What Went Wrong With Nursing?

My beloved Aunt Ena was a nurse almost all her life. She was tiny, fierce, immensely generous with her small possessions, secretly charitable,  happily self-sacrificial with no thought of reward, funny, full of poetry (she could quote at will from the English poets), profoundly and seriously Christian (her Bible, which I inherited, was soft from frequent and careful reading) selfless almost beyond belief (especially since she possessed the Hitchens temper, which in moments of stress is as hard to control as Chernobyl). She learned her calling in the great old London hospitals, under terrifying matrons who had probably met Florence Nightingale and in whose sight no speck of dirt, no badly-made bed, no bedsores and no sloppiness could survive. She learned even more in the Queen Alexandra’s military nursing service, as she followed close behind the Allied Armies as they fought their way into Germany after D-Day. As time has gone by, and I have learned more about what is important and what is not,  I have come to think that she was the greatest human being I have ever met or am likely to meet, though of course almost nobody (apart from her friends and relations) has ever heard of her , or ever will

 

She became, in the end, a Sister Tutor, passing on her knowledge , wisdom and experience to hundreds of others.  Soon after she retired, she became seriously ill and, I am sorry to say, was taken to hospital, where she died. I was present at the moment of her death, and one day I might be able to bring myself to write about that extraordinary and moving occasion, though it would need the pen of Charles Dickens (whose books she loved, and who had been born in her battered but strangely loveable home town, Portsmouth)  to describe it properly. I am still not sure , even at this distance, that it is not too private.

 

She was plainly not very impressed by the standard of nursing she encountered, though too kind and self-effacing to make a fuss about it. Nor was I, though I knew so much less than she about how it should be done.

 

By that time (it was the late 1990s) many people had begun to notice that something had gone wrong, In our minds we had a picture of what a nurse should be,  much like what my aunt had been – disciplined, devoted, always there, putting the patient first at all times, but it plainly wasn’t quite like that.

 

In a very interesting letter published in ‘the Times’ (of London) on Saturday, Dr Brian Posnee refers to Project 2000’, the scheme to turn nursing into a ‘graduate’ profession which was cooked up by Mrs Thatcher’s Health Secretary, the long-forgotten John Moore, in 1988.  ‘The consequences were so predictable that it was difficult to believe that this plan was a serious proposal’, Dr Posnee wrote.

 

‘The excellent, caring nurses, many not academic, were marginalised’ he added. ‘The driving force behind this concept was a desire for status, which permeates much of modern society’.

 

Well, I agree that the idea was obviously flawed, and I seem to remember getting some smug spokesperson on to my Talk Radio programme, who loftily and dismissively pooh-poohed any idea that it would lead to lower levels of care.  I thought to myself then ( much as I thought when the drink licensing laws were destroyed a few years before) that I was powerless to prevent something which was obviously wrong. It was the old Curse of Cassandra, being right but not being believed, which is actually a reflection on humanity’s general unwillingness to listen to timely warnings. It seems that most of us have to wait until the Greeks are inside the walls of Troy, before we realise that we have been betrayed. It’s yet another argument against that daft experimental system of government, universal suffrage democracy (results of the experiment have been in for years, and conclusions available – i.e. it leads inexorably to war, national bankruptcy and social breakdown – but there seem to be no plans anywhere to act on this information).

 

Actually Project 2000 only put the lid on something that had already begun long before, though I suspect it put off a lot of the kind of women (and yes, they mostly were women), who didn’t fancy themselves as students of thought, but who knew more about duty, kindness and human beings than a thousand ‘graduates’. Modern ‘equality-at-all-costs-and-in-all-things’ militant feminism had for years viewed nursing as a demeaning occupation for women. The old starched uniforms were derided as making their wearers look ‘like waitresses’ or ‘like serving maids’ (a mistake most people were unlikely to make, it seems to me). I think what the feminists really didn’t like about those uniforms was the strong suggestion of owing something to a religious order, which of course they did.

 

The interesting thing about Ann Clywd’s terrible experience, which brought this subject into public consciousness for a short while, is that there is nothing at all new about it . Remembering my frustrating exchanges with official spokespersons years ago, I plunged into the archives and found that there had been a major row about this very subject in 1998, sparked off a by a pamphlet called  ‘Come Back, Miss Nightingale’ written by a nurse, Janet Warren, and a doctor ( a GP) Myles Harris. It traced the decline to , yes, the 1960s, when the profession began to be ‘stridently combative, right-based and feminist…in an expanding consumer economy focused on youth and the contraceptive pill, traditional nursing would seem out of date and irrelevant…Having to dress yourself up as a Victorian serving maid, cloister yourself in a nurses’ home for three years and take orders from ruthless old maids in the form of the traditional ward sister was unlikely to attract recruits of the Beatle generation’

 

My own memories of hospital, of the old Cronshaw Ward of the then Radcliffe Infirmary in  Oxford after I smashed my ankle in a motorcycle crash in 1969, are of pretty dedicated nursing, though it is astonishing to recall patients smoking in the ward.  Can this have happened? I think so.

 

Warren and Harris identified the key moment as 1993, when new arrangements for nurse recruiting took full effect – with the introduction of university diplomas that no longer provided immediate attachments to hospitals.

 

‘Young women who want to nurse want to join a profession , to share its ideals, to be loyal to it. Twenty years ago, student nurses could do just that. Today they are faced with spending 18 months of their three-year training on the campuses of often very minor universities. Many feel at sea with subjects such as sociology and psychology’

 

They concluded ‘Nursing’s collapse is a cultural and spiritual one, a failure of the notion of charity and compassion, not the result of failed pay bargaining rounds’.

 

I suspect that much of fury directed against Margaret Thatcher is a rage against this sort of loss, which became more and more obvious during her period in government, but which was not necessarily caused by her policies or acts. Pre-1980 Britain was much less affluent than it became, but also much gentler and kinder. The economic storm came at about the same time the big social, educational and cultural changes of the 1960s began to make themselves felt. I don’t think the Thatcher government cared much about all this, or understood it, and I have many criticisms of it. But the thing people really didn’t like about the 1980s was the ‘cultural and spiritual ‘ change that came then with such force.  And that had its origins in the 1940s, 1950s and above all the 1960s, with the launch of the permissive society