In the Midst of Life

kept alive for the money they bring in.
    Look at it this way. Only a small number of nursing care homes are non-profit charities, and these are mostly faith-inspired. The majority of care homes are profit-making establishments, which can be bought and sold on the open market. Some of them are public limited companies, with a board of directors whose first responsibility is to their shareholders. Care homes can be very profitable, and it is alleged that some directors lead millionaire lifestyles.
    Every institution, be it something like a school or a sports clubor whatever, relies on numbers to keep going. If the numbers drop, the institution becomes economically unviable. Private clinics, rest homes and nursing care homes, all of which rely on cash flow, are no different. They have to maintain a certain number of paying patients to keep going. A death represents loss of revenue. The more expensive the place, the more urgent the need to keep the beds filled.
    Everyone I have tried to speak to on this matter shuts me up, or changes the subject. But body language is more eloquent than words. A sudden gasp of breath, a widening of the eyes, or tightening of the mouth, suggest that I have dared to broach a subject best avoided.
    Betting has never been my obsession, but I would bet that my hunch is correct!

WHO CARES?
     
    Half a century ago, there was no distinction between nurses and carers, because student nurses did all the work that carers now do. A young girl’s nursing training started with three months’ classroom induction. Then followed a full year of basic, hands-on, bedside nursing care – in other words, all the mucky work. Two more years of ward work had to be completed before State Registration. We were constantly under the strict supervision of the staff nurses, ward sisters and, ultimately, Matron – all of whom had been through the same training. It was a real apprenticeship.
    But nursing was firmly stuck in the past, based on the old Nightingale tradition – docile acceptance of rigid discipline under a hierarchical system that was sacrosanct. Reform was necessary.
    The Salmon Report (1966) appeared first, proposing new management principles for nursing. Some of these changes were undoubtedly needed, but I remember the shock that swept through the profession, and later the whole of society, when it was announced that the post of matron would be axed, leaving no one with overall responsibility for nursing standards.
    1972 brought the Briggs Report. It proposed that nurses’ courses in further education colleges should be established. However, nurses were still working long hours on the wards, and if they left, someone would have to replace them. This problem was not, and has never yet been, adequately addressed.
    The Griffiths Report came next (1983), under the chairmanship of Sir Roy Griffiths, the Chief Executive of Sainsbury’s, with a committee that did not include medical or nursing representation. The report recommended that management based on businessmodels should be introduced to save the government money. According to Griffiths, there should be no difficulty in transposing the principles of commerce to the NHS. Once you let economists and accountants get their hands on things, you quickly lose sight of the original objective!
    Project 2000, 1986, was the work of a new statutory body, the UK Central Council for Nurses (known as the UKCC) who, with the Royal College of Nursing, debated the training of nurses. Higher education was becoming absolutely essential. One small example will suffice to illustrate this: in my years of training we had a few hundred drugs, of which about forty or fifty were in common use. Now, medicine has hundreds of thousands of drugs in its armoury, of which about one thousand are in daily use. They all have to be known – their dosage, action, reaction, cross-reactions, allergic reactions. If I were working on the wards today, with my level of knowledge, I would be a danger to the public! A good education is essential, to degree standard.
    Project 2000 aimed to bring students under the aegis of academia, thus removing their isolation from mainstream student life, and enhancing the image of nursing as an academic discipline. This, in my opinion, is a wonderful aim. Project 2000 is lengthy and wide-ranging, mostly relevant only to the professions, but the following are three of the main features of reform that are pertinent to the care of the sick and