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Last week the Mail on Sunday published an extract from Tamsin Day Lewis’s account of the last days of her mother’s life, which were spent in the Petersfield Community Hospital, which is an NHS GP run hospital.
After all the negative reports I have read in the media, and on blogs, it was heartwarming to read that some hospitals still manage to give the kind of service for which we were all trained. I had become so disheartened by the brainwashing we are subjected to about the failures of the service.
I am sure there must be many more such hospitals around the country, (some of them are mentioned in the comments about this article) but of course they never make it into the headlines.
Why should some hospitals be able to maintain high standards whilst others fail so abysmally? Could the answer be hidden in the name of the hospital? The Community hospital run by GPs and nurses. Do they have fewer bureacrats interfering in the running? Have their LHA realised that those on the front line, who have been trained to give the best care, know better than accountants and career civil servants. Doctors and nurses do not regard patients as “units” to be dealt with in the most economical fashion, but to receive the best treatment they can give.
When Mrs Thatcher decreed that hospitals should be governed by “market forces”, she did not know what a can of worms she was opening. Of course they have to be run without unnecessary waste, but some economies are very short sighted. Putting the cleaning out to the cheapest tender opened the way for commercial firms to provide a sometimes slipshod service, where cleaners no longer felt responsible for any particular ward, and were no longer accountable to any one person. This led to the rise of hospital acquired infection and huge bills for “deep cleaning”.
I am old fashioned so I still think that there is a place for nurses to receive the same kind of training we had, i.e. an apprentice style where we combined academic training with hands on learning. I realise that nurses now have to use far more computerised machinery and a greater variety of drugs and they have also taken over many of the tasks which were done by doctors in my training days, but could they not have two types of nurse. One which had the traditional training and others who do the “technician nurses” training at university?
If they had this two stream training students could choose which path to follow, they would need fewer technically minded nurses and there would be student nurses learning (as we did) from those who are fully trained in bedside nursing and have years of experience, rather than from tutors who have been away from the bedside for (sometimes) many years.
If they had more community hospitals it would free up beds for the acute cases in the big hospitals.
I worked in small hospitals a few times during my nursing days and my mother ended her days in the excellent cottage hospital in Aberaeron. All these were friendly caring places but, sadly, many of them have been closed in the name of economy. How many years before a “think tank” will (at great expense in time and money) pronounce that patients get better treatment in these small units?
“Yesterday is history
Tomorrow is a mystery”
I am not sure who first said this,but it is very true isn’t it? Nobody knows what tomorrow may bring, whether it will be beneficial, malevolent or just plain ordinary.
In May 1963 I was in the third week of my midwifery training. I went to bed on the Sunday evening feeling slightly apprehensive about the ‘morrow as I had been out late for the third night running and had had to sign the night porters register. In my general training hospital we had to apply for a late pass in advance, and I did not know how the system worked in this new hospital. I was a bit worried that “someone on high” might inspect the register and cause me some bother.
I woke next morning feeling quite definitely “under the weather”, but , in view of that night porter’s register, decided that I had to go on duty somehow.
I was rostered to work in the nursery. In those days the babies were kept in the nursery, except for feeding ,and were cared for by a Nursery Nurse called Robbie and the pupil midwives assigned to her. Robbie was a very motherly soul and taught more about the care of newborn and premature babies than any of our tutors. She took one look at me and told me I looked pale. I admitted that I didn’t feel well but didn’t want to report sick, so she put me on milk kitchen duty. It was cooler in there so I thought I would be alright and set about making up the feeds for the bottle fed babies.
I managed this for a short time, but had to sit down when a wave of nausea passed over me. Just as I sat, the sharpest tongued Sister came in. She was about to treat me to one of her tongue lashings, when she realised that I had turned a pale shade of green. The next thing I knew I was being taken along to Sickbay.
I was amazed to find that my appendix, which had “grumbled” intermittently for about 10 years had decided to develope into full blown appendicitis at this most inconvenient time. I was three weeks into a six month course and was due to be chief bridesmaid at my brother’s wedding in less than two weeks!
I ended that day minus my appendix. I was convinced they had operated needlessly as I had had no pain, but the surgeon assured me next day, with great relish that it had been “a juicy one” and just removed in time.
So, that was a “tomorrow” I hadn’t expected, and yes, I did make it to the wedding to perform my duties, and I had no repercussions from the night porter’s register!
Until I was 9 years old there was no NHS. If people were sick they had to pay or rely on old wives remedies or charity.
We were fortunate because we belonged to a “friendly society” and paid a small sum each week which covered us for GP visits and convalescent homes. It may also have paid partly for dentists and opticians, but I am not sure about that. The GP I worked with in the 60s and 70s had been in practice for nearly 40 years and some of the patients remembered him in his younger days before the war when he was known as the “Shilling Doctor” because he charged one shilling per consultation (this included a bottle of medicine)
After the NHS came in (which at the beginning included free dentures and free spectacles) you suddenly saw toothless people sporting wide letterbox style grins with their new free teeth and even quite young people had protruding or discoloured teeth replaced with dazzling white ones.
Free hospital treatment (before, you had to pay what the almoner calculated you could afford) meant that they were no longer regarded as the place of last resort for the poor and only one step up from the workhouse, but as somewhere you would be given the best care available at that time.
When I entered the nursing profession (1958) it was considered an honourable profession which worked with the medical profession and the physios and radiographers etc. not under them and not over them. Contrary to Nurse Anne’s opinion we were from good educational backgrounds and chose nursing because we wanted to nurse, not because we were too dim to go to university! Many of my set had the educational requirements to pursue a degree based occupation but we chose not to. If I had wanted to I was given every opportunity to study medicine, but I did not take them and have never regretted the decision, though with this degree obsessed generation and the administrative staff who are more interested in statistics and bits of paper, than the way patients are treated, I doubt if I would make the same decision now. Dr John Crippen posted a letter from an ex nurse’s husband on April 4th which explained why an excellent nurse has now taken a non clinical job.
We were given an excellent training both theoretically and practically. We had a book which we took on every ward and at the end of the three months there the sister filled in all the tasks at which we were proficient. By the end of our third year this had to be completely filled otherwise we could not take the final exam as it was sent off with the exam papers and results of the oral and practical exams to GNC for assessment before we were awarded State Registration, only then were we legally entitled to call ourselves Nurse without the Student prefix.
Nurse Anne accuses us of “rose tinted specs” and says there were “needless deaths” in the bad old days. Of course there were deaths then which wouldn’t happen now, but remember that antibiotics, kidney dialysis, steroids and cancer drugs were in their relative infancy and keyhole surgery and transplants hadn’t become everyday surgery so yes maybe there were more deaths from those kind of illnesses, but,we did not have patients dying from hospital acquired diseases, starvation or neglect! She says nurses were “seen and not heard.” Tell that to sisters Gadd, Underwood, Jaeger and Tillotson and Matron Pierce amongst others. Everyone listened to them from junior nurses and doctors to senior consultants!
Many of the things she complains about would not not have happened when I was training. A recently qualified SRN would not need mentoring, we had been mentored for three years. In another post she explained why it appears that nurses congregate around the nurses station, she claims that all sorts of staff gather there for recreation breaks etc. They would not have dared to eat their lunch in sister’s office and were easily recognised by the uniforms they wore and would not have been mistaken for nurses anyway.
She cites another occasion when they could not deal with patients and their relatives because she was laying up crash trolleys and the auxilliaries were busy trying to do the beds etc. If they had nurses learning on the ward, the 1st years could be trusted to do basic nursing care, 2nd or 3rd years could lay up the trolleys and assist the houseman with the “crashed” patients leaving her free to catch up with paperwork, deal with relatives and scheduled drugs.
The system started to go wrong when the structure was removed, the trained nurses were graded and given numbers and moved further away from the patients, sisters no longer seem to run their own wards with responsibility only to Matron and goodness only knows what the multiple matrons do now. They don’t appear to run the hospital or even have day to day contact with patients and staff. The people giving orders appear to be an army of bureaucrats. According to Dr Crippen the medical side is just the same and the consultants no longer have “firms” of registrars, housemen and students, so, if nurses are taking over more of the jobs they did, where do the junior doctors get their practical training?
I think when Nurse Anne writes about traditionally trained nurses she is unaware of how nursing was in the days when the public gave us respect and were well cared for and we got a great deal more job satisfaction than she seems to get now. The rot had well and truly set in over 20 years before she came into nursing, when the bureaucrats had been allowed to steal the authority we once had. I don’t suppose she will ever agree with me, how can she if she has only experienced nursing in the modern era, but I have experienced both, as a patient and as a nurse and I know which one I prefer, and I’ll bet that given the choice the patients would agree. They don’t give a fig whether a nurse has a degree or was state registered, just that they are looked after properly in a clean environment. After all the hospital is supposed to be run for the purpose of treating patients isn’t it? Not to provide work for bureaucrats and medical staff.
When we were packing to move to this house, we had to reduce our belongings quite severely. In our previous house we had a huge loft, large dry barn and other outbuildings where we could store a great quantity of miscellany and tended to store anything which might be useful one day or had sentimental value. As well as all our “Stuff” we also had boxes which had come from my mother’s house as she had moved in with us. Many of these boxes had not been opened for 20+ years! They all had to be opened and examined to evaluate the contents and decide whether they merited keeping.
One of the boxes contained a collection of diaries. I have kept a diary for most of my life. Many of them were filled in for January and then gradually tailed off to entries marking appointments etc for the rest of the year and little else. A few carried on for several months with mostly trivia, no great thoughts alas.:)
I glanced through them and noticed that January 6th was significant several times in my life. The first time I found it was 1958. That was the day I started my general nurse training.
The letter I had received a few weeks earlier had given me a list of things to take with me, which included 12 white handkerchiefs, 6 pairs of stockings, a laundry bag and an umbrella! All these had been carefully labelled with Cash’s name tapes and carefully packed in a trunk which had my name painted on the end and sent on ahead, as instructed. I was told to arrive between 2pm and 4pm on Jan 6th, so, being my father’s daughter, I arrived promptly at 2pm!
The Preliminary Training School was housed in a pair of large house about 1 mile from the hospital The school was built in the grounds of the house. I was shown to a six bedded room, very plainly furnished with a lino covered floor, there was only one occupant when I arrived, a beautiful olive skinned girl. This was Havva, a Turkish Cypriot and the only foreigner in a set of 76. A large number of the girls were from Birmingham and the surrounding counties and spoke with varying degrees of a “Brummy” accent which I found quite difficult to understand at first. The rest of us were from all corners of the UK and Ireland. There were 75 female students and one brave male. It was still quite unusual to have male nurses in general training, though there were more in mental nursing and the armed forces.
We had had interviews about a year previously where we had a written test, a thorough medical and an interview with a panel of the Matrons of the 3 largest hospitals in the group and the senior tutors, where they had told us that a new scheme of training was starting. We would spend 3 months in our 2nd year at the Children’s Hospital, 3 months in the 3rd year at the Women’s Hospital and the rest of the time divided between the General Hospital, where they dealt mainly with Accident and Emergency admissions and had very busy Casualty and Outpatients Departments, and the Queen Elizabeth Hospital which did very specialised work in Cardio-thoracic surgery and Neuro-surgery as well as the general wards. In this way we would get the most rounded training possible. Each year we would return to the school for a study block. We would take our State Registration exams after 3 years and once registered we would do a fourth year as a staff nurse and then get our hospital badge and certificate.
At 4pm we went to tea and met the rest of the set. Over the next four years we became as close as a family and made life long friends. I suppose this is because we were all single, (we had to leave if we wanted to get married) and for at least the first two years we had to live in the nurse’s home where we came under the care of the Home Sister and the warden who guarded us like novice nuns! Board and lodging and laundry was automatically deducted from our monthly salary, so we mostly ate together too.
After tea we assembled in the school building where we were welcomed by the tutors and given our schedule for the next 12 weeks.
The day started at 7.30 am with breakfast, followed by a short service, then 30 mins cleaning! ( we were told this was so we could supervise the ward maids, but I think we were a form of cheap labour)
Lectures on many subjects including, anatomy, physiology, nutrition, medical ethics and history of nursing would be given in the mornings and after lunch we would learn the practical procedures including invalid cookery. The evenings were “free” for writing up notes and revising.
We were free from 1pm Saturday until 10 pm Sunday. Hospital placements were arranged for us in the last three weeks, one morning session, one afternoon and one whole day.
Despite the long hours, low pay ( it started at £7 a month) and a few miserable sisters, most of us finished the three years. A few left to get married and one left after the first hospital placement complaining that it was nothing like “Emergency Ward 10″ (a popular soap then on TV):) A few left before their 4th year, again to get married and a large majority completed their 4th year, before dispersing around the world.
Do you have a “special date”?
When I wrote my previous post it was not an attack on the nurses of today, but an attack on the system which produces the chaos. It is just so different from anything I was used to. I confess that it is many years since I worked in an NHS hospital. I have worked on the district, in Norway, with a busy GP and in industry, but my experience of hospitals in recent years has been from the other side, as a patient.
The problem as seen from an outsider seems to be the over importance of “Management”. We must have had management I suppose,but we were not aware of any management other than the senior nursing and medical staff. I know there was a board of governors with a hospital secretary, treasurer and chairman, but they did not intrude into our lives. I don’t know whether there were any complaints made, but again I was not aware of any, other than minor ones dealt with by the Sister.
I think the attitude of patients and relatives seems to have altered completely too. When I started the NHS was still relatively new (about 10 years old) and there were still many people who remembered the time before it and were very cooperative with us and, providing we gave them the best care available to us, they were grateful that we had done our best whatever the outcome. Now, in this increasingly litigious society, they seem to expect miracles every day.
When there was a call to bring back Matron, I think they meant the old style Matron, not one of the new style group of Matrons. In my varied career I only came across one fairly useless matronof a general hospital, and as I was working on the midwifery unit which was autonomous was not much affected by her. All the other Matrons I met had been ward sisters and assistant matrons before becoming Matron and had a wealth of experience which they were not above demonstrating if necessary. They took a keen interest in both patients and nurses. They took their responsibilities to the nurses very seriously. In fact as student nurses we were as closely guarded as nuns! We were mostly straight from school, unmarried, aged 18 (the age of majority was still 21 ) and had to live in the nurses home at least until our 3rd year. When we wanted to live out we had to take written permission from our parents, before Matron gave permission for us to move out. Along with this discipline though we had the security of knowing that, if we had been following hospital policy, we would be defended against anyone from outside and not referred to any committee.
When did these bureaucrats gain so much authority and the medical and nursing staff become divorced from running the hospitals? Were they seduced into taking jobs with fancy titles and forgetting their basic nursing? Was there too much government intervention. This must have been an insiduous process, maybe it started as a good idea but just gathered momentum as it rolled on unchallenged by colleagues of my generation who were still working in the NHS.and by the RCN. I can remember when ward clerks were introduced and it seemed a great idea at the time as it left the senior staff free for their ward work, but was theirs the foot in the door which has produced this army of “management” who seem to be running the hospitals more for their own benefit than for the patients’?
My idea that the old style of training was more effective was because it was a cost effective way (then) of having a ward staffed by students who had varying degrees of experience. There were 4 intakes or sets each year so at any one time there would have been 2 sets from each year on day duty, one set in study block, or on holiday, and one set on night duty. There were usually 2-3 from each set on each ward so there would be 4-6 students from each year on the ward plus the sister and staff nurse and permanent ward maid and orderly to cover the day shift from 7.30 am-9pm and, as I said, it seemed to work. Sister spent quite a lot of time on the ward, she did the medicine rounds usually with a student nurse, accompanied the consultants on their rounds, served the meals and made sure that the patients were fed, as well as mentoring the students and dealing with relatives. Most of them could be seen with their sleeves rolled up and helping on the ward. When I was a patient a few years ago the only time I saw the Sister was when the girl in the next bed inadvertently pressed the emergency button and the crash team led by the Sister burst in through the door with the cardiac arrest trolley!
I don’t know what the answer to all this is other than complete reorganisation and redressing the balance of top heavy management and , if they could find any, real Matrons with the authority to overrule the bureaucrats and run the hospitals as they need to be run. Last week there was a report about the difference competent heads had made to some previously failing schools. Wouldn’t it be nice if there were similarly courageous senior staff who could turn around the hospitals.
This is probably a pipe dream but something has to be done before the staff are completely demoralised and the patients lose all faith in them.
I have just been reading a disturbing website about working on a medical ward in the NHS (warning, contains bad language!)
If this is how things are generally now, I fear for the future . There seems to be no cohesion and nobody in overall charge. This seems like an army with no officers.
I know that we were probably too regimented when I trained, but it seemed to work better then. Cross infection was almost unheard of, patients were comfortable, well fed and clean. Relatives were treated courteously and with kindness. Nurses were respected.
To keep the army analogy, Matron was the C in C. She had a deputy Matron and one or other was on duty throughout the day shift, when they handed over to the Night Superintendant. There were 4 assistant Matrons each with her own sphere to supervise.
On the ward there was a Sister and one or two Staff nurses. One of these was always on duty. The rest of the staff were Student Nurses at various stages of their training, from those just out of training school to those about to take their final exams. We all assembled for report when we came on duty and then went off to perform our various duties (according to our seniority)
The only other staff were a ward maid (who kept the ward sparkling clean!) and an orderly, who cleaned the lockers, helped with meal serving, took around the drinks trolley, provided clean water etc. These two were on the permanent staff and took a great pride in “their” wards
There were no care assistants, “hotel services” or any of the fancy titles dreamed up by civil servants.
Every morning and evening a report on each patient was written in a large report book. This included the general condition of the patient, any new or amended treatment, operations or tests performed or due etc. All medication, tests etc was also written up on the charts which hung on the end of the bed, so it was quite easy to check on anything.
She also says that the report was constantly interrupted by relatives phoning to ask about the patients. When I was nursing the relatives were given times to ring, of course this was adaptable as circumstances warranted, but I don’t remember report times being unduly interrupted by the phone.
The Consultants and medical students were also more organised and came round at regular times. As I said before we may have been too regimented but it seems to have worked better than the disorganised chaos she describes.
I left a comment suggesting that maybe the “apprentice style” training worked better and had a rather condescending reply that medicine has advanced so much that they need an academic training now because they have to understand the science etc. now not just practical nursing! Now they have to make life and death decisions! I’m not sure who she thinks made those decisions before, after all the Sisters had had the same training as the rest of us!
I know that there is far more technology and different medication and treatment now but on the plus side the technology also makes life easier for many time consuming procedures in other parts. They do not have to deal with IV drips manually anymore a micro chip tells them when it is finished. They do not have to spend time boiling instruments and packing sterilising drums, they take down a disposable sterile pack. Temperatures etc. are not taken manually but by a machine, and of course the nurses no longer do cleaning.
I think one of the main changes now which causes so many difficulties is the rapid turnover of patients. It must be very difficult to keep up with the patients when they change so frequently. Another change is probably the use of so many part timers. This would be alleviated by having student nurses on the ward again as they would be full time.
She also makes the comment that “the pace of life on the wards was slower in days gone by” but I can assure her that it did not feel slower as we rushed around the wards!
When we spent the majority of our training on the wards, (contrary to modern belief we did have “academic” training too, 4-6 weeks of very intensive study every year in the nursing school, where we had 6 lectures a day for 5 days a week), we were receiving not just practical training but also ward management and decision taking. After all we were the Sisters, Tutors and Matrons of the future. Indeed many of my colleagues held responsible positions around the world until they retired only a few years ago.
I suppose in the future some expensively convened “think tank” will have the bright idea that every ward should have a full time permanent Sister and nurse training should be based on the ward.
I read an article this week that claims midwives are grossly overworked and are delivering more babies than stipulated in safety guidelines. The guidelines say that a midwife should deliver an average of 27.5 babies per year (does anyone know where the .5 babies are or should they deliver the last one half in one year and half in the next 
?) This works out at 1 every 13 days or so!
The average midwife delivers 34 babies in a year. Apparently the ideal is for all women to have one to one care from a named midwife throughout their pregnancy. This is quite impractical as, a) midwives have off duty and holidays and, b) babies don’t always arrive on their due date but tend to be like buses and arrive in clusters!
They obviously did not have safety guidelines when I was a midwife in the 1960s, but I don’t believe it caused worse neonatal rates or created traumatised mothers. We did our training in two parts of six months each. The first part was all in hospital. We had to witness 10 deliveries and then do a minimum of 10 deliveries under the supervision of trained midwives. To begin with they guided our hands and then as we gained experience they stepped back a pace. Part two was divided into two halves, three months in hospital and three months on the district and had to do 10 deliveries in each. On the district we were on call 24 hours a day for five and a half days a week, and took our own antenatal and post natal clinics, so most of the time the women did have the same midwife throughout, but far fewer deliveries are done at home anymore, so I don’t know how hospital deliveries can offer this service, are the midwives going to combine working in hospital and visiting the patients at home, and will they be on call 24/7. The logistics baffle me. It sounds like a “think tank” thought this one up.
My first Christmas away from home was 1958. I was at the end of my first year nurse training and was on Junior Night duty. I was working on Casualty at the General Hospital Birmingham, which was right in the centre of town so very busy.
My brother was in Malaya doing his National Service, so it must have been strange for my parents to have us both away for the first time, though as they had always kept open house to our friends they were not too short of the company of young people.
It was quite unusual for a junior to be on Casualty, but we were an extra large set so I was the lucky one who was quite spoilt by the more senior nurses (I think it helped too that I was little and looked even younger than I was!)
The evening started early as, by tradition, the night nurses did the carol singing round of the wards. Each of the ward sisters had chosen a carol and we had been rehearsing them for several weeks before. We all assembled, wearing our cloaks red side out and carrying lanterns. As we approached each ward the sisters dimmed the lights and stood at the ward door to greet us. As many patients as possible had been allowed home, but there were still plenty left on the wards to enjoy the singing. All the wards had a Christmas tree and decorations and it was a lovely experience.
After the singing we had a quick meal and then it was off to Casualty at 9pm for a hectic night. The nursing staff was supplemented by senior medical students and several burly policemen! The main police station was just across the road from us and we had a good working relationship with them. They opened up one of the day clinics and lined up spare stretchers ready for the many inebriated customers we were expecting, the uninjured ones were going in there, and they did a sterling job filtering out the drunk and disorderly (I think it was probably easier for them to do this than try to process them in the police station!) They were useful too for the occasional obstreperous patient. I don’t think we had so much violence against staff in those days and I don’t remember security people being employed in those days.
On a normal night we were usually busy until about midnight and then it quietened down for a few hours, before the morning rush started, but on Christmas Eve they just kept rolling in, literally! We were too busy for any of us to take our meal breaks, just quick cups of tea from the constantly refilled teapot and a hurried snack from one of the generously donated hampers. We had no serious accidents brought in fortunately, but a constant stream of cuts to be stitched and bones to be set and those suffering from alcoholic poisoning of some degree or other. At last about 4.30am it quietened down and we were able to congregate in the office and relax for a short break and to exchange cards and presents. The Sister who was Italian had bought us all beautiful scarfs (I stillhave mine 40 years later!)
At 6am it was the night staff job to go round the Nurses home waking up the day staff and I can’t tell you how gladly I performed that duty that night
At 8am the day staff took over from us and we went off thankfully to partake of a hearty breakfast.
I was on duty again on the next 2 nights and then had four nights off ,so we had our family Christmas a few days late, and then I went back in time for New Year’s Eve and more of the same!
I was tagged to list 6 things which make me happy, so here goes.
1) My family of course. It is said that you are given your family but choose your friends, well my family are the friends I would choose anyway. My husband of 35+ years has always been there for me and supported me in whatever I do however much I must have exasperated him over the years! My lovely daughter helps me, giggles with me and stops me feeling old. Her husband GG sorts out my digital equipment and helps to drag me into the 21st century and they have given us two lively and gorgeous grandsons, who think I am the fount of all knowledge because I watch Dr Who and understand about Cybermen and Daleks etc.
2) I love opening my Christmas cards and finding a letter inside from one of my far flung family or friends reminding me of the fortunate life I have had. A secure and happy childhood provided by loving parents, a protective beloved elder brother and large extended family. Happy schooldays, a fulfilling and varied career in nursing, several years in Norway, and happy years as a wife and Mum.
3) It makes me happy when I buy a sad looking plant from the bargain bin at the nursery and see it flourish into a magnificent specimen.
4) I am happy whenone of my favourite authors publishes a new book, especially when it is an ongoing saga or features characters that I have become familiar over the years.
5) I get very happy when I discover another ancestor for the family tree I have been working on in the past few years, or a third or fourth cousin gets in touch with me and fills in another gap or two.
6) I feel happy and peaceful looking up at the night sky in the country, away from city lights. This was even more magical when I lived in a mountain village in Norway and stood in the snow looking up at the vast universe.
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