Libby Purves, writing in the Times on Tuesday (Send in the storm-trooper nurses) suggests that dirty hospitals be visited by
“a volunteer regiment of ex-nurses trained before 1975: opinionated middle-aged women with strong memories and no fear of offending. Every hospital would be invaded by several dozen for one month. During that month all normal taboos would be suspended: there would be no interdicts on workplace bullying, harassment, job demarcation, paperwork, or protocols of line management.”
I know one or two of that generation of nurses. They are appalled to see nurses out in the street in their uniforms, never mind the visible dirt in the wards. Their fear of long-dead Matrons remains as strong as their conviction that the discipline was right and necessary.
You might think that a reforming government with a big purse and a belief in its capacity to change the world would have managed at least to clean the hospitals. The stumbling-block is that those things which are at the root of the problem are things which are simultaneously dear to Labour’s heart and susceptible to Labour’s great weakness – lack of attention to detail.
It is not inevitable that cleaning must be sub-contracted to the lowest bidder; it is not even inevitable that the lowest bidder will do it badly; but it is very likely that they will. Degrees for nurses killed off the State Enrolled Nurse and now nurses compete for roles with doctors; we have expensively-trained unemployed junior doctors and no-one wants to wipe bottoms. No group of employees is more alert to its human rights than hospital staff, but their rights seem to come ahead of patients’ rights. The terrifying Matron is replaced by a line manager for whom a bed is part of a business unit. Discipline goes to hell when no-one dares criticise performance for fear of claims of bullying or harassment.
Any attack on these things arouses a fierce counter-attack – the NHS is always there for you, cleaning costs must be controlled, nurses are entitled to a formal career structure, health workers must stand up for their legitimate rights. There are, of course, many fine nurses, dedicated cleaners and competent administrators. There are wider factors as well – the sheer expense of running the health service for a growing and aging population, the quality of the health service administrators as a class, the gross error of putting – and then leaving – Patricia Hewitt in charge of it all.
The fact is, however, that it is not working at a nuts and bolts level. Whatever savings are being made by cost-cutting on the wards are more than wiped out – politically as well as financially – by MRSA and the perception of those who visit hospitals. The corollary to the idealised world of graduate-only entry to nursing is that we lose many who would have made good nurses. The protection of workers’ rights is fine, but must be balanced against the rights of the patients – and, frankly, there is no more fundamental human right than to be properly looked after in hospital.
Alan Johnson is quietly competent, at least by comparison with the shrill and inadequate Patricia Hewitt. He is not, however, a man for rocking boats. Apart from a few misjudged comments in the deputy leadership campaign, he keeps his head below the parapet, keeps his nose clean, and hopes to rise to better things one day. He is a union man and, whilst he could use his union background to good effect, it seems unlikely that he will take on the entrenched power of the health unions.
Why not give a try though? There is nothing much to lose by trying a radical approach in a sample hospital. I doubt we can unleash the pack of old nurses as Libby Purves envisages, but the principle of restoring the standards of discipline and cleanliness – and the spirit – of hospitals as they used to be must be worth a try.
Tony Blair was a great one for glib, memorable phrases, most of which proved to be oratorical clouds without substance. One of the best, addressed to Frank Field when he was appointed to Pensions, was “think the unthinkable”. It was an empty phrase, of course, and Field was sacked as soon as he dared do anything of the sort, but it is a valuable concept for all that.
Give it a go, Alan Johnson. Take time out from the big policy issues and do some hands-on micro-management of the sort which New Labour loves in principle but never achieves in practice (thus giving us the worst of all worlds – paralysis of local control with no meaningful replacement from above). When people – voters that is – say that the NHS is failing in hospitals, they generally mean that the wards are filthy and staff apparently indifferent to patient care. Fix it – do whatever it takes, tread on however many toes, undo whatever working practices get in the way – to fix it in one hospital.