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'It may be Christmas but we can’t extend goodwill to all men'


A long time ago, let’s call it 1988, I was working on a urology ward in London.

Yes it was damp, of course it was, but mostly it seemed full of people having legs amputated. We went through one of those “times”, where a group of patients with poorly managed diabetes seemed to gather on the ward in a cluster, eating unwisely, smoking too much, not quite embracing self-care in a way they might.

The sister, whom I believed to be close to all-knowing, managed wonderfully but she was mindful of the fact that her ward was changing slightly because of the different needs, treatment and experience of the patients. She was also aware of the fact that the morale of the staff was being affected. We know this, of course, but some members of the general public may be surprised to discover nurses do not enjoy removing limbs from ill people.

Anyway, as Christmas drew near, the rush of amputations had slowed and the ward was calming a little. The patient group - mainly older people but with a smattering of others - had varying feelings about being in hospital at Christmas. Some dreaded it, one or two seemed ambivalent but a few, particularly among the older ones, were seemingly quite relieved. The sister knew this; we all did. When I asked one nurse if we would, before Christmas, be discharging a woman who was approaching 80, lived alone and had one less leg than when she had arrived, she said: “Why would we rush her out, under the circumstances?” Which struck me as reasonable.

When Christmas came we made a bit of an effort. There may have been dressing up, there may have been singing, there was definitely laughing. I suspect our attitude was borne in part from relief - the lead-up to December had felt difficult and relentless and, perhaps, there was a sense that helping patients who were lonely or recovering through an emotional time was part of the job. There had been so much misery among the patient group and we felt it because misery is contagious. In my head it doesn’t feel that long ago since that Christmas but culturally, professionally, and organisationally it may as well have been another country.

I was thinking of that Christmas when I read last week that hospitals were full to bursting, which was creating a dangerous environment for patients. Coming as it did a few days after another report on poor standards of care, I was struck by the seeming reluctance of the news tellers to put those two observations together. Is it possible that nurses find it harder to care in overly full hospitals? If misery is contagious, might danger be too? I’m not saying this is remotely close to an excuse, but could it be part of a reason?

Beyond that I also wondered about the culture of the “overly full and dangerous” hospital. It is hard to imagine nurses being able to think as holistically about the wellbeing of the lonely new amputee as we were able to in the past. The pressures and measures used to drive care decisions are not made according to those sorts of judgements - judgements that took

into account the wellbeing, recovery, humanity and emotional residue of the patient rather than just the immediate clinical need.

And I suppose I can’t help wondering: might the absence of care that concerns us all also have a little something to do with a decision-making process that effectively outlaws proper care? Or at least limits its nature?

Have a good Christmas when it comes. Be kind to yourself.

Mark Radcliffe is senior lecturer and author of Gabriel’s Angel


Readers' comments (6)

  • How do we address the fact that the gap between the private 'wealth creation' sector & the public 'caring' sector is increasingly widening? Electing people that genuinely care about other human beings could be a start but is there anyone out there in that category?

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  • as long as attempts to run the NHS like the manufacturing industry continue 'CARE' of patients and all the staff looking after them and those providing support services to the staff will never improve. The NHS needs to develop its own management model appropriate to the 'CARE with COMPASSION' of sentient human beings who are all individuals in their own right with unique manifestations of any illness and unique treatment and care needs and not attempt to adapt a system which is suited to manufacturing and marketing processes of inanimate goods. This is bound to be a failure at the outset and this has been proved. Time now to leave this system to the industry where it is effective and put it to bed and lay it to rest in the NHS.

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  • The pressure put on clinicians to discharge patients is immense. My Husband is a consultant and receives emails from managers instructing him to go to the ward and empty beds every single day! He had enough last week and replied saying "No today I plan to sit in my office and scratch my bum all day"!! It didn't go down to well apparently.

    We now have an astonishing award in our Hospital called "ward of the week" or "wow" as they like to put it. It is given to the ward that manages to discharge the most patients in a week. Yeah great idea - not.

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  • michael stone

    'Is it possible that nurses find it harder to care in overly full hospitals? If misery is contagious, might danger be too?'

    I suspect:



    It makes me quite 'grumpy', as it happens !

    Your prize for the most discharges, illustrates how a good concept (treating patients as quickly as possible) can easily be corrupted into something very different, conceptually - that happens all over the place !

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  • The current pressures on beds within our Trust makes me very very uneasy, angry, sorry, worried, inadequate..... etc which has wrecked the way i feel about nursing, being a nurse and wiped out any job satisfaction i once had.
    Issues faced daily for staff & patients:
    Ambulances cannot off load seriously ill patients for 2 hours - no beds in Emergency dept or Acute Medicine. Emergency dept & Acute medicine attempt to outlie medical patients onto surgical wards to create capacity - today we had minus 44 medical beds. This should be a shocking figure but it has been going on at this level for months & months & with winter pressures approaching we are expecting the figure to be much higher. Surgical wards having to look after patients who are supposedly fit for discharge but are still recieving acute medical treatment and have no panned discharge or package of care arrangements in place. The additional problem here is the physicians don't always know where their patients are and don't always catch up with them for days.
    Waking patients in the night - often between 1-3am asking them to pack their belongings to execute a bed move.
    Our bed management team is at burn out and our ward staff are totally demoralised with a tangible level of discontent.
    How much more with the suits expect us to endure and for how long as currently, no sign of let-up sadly.
    Frankly I'm afraid of being ill and ending up in this risky environment. The scope for adverse incidences occuring is massive at every stage along this path - why are Trusts willing to put up with this level of risk?
    What is the government doing????????

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  • The HSC bill has put this into perpective. This is why the DoH wanted to wash their hands of te risk inherent in running the health industry liek a business, not a place of care and humanity. The reason we are all pressured beyond the sane is becuase bums on beds or through doors means money to a profit driven company.
    The suits don't care about patients, why would they care about the staff twittering on about something they have little or no interest in? Patients are not the primary focus or concern for management not having emerged from a 'service' orientation.
    I couldn't agree more with you above, my job satisfaction is at an all time low.
    I can only hope that even though staff apathy has allowed this situation to blossom that they will get off their collective backsides and vote for people with a conscience next election.

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