A book by a woman who spent her life in the NHS exposes the unthinking neglect of patients by some of today's nurses. Her words will shock you, but make a vital contribution to the debate over the NHS's future

A book by a woman who spent her life in the NHS exposes the unthinking neglect of patients by some of today's nurses. Her words will shock you, but make a vital contribution to the debate over the NHS's future

My next door neighbour ­Lillian was a spritely lady in her 80s.

For much of her life she had been a skilled seamstress and paid particular ­attention to her dress and appearance, but one morning her daughter Margaret came round to tell me Lillian had been taken ill and admitted to hospital.

I went to visit her that afternoon, after finishing my shift as a practice nurse at our local GP ­surgery. When I arrived on the geriatric ward the sister in charge and several other nurses were ­sitting around their station, drinking tea and ­sharing a joke.

I asked where Lillian was and Sister pointed to a four-bedded bay directly opposite them. The only occupant was an elderly lady who was sitting slumped over her table, face down in her ­congealing meal, both slippered feet surrounded by a puddle of urine.

As I approached, I had great difficulty believing what I was seeing. I was disgusted that my friend and neighbour could be treated in such a manner.
Tears welled in my eyes and I had to hang back for a moment to regain control before I went over, bent down and held her hand. She didn’t even have the strength to raise her head so I helped her sit up, her face and hair covered in gravy.

‘Is that you, Joan?’ she whispered, and I assured her that it was and asked whether she would mind if I cleaned her up.

‘Yes please,’ she said.

I was seething with rage. I wasn’t in my nurse’s uniform and none of the staff knew me yet they all just sat and watched as I grabbed a washing ­trolley and pulled the curtains around the bed.

Lillian was incontinent, so I washed her from head to toe, changed her clothes and bagged up her nightdress, slippers and dressing gown. She ­whispered her thanks over and over again but was so weak that she could barely move.

When I pulled back the curtains, the staff were still sitting there, not one of them having offered to help. I dumped the dirty trolley in front of them with a bang and presented myself to Sister, angrily pointing out that it now needed cleaning.

‘Have you let Lillian’s daughter know how poorly she is?’ I asked, trying to remain calm.

With a total absence of empathy or care, this ‘angel’ stared at me like I had two heads and told me that Lillian was just tired and sulking because she didn’t want to get up.

‘She is dying,’ I said, but this statement simply brought looks of ­derision from the assembled nurses.

As I left the hospital, Margaret was just coming in. I made her aware of all that had taken place since my arrival, then went home and sobbed my heart out.

Lillian died that night, yet another example of the neglect and lack of professionalism which is all too ­common in the NHS today
When I left school, nursing was seen as a vocation rather than a job. What you needed was common sense and a ­willingness to work hard,' said Joan

Another friend, in his sixties, was admitted to hospital for a chest operation last year. His condition made it impossible for him to bathe himself normally, yet not once ­during his two-week stay was he given a bed bath.

Like anyone who prides themselves on basic cleanliness and hygiene, he found this deeply distressing, but his concerns were ignored even when he asked for a bowl so that he could clean himself.

Not long afterwards, another friend was on an NHS ward while doctors investigated a problem he had with swallowing. You might think that this would focus the nursing staff’s attention on his oral hygiene but his brother, who spent many hours at his bedside, later told me that no attempt was made to moisten his mouth or keep him hydrated.

After his lips became severely cracked and began bleeding, the family asked me for advice and I ­recommended they buy him a basic mouthcare kit which is freely ­available at the chemist’s, and ­immediately brought him relief.

I would have presumed that this was familiar to modern-day nurses but I have learned that nothing can be taken for granted in today’s NHS, including basic attention to cleanliness.

Another friend who went in for an operation last year was appalled on arrival to find a pool of congealed blood on the floor next to his bed. When he pointed this out to a cleaner, she told him that dealing with bodily fluids was a nurse’s job. But the nurse he approached looked at him with disdain.
‘I’m a nurse not a cleaner,’ she said.

That blood was still there when he left hospital two weeks later.

I find it all the harder to accept such attitudes when I think of the amazing examples of good old-­fashioned nursing I witnessed during my 41 years in the profession.

When I arrived at Blackburn Royal Infirmary as a nervous 16-year-old nursing cadet in 1966, I wondered if I had strayed into an army barracks instead of a hospital.

Everything had to be spotlessly clean and tidy, including our uniforms. Hair was to be kept off the collar and jewellery was banned and Miss Donavan, the Matron, came down hard on us if there was any breach of these rules.

Anyone senior, from Miss Donavan downwards, could tell you what to do; and believe me there was no argument. Etiquette was fierce. ­Juniors were expected to open doors for senior staff, always standing back and letting them through first.

It was also frowned upon for anyone to address you by anything other than your rank, especially in front of patients. Familiarity was totally unacceptable.

As nursing cadets we were expected to play our part in cleaning everything from patients’ lockers to their false teeth. I took care not to repeat the mistake of one cadet who had the bright idea of collecting all the false teeth together in one bowl, with resulting chaos.

One illustration of the high standards demanded of us arose when I was scrubbing down a bed after a patient had been discharged. I thought I had cleaned every square inch until our tutor Miss Yates got on her hands and knees and, with a gloved finger, found a trace of dust under the bed frame.

When she ordered me to start all over again, I was so embarrassed I could have died — but she was right, because Matron would be apoplectic at any hint of slovenliness.

What an indictment of the modern NHS that private hospitals can now use the prospect of a patient ­receiving treatment in a clean room as a marketing strategy.

Although strict and demanding, matrons were greatly respected as highly experienced nurses whose lives were devoted to the interests of their staff and patients, and this dedication inspired all of us.
\There is longer any one person in charge of patient care in each hospital, no one with authority

In today’s climate, where nurses seem averse to dealing with the basics such as hygiene, Miss ­Donovan would have approved of the ­dedication shown by Valerie, another nurse who trained in that era when our only priority was the welfare of our patients.

Once we were working together in Casualty when two ambulance men brought in a bedraggled tramp who had collapsed in the local park. He had head and body lice — even his beard was crawling with wildlife — yet Valerie spoke to him as if he were her father.

She washed and scrubbed him and gave him a haircut. Amazingly, under all the layers of dirt and hair there was a reasonably normal middle-aged human being, and I will never forget Valerie’s kindness.

That tramp couldn’t have been treated any better if he had been a member of the royal family and that was a tribute not just to Valerie’s own caring nature but the commitment to patients’ well-being insisted on by the matrons.

When matrons were phased out at the end of the 1960s and replaced by managers, things soon began to slide. There was no longer any one person in charge of patient care in each hospital, no one with the authority and respect of those like Miss Donavan.

She would certainly never have ­tolerated the disregard for patients I saw for myself when visiting an ­elderly neighbour in hospital many years later. I was appalled to find that my friend had been plonked on a commode in the middle of the ward, half-naked and crying with embarrassment.

Things had not improved when my husband and I went to visit his dying father in hospital. As we sat at his bedside, we heard an old man asking repeatedly for a urine bottle but he was paid no heed by the nurses who were at their station, writing up their reports. When I finally went over and told them that he needed to urinate, one of them informed me that his ‘named nurse’ was on a break.

‘So you are telling me that this poor man will be ignored until she turns up again?’ I asked.

‘Yes,’ was the answer and I was so angry that I went and got him a urine bottle myself.

I am sure that many of the new generation of nurses are as caring as we were. But what chance do they have of showing it when the hospitals in which they work are run not by experienced nurses but by bureaucrats?

Too often these managers fail to realise that patients are people, not commodities, and that management skills acquired in banks and retail ­business don’t necessarily transfer to the running of NHS hospitals.

Part of the problem is that medical advances are happening all the time. New life-saving operations and machinery are wonderful news for everybody but not if the money to pay for them is being taken from the nursing budgets, with fewer qualified nurses on the wards.

The constant squeeze on finances also results in more and more ­targets and financial controls. So much time and effort today is spent on ­administration and paperwork that management have lost sight of the real purpose of nursing. We can see this in their recruitment policies.

From 2013, all student nurses must possess a degree-level qualification in order to be allowed to train, yet I have never seen any ­evidence that graduates make ­better nurses.

When I left school, nursing was seen as a vocation rather than a job. You didn’t have to be exceptionally clever, but what you did need was common sense and a ­willingness to work hard.

Most of all, you had to be caring and compassionate, something which Miss Donavan never let us forget. The reputation of matrons like her clearly stuck in the public mind because, nine years ago, the then Labour government made much of the return of matrons. But these are matrons in name only.

There are often many of them within one hospital, each presiding over only one department — one for geriatrics, one for surgery and so on. This completely misses the point of having a single authority figure to remind everyone that the purpose of nursing is to look after sick people.

Miss Donavan taught us that no task is too basic or unpalatable. It doesn’t matter if it’s cleaning up an incontinent patient or simply ­taking the time to observe whether someone is cold, hungry or in pain, and acting upon it.

Somewhere along the line this seems to have been forgotten. Only a few months ago, a former ­colleague who is a senior sister in a hospice asked a student nurse to help her change a dying lady who had been incontinent. The student looked at her in disgust.

‘I don’t do mess,’ she replied.

I dread to think what Miss ­Donavan would have made of that.

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