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.

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