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