Great nursing needs more than a smile

Sunday Post column in full.

"He died with the dignity of a battery hen. He died of cold -- he died from people who didn't care. I should have stood in that corridor and screamed - where are the nurses?" You'd need to be made from stone not to respond to Ann Clwyd. The veteran Welsh MP's description of her husband's last days in the flagship University Hospital of Wales was harrowing, detailed and painfully honest. Tony Blair's former envoy to Iraq named and shamed Cardiff hospital staff in a brave and emotional Commons speech. Fighting back tears she told MPs how she found her tall, 73 year-old husband Owen Roberts squashed against the bars of his hospital bed with an oxygen mask so small it cut into his face. His lips were dry and his body cold from a fan in an adjacent bay. The MP repeatedly asked for help – none was given.

Owen finally died of hospital-induced pneumonia. The big question is whether this appalling treatment is commonplace or exceptional.

And of course that's very hard to say. Have cuts and shortages stopped nurses doing their jobs properly – does a tick box culture make clinical tasks more important than simple acts of common humanity? Both sound like lame excuses. And yet, something makes us very, very reluctant to criticise "the angels." How do we know what they cope with every day? The tragic, suspected suicide of the "royal hoax nurse" Jacintha Saldanha demonstrates that all too graphically.

Who are we to second-guess clinical decisions or sit in judgement?

Clearly though, Ann Clwyd's experience is not unique. Days earlier Jeremy Hunt condemned the "coldness, resentment, indifference and even contempt" some patients experience in care homes and hospital. The English Health Secretary said poor care is "perhaps the biggest problem facing the NHS" and distressing cases are not isolated but part of the fabric. Some managers are so "buried in spread-sheets" they've become blind to the fact patients are not treated with dignity or respect.

"It's a kind of normalisation of cruelty where the unacceptable is legitimised and the callous becomes mundane."

Those are very, very strong words for a government Minister.

But is he describing conditions in England – or in Scotland too? The day Ann Clwyd addressed the Commons I was at the Orthopaedic out-patients department of Perth Royal Infirmary. The unit's under-staffed but no stress was passed onto patients. A nurse apologised for a ten minute delay -- the consultant took time to shake hands with waiting patients and later took time to explain the problem with my gammy knee. Sure, that demanded compassion – it demanded good systems and teamwork as well. Last year I had an emergency overnight stay at Dundee Ninewells Hospital where I also encountered smiling, friendly staff. But it took five attempts to extract a blood sample which became unusable after it was left on a window ledge – likewise urine samples were never collected. Finally, I was prescribed drugs for a condition I didn't have -- it took some insistence to recall the consultant to clear things up. In the great scheme of things that was very small beer. But it illustrates a point.

Ann Clwyd's not just asking nurses to smile and say hello more often. Compassionate nurses can't save lives without effective systems. Compassion and organisation go hand in hand -- understaffing undermines both. That's doesn't excuse staff who saw Owen Robert's pain, humiliation and discomfort and turned away. But his memory deserves more than the introduction of patient feedback forms.

Good systems are the best way to raise standards and safeguard against uncaring staff. That means worried staff must be encouraged to act when colleagues take disastrous short-cuts or things go wrong – not keep mum. That demands talented, confident NHS managers - not over-promoted accountants. Are systems better in Scotland or are Scottish nurses just better able to grin and bear it? Scottish patients and taxpayers deserve to know.