No blaming the Tories on this one, Paul Cotterill. Why can’t you bring yourself to name and shame the Labour government under whose watch these sorts of things happen?

Re: 1

He doesn’t mention Thatcher anywhere, he simply states that union power has dissolved since the 1980s. Why do you keep bringing up this agenda where it’s not relevant?

The Royal College of Nursing is a pretty useless union. Unison does a better job representing nurses. However, when staffing levels are so low how can nurses take industrial action? It would take time, planning and a lot of determination that could only happen with the co-ordinated activism of a significant number of staff. Not something the RCN is renowned for.

Government regulation regarding patient / nurse ratios can always be pushed upwards just as they have by management chasing “efficiency”. It started under Thatcher but New Labour’s extra funding largely went on increased wages (justifiably), consultants and management (questionable) and poorly negotiated contracts with GPs and consultants. The creeping privatisation of the health service pours millions of public money into PFIs and ISTCs as well as the extra admin for privatisation-ready bitesize PCTs, polyclinics etc.

Perhaps exposing the facts to public scrutiny would be the best way to prevent this happening again, but with the half-witted nature of our media I have little hope of it happening.

I’d agree with most of Paul’s analysis, and add some points, which while they can be laid at new labour’s door, I can’t see either them or the Tories addressing; a major issue is the erroneous assumption that any work with a physical ‘hands-on’ aspect is to be provided at the cheapest level possible, with the concomitant assumption that people with degrees shouldn’t do that kind of thing.So, we get nurses with degrees who have bugger all actual nursing time under their belts but a lot of padded-out theory to ocupy their time, and many HCAs, who haven’t adequate skills or scope to take up the hands-on stuff, so protocol-bound are they.
What should have happened is that (along with many other lines of work with a physical side to them) nurses should have been given more scope in running wards in a hands-on way, instead of young recruits to the profession being encouraged to think of nursing as a theoretical exercise, with a dismal detachment ensuing in too many cases. In other words restore and elevate the status of hands-on nursing,trusting such nurses,instaed of trying to turn them into something that is neither fish nor fowl: too remote for the dirty work, not equipped to be quasi-doctors which the more naive take themselves to be.
I’d argue it goes with the haughty (New lab/think tank/wonk) denigration of practical work, and the strange belief that such work is not worthy of decent rewards: for pay rises, the decent worker has to be distanced from the workface, resort to managerialist-speak, and devote themselves to the airy world of protocols and policy.
The ‘answers’ are relatively simple: fewer HCAs, more nurses with their prime function being hands-on, and better pay: it’s akin to rewarding your NCOs because of their experience, as opposed to wanting everyone to go to Sandhurst.

Reportedly, the Stafford hospital management was obsessively committed to meeting official targets. Evidently, it was selective about which targets to achieve. Apparently, patient care and comfort weren’t among them.

The customary cliche surely applies: Lessons will be drawn. Mind you, some of us have been warning for years about the way targets distort resource allocations and the recurring failure of the NHS hierarchy to learn from Soviet experience reported as far back as the early 1960s – see the late Alec Nove’s book: The Soviet Economy. One of our problems has been a succession of ignorant and stupid health ministers, starting with Frank Dobson.

How about surcharging Patricia Hewitt for the fiasco of that £12.4bn programme to create a national database of personal medical records – despite numerous warnings from healthcare professionals about the risk to patient confidentiality and from IT people about technical issues?

4 Nurses with degrees, perish the thought – the reason that nursing is to become a degree based subject is quite simple, nurses are now doing the jobs that, at one time, were left to junior doctors (who would be expected to hold a degree).
Health-care assistants are now doing nursing jobs, the criteria for nursing has been downgraded, particularly with reference to the care of the elderly. This is fueled, in part, by the aging demographic and the pursuit of ever cheaper healthcare.
Hands-on nursing, whatever you perceive it to mean, is, for me, a reality. All nursing disciplines are not physically hands-on eg running around with bedpans,
you grossly misrepresent what the role of the nurse actually is, I suspect you hold right-wing views, and all the answers are so naively easy.

I still chuckle every time I read this;
http://www.mentalnurse.org.uk/2010/02/mid-staffordshire-uncaring-or-overwhelmed/

Let’s be honest very little will ever change as long as the movers and shakers remain far, far away from the reality of the patient’s situation.

At the very least any new policies should be withheld until it can detail specific time, cost and training implications for staff on the ground (none ever do, of course).

The DoH is like a gargantuan life support machine pumping out a steady stream of gibberish designed to irritate front line workers who have barely had time to digest the telephone book issued just 5 minutes ago.

As Bob B [5] succinctly points out – lessons will NOT be learnt.

@6: “4 Nurses with degrees, perish the thought”

The trouble with your analysis is that it has absolutely no regard for the much wider range of career options open to young women nowadays when more than half the students taking undergraduate degrees are women:

“Women students outnumber men across the board”
http://www.timesonline.co.uk/tol/news/uk/article1074003.ece

Decades back, the London teaching hospitals could demand and get A-levels as entry requirements from applicants for nurse training places.

Nursing was a hugely respectable and hugely respected career option for young women but times have moved on and young women now have many alternative challenging and interesting education opportunities and career options open to them. If there are no higher education opportunities to qualify for a nursing qualification, why would any bright young woman opt to choose nursing as a career? Besides, a degree provides greater job flexibility later on.

@jb (6)
A complete misreading of both my post and my political viewpoint (a dime to a dollar says I’m to the left of you). The issue is the technocratisation of the profession, and the structures for progression. What is emerging is a disconnect between the protocol-fixated managerialist nurses with little on-ward experience, but thoroughly versed in managerialst-influenced DH theory, and those with hard-earned real-world insight.The insistence upon degree before all else is back-to-front, tied in with the delegation of supposedly menial tasks to HCAs, which reduces the amount of vigilance/monitoring time for full-blown (ie better clinically qualified) nurses.An HCA is not well-equipped to pick up on small, but possibly significant pointers. Where training and career progression should be focussed, but isn’t, is upon taken those who’ve built up on-ward time and experience and enabling them to upskill,take degrees etc. Instead we have a curious approach whereby theory-heavy but experience-light fast-trackers process top-down DH pronouncements without the ability to query them or tailor them to the actual cases encountered.

What is needed is the re-establishment of the matron system .
Hattie Jaques type figures who dominated their wards.
No more privatisation and auxillary nurses but nurses cleaning beds, where they can see some of the problems.

I think you’re begging the question about the structure of the nursing degree. I would hope that placement in varied workplaces featured strongly in any such course, a bit like PGCE where teaching students find themselves facing classes of kids after only a few weeks.

My last posting was in response to Alisdair @9, not that old saw from Golden about matrons.

Blanco @1: As Gwyn @2 says, I’m not trying to excuse the Labour government in any way over this. That’s why I write the first sentence as I do. The piece is actually the companion piece to yesterday’s (and was written as the same post at http://thoughcowardsflinch.com/2010/03/03/labours-manifesto-the-need-to-commit-to-nursing/, and it’s about how Labour should take responsibility for what has gone wrong, and commit to decent staffing levels in its manifesto. Ed Miliband, or at least his tweetmeister (see yesterday’s post) has at least stated that my proposals as submitted by twitter are ‘very interesting’. We’ll see, but it’s a start.

Yurrzem @3: I couldn’t agree more about the RCN. One bit that got edited out of this briefer version at LibCon from my original post was:

“Even more perniciously, though, the shift towards degree-based nursing removed nurses from the immediacy of a workforce-based relationship with the nursing trade unions (originally NUPE and COHSE, then combined as UNISON), for whom a key issue in the 1980s had been the maintenance and improvement of ward staffing levels.

The Royal College of Nursing (RCN), which sometimes describes itself as a trade union but is not one in the terms that I understand, became the more ‘normal’ membership organisation for many degree nurses, but has never to the best of my knowledge campaigned for decent staffing levels on wards. Rather, it remains bound up as it is in its own insular world of professionalisation and a pandering to the ‘health elite’, to the extent that I even take great exception to its definition of what nursing is (there’s another full post to be had here when I feel angry enough about the RCN’s betrayal).”

This was challenged in the comments by the RCN press office (see http://thoughcowardsflinch.com/2010/03/03/labours-manifesto-the-need-to-commit-to-nursing/#comment-5630). Fair enough, that’s as you’d expect them to do, and as a courtesy I added the note to the bottom of this piece, as recognition that staffing levels are at least on their agenda. It’ll be interesting to see who has the biggest impact on Labour’s manifeso – this tiny piece of mine or the ‘campaign’ of a 400,000 member organisation.

Apologies to all others – got to go out now and help get elected a Labour government who may put this commitment in its manifesto – more replies later but thanks in advance for v good engagement.

8 You can’t have it both ways:- nursing isn’t what it was in the 50s or even 60s and 70s, new technology, the shortage of doctors and a different demographic has totally changed nursing. There are now good career opportunities within nursing but then this is criticised as not representative of nursing (usually this means something akin to the stereotype of ‘Carry on Nurse’ ) In fact, not only is nursing going to become a degree level profession, ‘The Sainsbury Centre for Mental Health’ is suggesting that mental health nursing should be degree-level entry.
9 I did not misread or mis-represent your post, you clearly have your own value-judgements about the role of the nurse, but would you insist that doctors had ‘hands-on ward experience’ before taking a degree? And what is your definition of a menial task?
7 a&e charge nurse, totally agree with you, it doesn’t help either when reams of diktaks, changes to procedure and a plethora of different risk assessments land on your desk.

@14: “8 You can’t have it both ways”

I’m not having it bothways.

What I’m saying is that there are now many more career oppotunities open to young women through higher education routes than there used to be decades ago. Nursing has to compete against all the other opportunities when girls are leaving schools with more and better exam grades than male students.

Unless nursing is made a graduate career, there’s a real risk of recruiting as trainee nurses only or mostly those who can’t make the grades needed for university entrance. And that would be a shame – especially since nursing requires more professional knowledge nowadays as well as the ability to deal with increasing use of technologies.

Btw I’ve a friendly argument going with a highly computer literate personal friend who is almost a decade older than I am. He says that on the basis of his (long and wide) career experience using computers, women are constitutionally averse to handling computers. I say that’s nonsense and that IME women technical advisers in Indian call-centres are often much better than their male colleagues – and my son agrees and he has management experience in India.

Article from Telegrpraph . It would appear that not only do we need matrons but we need to ensure they have the same authority which used to be held by those such as Emily McManus .

SIR – I would suggest that anyone interested in how hospitals were once run should try to get hold of a copy of Matron of Guy’s, the autobiography of Emily MacManus. She was Matron when I was training at Guy’s during the war. She was a formidable woman and her knowledge of running a hospital efficiently was remarkable.

In those days, nursing was looked on as a vocation. The staff were, in most cases, single women, not juggling home and family commitments with their work. Care and compassion for patients was their main priority.

We can never go back to those days, but I think it does explain the difference in attitudes and efficiency in our hospitals today.

Glennis Leatherdale
Bradford on Avon, Wiltshire

Not sure what the answer is here, but I am pretty convinced it is not best answered by assuming nursing only applies to young women – since that cuts out half the potential labour force. So the discussion between Bob B and jb is perhaps a bit obtuse.

Mind you, it perhaps dates from the era of matrons. The problem is that a matron was a manager, and to wield that sort of power in a modern system requires also filling in a lot of paperwork etc to show why and how power is being wielded. I doubt titles are a problem – good managers are good managers regardless of title – but rather a culture where managing requires paperwork. Tends to take your eyes off the ball a bit does a pile of forms…

@17

If you visit acute hospitals – as I often do for healthcare reasons – you’ll find that not only are most of the nurses women, but so are a majority of the technicians and administrative staff too. Around where I live, the CEOs of several hospital trusts and PCTs are women – and I’m not complaining. There are male nurses and technicians, of course, but they are in a minority.

In practical terms, for the most part recruiting trainee nurses means attracting young women away from the many alternative and attractive careers now open through the greater employment opportunities created by higher education when girls are leaving schools with better achievements in the school leaving exams than boys.

The majority of medical school graduates are now women – which rather diminishes all the stuff here about bringing back the old hospital matrons with their nursing qualification. Senior hospital administrators are now quite likely to have a MBA in addition to medical qualifications.

Face the facts.

Failing to make nursing a graduate profession will result in nursing becoming a career option for those who can’t make the standards in the school leaving exams needed for university entrance. In only a few years time, the majority of new GPs and hospital doctors will be women. Nurses will need to be graduates for status reasons.

[17] “Not sure what the answer is here”.

Oh, it’s very simple, and has virtually nothing to do with the reincarnation of a
50′s-type Hattie Jacques figure.

Nobody expects a barrister to prosecute 20 cases at the same time.
Nobody expects a surgeon to perform 20 operations simultaneously.

Yet nurses are expected to manage a ward with ratios of 1:20 – it’s so common place that hospital managers expect no difference nowadays;
http://militantmedicalnurse.blogspot.com/2010/02/what-actually-happens-when-we-are.html

Don’t forget nursing is labour intensive (especially for the 25%+ of patients in hospital who are cognitively impaired) while acuity and complexity are far greater compared to admissions of even 20 years ago.

Has there been ANY hospital scandal recently (in the NHS) that did not arrive at the the self-evident conclusion that there were not enough nurses at the coal face?

18/19. Is not the problem here that we are pulling in two different directions? Bob suggests we need to make nursing a graduate profession, whilst a&e (if I may be so informal?) indicates we need more nurses on wards, which is not what happens through University degrees.

Perhaps we need something different than a single class of nurses then? Is the entire current system not working due to competing issues such as these pulling it is different directions. After all, if we asked what does a nurse actually do, would the resultant picture show just one job description, or a variety with hugely varying responsibilities and levels of education. And if the latter (which I am certain is the case) is classing them all as ‘nurse’ not just merely a historical relict which is confusing our ability to discuss the evidence?

” which is not what happens through University degrees.”

Nurses need university degrees because – as A&E charge nurse has pointed out @19 – “acuity and complexity are far greater compared to admissions of even 20 years ago.” One major cause of this is increasing longevity with our resulting ageing population so that more patients will have developed chronic ailments, perhaps several.

We don’t just need more nursing hands but also more educated, trained and knowledgeable brains to go with the hands as well.

Btw on the claimed need for more Hattie Jacques matrons, the CEO of our local hospital trust is a young woman who started out her career as a trained children’s nurse. She looks nothing remotely like Hattie Jacques. As reported in our local press, she has recently become a single mum with the birth of twins but is now back at work.

Bob,

My question was more fundamental – are we so caught up in using the term nurse that we have ignored the possibility that it covers a multiplicity of roles? I do not doubt we need degree-trained nurses, but do they need to provide all the nursing care? I have no particular axe to grind, just floating ideas.

Of course, not all caring and ward staff in hospitals need be graduates but we certainly need nurses – and technicians – educated and trained up to graduate standards otherwise I’m very fearful about what will happen to the ability range of those recruited into nurse training places.

I’ve some fond memories of a group of hospital nurses I knew in the Midlands in the early 1960s but they all needed a string of O-levels to be accepted into training – and recall that O-levels were set for the top 20 to 25% of the ability range. There are hazards ahead from overlooking the fundamental changes in the opportunities open to young women nowadays – more than half undergraduate students at our universities are now women. Sadly, it was never like that when I was a student.