we are relatively well endowed with nurses. So do we really have too few, or are they used inefficiently, or do most countries also have too few?

    Can anyone throw any light on this?

    • Holly

      Maybe it’s because other nations have fewer patients, due to the fact many of them are here, those that stay in the other nations, ‘cop it’.

      • HJ777

        I don’t think that is the case. The figures seem to show that we have fewer hospital beds per head of population than most countries, but just as many, if not more, nurses.

        I genuinely don’t understand why we are deemed to have a particular shortage, unless, of course, every country feels they have a shortage but I am just unaware of this.

        • Alexsandr

          we dont train enough medics so have to import them -probably from countries that have a dire need for them at home. but training medics is expensive.

          • HJ777

            Yes, I knew that. We have long artificially restricted access to medical training in the UK, turning away many eminently suitable candidates.

            That’s central planning of the NHS for you, supported by the BMA who rather like there to be a shortage in order to guarantee employment and high wages for their members.

      • Shazza

        International Health Service

    • Fergus Pickering

      Do ‘most countries’ do better?

  • you_kid

    Not a single healthy individual in Britain cares about the state of the NHS, and why would they, it’s virtually free.
    That is diametrically opposed to nations in which far larger amounts of cash are automatically deducted from pay packets to fund far superior healthcare. When 15%+ of your income goes on healthcare then you bet people will do every single checkup and preventative treatment available to mankind. You betcha there’s waste.

    So in the end it all boils down to one thing: what are respective nations prepared to afford.

    • pointlesswasteoftime

      I have been an intensive user of the NHS for the past 20 years and, I have to say, have never encountered “bad attitude” from any frontline carer/professional. The worst offenders are the bureaucrats in the middle who don’t actually get to to see the effects of their decisions to delay surgery, cut nursing staff, impose new targets, or whatever is their latest fancy. Those bureaucrats, by the way, include the politicians who won’t let nurses and doctors get on with their job the way they want to.

      • JimHHalpert

        Wow. You should buy a lottery ticket.

    • Alexsandr

      have you looked at the NI you pay. That is supposed to be for NHS and welfare.

  • English Majority


    It was a very good idea to allow 20 million Third World immigrants to drain our NHS, wasn’t it.

    This is what happens to a dying nation. Our heart and soul have been torn out.

    This is what happens to a colonised and defeated people. This is what immigration has done to us.

    Only just beginning.

    • Shazza

      If you import hordes of Third World immigrants into a First World country, it will not take very long before you are a Third World country.

      This toxic policy, which Labour’s deliberately and ferociously pursued during their Reign of Terror 1997- 2010 is the foremost cause of the chaos that is now being experienced in housing, schooling, NHS etc.

      The true legacy of this traitorous Party will be the rapid transformation of the UK into an islamic state within 30 years. The NHS will be the least of our worries then.

      • English Majority


  • Alexsandr

    i blame the conversion of nursing to be a degree entry one. Nurses have been converted into technicians and the caring part of the job seems to be neglected.

    • HJ777

      It is only just happening, so can’t be the reason.

      • DavidJohnson

        Well not quite, the old state registered nurses are now all retiring, and have been replaced by the degree entry nurses. It’s been a generation since degree level nurses were introduced.

        • HJ777

          My point was that it is only now that nurses are being required, for the first time, to take degree courses.

          Of course, some already have been taking degree courses for some time, but most took diploma courses.

          • DavidJohnson

            Oh I see, I wasn’t aware that there had been a change from diploma and degree level.

            Based on what I’ve been told by relatives who are of the SRN variety, the problem now that teaching is done in universities, is that there is a lack of hands on experience and a reluctance to do what you might call basic care. Essentially the conversion to technicians Alexandr mentions. Another possibility is the expansion of roles like Auxiliary nurses and Care Assistants has distanced nurses from direct patient care turning them into pseudo- medics. I appreciate that there may be a bit of “it was better in my day” from my relations, but it’s worth considering.

            I am not sure how this problem is to be fixed, with every improvement in technology there’s more demand on medics and nurses to operate and apply the technology. As a result there is less time for making patients comfortable and so on.

            In addition there have been some fairly hokey management practices in recent years. One in particular has been the removal of “task orientated nursing”. The idea is that nurses shouldn’t be doing rounds of the ward every hour or so to check on patients, as this is an “inefficient” task, rather they should be “responsive”. Personally this all sounds like a way of justifying less nursing staff on the ward.

            • HJ777

              I’m not sure that the adoption of the role of ‘medical technicians’ by nurses – at least some nurses – is necessarily a bad thing, or at least not universally so.

              There have long been rather ridiculous demarcations within the NHS, where medics sought to preserve privileges even for relatively straightforward diagnoses and treatments – things that could easily be done by other staff, suitably trained.

              The one time I have needed NHS treatment in the last decade, I was very capably diagnosed and given initial treatment by a nurse practitioner.

              • DavidJohnson

                I’ve used the NHS twice in the last 5 years, once for a piece of glass in the finger, once for labrynthitis. Both are acute problems which were dealt with promptly and efficiently. I couldn’t fault them.
                When there’s a clear process involved the NHS is very capable. However, when it comes to managing chronic or end of life care it seems much less able to provide quality care. I suppose it’s unsurprising a state funded monolith could deal with a problem which the treatment is always the same (like glass stuck in finger) but not so good at listening to the individual needs of a patient. This I think is only exacerbated by moving the nursing staff away from basic care.
                It’s not that I don’t think nurses are capable of diagnosing and treating many conditions it’s more recognising there’s a cost associated with that. Perhaps the solution is to train care assistants up to the level we’ve previously trained nurses to – but that would involve paying them more..

                • HJ777

                  “It’s not that I don’t think nurses are capable of diagnosing and treating many conditions it’s more recognising there’s a cost associated with that.”

                  There’s also a cost saving, as medics are highly paid in this country. It could be argued that this cost saving could be used to pay for more nursing care.

                • DavidJohnson

                  Sorry I didn’t make myself clear, I didn’t mean cost in terms of expenditure. I am suggesting that in expanding the nurses role has cost us some of the expertise and attention paid to their traditional role.
                  I agree economically it probably makes sense, but unless as you suggest, we invest more in basic nursing care there’s undoubtedly going to be a decrease in the quality of nursing care.

                  Don’t misunderstand me, I would rather be cured of a disease than have a nurse sympathetically mop my brow as I die. But I think we all recognise there’s a problem with the ‘care’ side of thing.

                • HJ777

                  The problem is that the ‘care side’ is very labour-intensive, and therefore is expensive and has low ‘productivity’.

            • Damaris Tighe

              Sounds like the change from beat policing to panda cars.

      • JoeDM

        Its been getting worse over the past 20 years or so.

        • HJ777

          What I meant was that the requirement to take a degree course has only just happened and until now, the vast majority of nurses too diploma courses.

          • Alexsandr

            but nurse training have become less hands on and more academic. We dont see the student nurses on the wards like we used to.

            • HJ777

              Perhaps, but my point was simply that this can’t be attributed mainly to degree entry nursing.

  • Damaris Tighe

    Very sad & I think your analysis, Jane, is a good one. But isn’t it interesting that the more a society witters on about ‘caring’ & ‘compassion’, the less caring & compassionate it actually becomes.

    • Holly

      Easier to say, (makes the ‘sayer’ feel better about themself for ‘thinking it)
      Than do, (too busy wittering about, it to do anything).

      • Fergus Pickering

        I think you have the crux of it. Jane feels really god about being a caring person. Not doing anything of course, just being a caring person. For a laoad of self-satisfied wittering this takes some beating.

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