Having just got back from a two day conference in the Netherlands on researching and teaching spiritual care for nursing students, I was once again confronted on my return to our island shores by more stories about the failures of even the most basic care in our country. Indeed, one of the features of all the British presentations at the conference was the unending series of reports that show our nursing care is far from consistently good, and in some cases downright appalling. It seems that the nurses in other parts of Europe were somewhat surprised at this, and had not faced anything comparable in their own nations (I may have read that wrong, being typically British in being rather poor at my European languages).
Today the Patients Association has published yet another report cataloguing some very poor care – from a terminally ill patient being left without analgesia in her last few days, to a man left to sit in his own faeces because a nurse was too busy to take him to the toilet. This report seem more anecdotal than the more systematic report of the Care Quality Commission last month, but it adds to a growing picture of some seriously bad standards of patient care in the NHS. Whether these reports show up to a total failure of care, especially for the elderly, or highlight a growing number of exceptions to otherwise good care standards, is somewhat harder to determine. It is not clear whether these reports represent the exceptions or the rule.
At the Annual General Meeting of the Royal College of Nursing last month, there was a lot of anger about this, and the widely expressed opinion from the platform was that most nurses were giving excellent care, but where this was falling down it was largely due to cuts in frontline services putting staff under too much pressure to care properly. I am sceptical that this is the whole story – while I do agree that being short staffed means you cannot give all the care you would want to, it does not mean that you neglect the essentials and treat people as objects not human beings. Having worked in under resourced wards and community teams in London during the eighties and nineties, I know how hard it is to give the best standards of care in such circumstances – but I also know that it is far from impossible!
The RCN’s in-house journal, Nursing Standard has now joined with the Patients Association to launch a major campaign for an improvement in nursing standards – arguing that it is not enough to bemoan the state of care, we must do something about it. A sentiment we cannot but wholeheartedly support! However, the existence of this campaign suggests that there are issues that go to the heart of how nursing is actually practiced, and tackling a culture that increasingly lacks compassion for the elderly and frail.
One of the most striking plenaries at the conference was from Professor Kees Waajimn, from the Radboud University Nijegen in the Netherlands. In short he said, good spiritual care is compassionate care – it is not easily quantified, so is often ignored by health economists and politicians who are more concerned with input/output models of care. But ask patients and their relatives what they value most in their treatment, it will be kindness, thoughtfulness and being treated as a person, and not the bed occupancy rate, staffing ratio or any other readily quantifiable indicator. While the latter are relevant, they ought not to lead to the neglect of the former. As Jesus put it to the religious leaders of his day, so obsessed with the minutiae of religious observance that they forgot justice and compassion, ‘you should have practiced the latter without leaving the former undone’ [Luke 11:42].