Wednesday, October 22, 2008

Rough NHS nurses

I knew my mother Norma's 81st birthday would be poignant. She had been diagnosed with lung cancer six months earlier - a terrible twist of fate considering she never smoked - and was not expected to survive the year. But at least, I reasoned, she was being treated at the world-renowned Royal Marsden Hospital in West London. There she would not only receive the best possible treatment but be cared for by dedicated nurses accustomed to looking after the terminally ill. Or so I thought.

But when I arrived on Horder Ward on the morning of my mother's birthday, she was distressed and disorientated. Instead of wearing the white linen pyjamas she had gone to bed in, she was wrapped in an NHS gown. Gradually it emerged that she had woken up in the middle of the night in a pool of blood, terrified she was haemorrhaging. She had rung the bell next to her bed but there was no response. Eventually a nurse turned up to discover my mother's cannula - a tube inserted into her vein and attached to a saline drip - had fallen out of her arm.

The nurse bustled around changing the sheets while my mother sat covered in blood, shivering beside the bed. When she asked for a blanket, the nurse told her to put on her flimsy cotton dressing gown, an offer she declined as she didn't want it covered in blood. Finally she was dressed in a hospital gown, put back into bed and left alone until I arrived in the morning. 'Where are her pyjamas?' I asked the nurse. 'I don't know,' she shrugged.

Not only was it a terrible start to my mother's birthday but an omen of things to come. For the next three weeks, our illusions about palliative care were shattered. We're all familiar with the problems facing the NHS: the chronic shortage of nurses, the drain on funding, target-orientated managers, government edicts. And earlier this year the Royal Marsden had to contend with an additional disaster, a fire that destroyed its top floor. But there's one question that cannot so easily be dismissed: when did hospital nurses stop caring?

My mother's battle against cancer began in January when she went to see a respiratory consultant at Cheltenham General, 15 miles from her home in Cirencester, Gloucestershire, and was diagnosed with cancer of the lower left lobe of her lung. 'A surprise and a shock,' she wrote in her diary, with typical understatement.

Until then she was fit and healthy. We'd spent New Year's Eve together at Somerset House in London, watching the fireworks and walking several miles back to my house in South-West London. Everybody had wished her Happy New Year - she was the oldest person on the streets.

Around 38,300 people are diagnosed with lung cancer each year - 90 per cent of them are smokers. My mother had adenocarcinoma, a cancer commonly found in non-smokers. But there were no signs it had spread. Determined to fight the disease, we asked for her to be referred to the Royal Marsden, a specialist cancer hospital and conveniently close to my home. There she underwent a six-week course of radiotherapy. Her consultant was sensitive and caring, and my mother handled the treatment well, walking a couple of miles to the hospital nearly every day. We were hopeful she would go into remission, and soon she was able to go back to her own home.

However, within a month, she began to get breathless and was taken by ambulance back to Cheltenham General. My brother Justin went with her and described the hospital as vile. Some nurses were disrespectful, unfriendly and unhelpful, others were downright aggressive. On a large mixed ward, my mother had to sleep next to the nurses' station, which was noisy all night. 'A terrible night due to nurses talking, laughing and searching records,' she wrote on July 3. The following night she recorded the name of a nurse who was 'frighteningly angry and shouting because I asked if it would be possible to be quieter'.

How terrible it was to see such a strong woman feeling so vulnerable. The next day I took her back to her home in Cirencester, vowing that when she had to return to hospital, we would get her into the Royal Marsden. Her condition deteriorated and my brother brought her back to London. First she went to the Royal Brompton where we had the most amazing experience of care in the NHS. The Brompton stood out as a beacon of hope. The ward was clean and modern, the consultant gave us his mobile number and the nurses were caring and cheerful. But they couldn't get her sickness under control and my mother was transferred to the Marsden.

Her three-week stay on Horder Ward began on July 25. Walking on to the ward, used for patients in palliative care, our faces fell. The contrast was incredible. Dark and gloomy, it hadn't been renovated for years. It was also incredibly stuffy. Despite a security buzzer, the door was constantly propped open to allow air into the ward. I had to buy my mother a fan on the hottest day of the year. When I complained, I was told she should have asked for one. Dozens of flies were buzzing around the ward but every time she mentioned them the nurses treated her as if she was being precious.

Apparently, Horder Ward had been next in line for renovation when the fire broke out. But why were dying patients being put on the worst ward in the hospital? Had they already been written off? Certainly, morale on the ward was low - on several days there were only three nurses for 13 patients - but that doesn't excuse unfriendliness or lack of caring. I had to remind the nurses repeatedly to call my mother Mrs Joseph, rather than Norma. Shouldn't that be automatic for a woman of 81?

One of the most disturbing things was their total lack of understanding that time is precious for terminally ill people. Staff took ages to come when bleeped - understandable when they were busy with other patients but not when they were in 'meetings' or during staff changeovers. One night my mother lay in agony in for two hours waiting for pain relief. Other nights the bed bells were out of reach and she had to wait until a nurse heard her cries.

During the days she became increasingly upset that nurses took so long to get her up and dressed. It was bad enough that the only bath on the ward was broken during her entire stay, but her showers got later every day. Sometimes she was not washed before lunch. Elderly people like routine, though this seemed to take second place to the nurses' convenience. Once my mother had to finish wrapping her own bandage, presumably because a nurse got distracted. Another day they forgot to give her a mouthwash. She was supposed to get one four times a day.

My mother wasn't the only patient being ignored. I fetched water for the woman in the bed opposite who was thirsty and a blanket for another woman who was freezing. My mother told me that, on one occasion, a male visitor had to help her when she was being sick.

One afternoon I finally lost my temper. A staff nurse had told my mother she had to keep her arm straight because the machine for her saline drip kept bleeping while she was asleep. When I argued that it was unreasonable to expect an 81-year-old woman with terminal lung cancer to sleep with her arm straight all night, she shrugged: 'What do you expect me to do?' 'I expect you to rectify it,' I said. 'It wasn't bleeping before you changed the saline.' Her response: 'She has to work with me.' But as my mother pointed out, she was the one doing all the work.

Another staff nurse, barely out of college, insisted on making my mother's bed the way she had been taught - even though she was not comfortable - due to health and safety rules, and bristled if I tried to help her lift my mother. She also had this infuriating habit of talking to patients in baby language saying things like: 'Let me lift your leggies.' My mother had lung cancer. She hadn't lost her mind.

We finally managed to take my mother back to my home on August 19. Her diary entry for that day says it all: 'At last I can come home to Claudia. A daughter does things far better!'

But that was not the end of our ordeal. In the early hours of August 30, my mother was taken by ambulance to Chelsea and Westminster Hospital because she had a ruptured bowel and was given only hours to live. Even then nurses did not make her a priority. Instead of allowing us to stay with her, they insisted we wait in the visitors' room while they settled her.

Finally we had to wait six hours for an ambulance to bring her home. Thankfully, the prediction was wrong. She did not die that day in hospital. She survived another week, dying on September 7 in my bedroom.

My mother came from a generation that believed hospital nurses were 'angels' ruled over by a strict but warm matron. Well, not any more. We met a few nurses who were brilliant, some who were passable but too many who just didn't seem to care at all. They may as well have been factory workers on a production line. We were hoping to make my mother's last birthday as special as we possibly could, yet the nurses managed to give her - and us - the worst one of her life.


British mothers-to-be offered gift vouchers and beauty treatments to quit smoking

Rewarding bad behaviour? The NHS plans to offer treats to pregnant women who smoke so as to encourage them to quit. Pregnant women who smoke are to be offered gift vouchers and beauty treatments to encourage them to quit. The incentives, which also include baby goods, will go to those women who can prove they have kicked the habit.

Telford and Wrekin NHS Trust in Shropshire plans to begin a pilot scheme soon, having already agreed to the idea in principle. But it has been warned that the move could be seen as the Health Service rewarding bad behaviour.

Expectant mothers who agree to the trials will have various examinations, such as carbon monoxide monitoring, to show if they have recently smoked. Samples may also be taken to prove their bodies are free of nicotine and other harmful substances found in cigarettes.

Dr Kevin Lewis, director of Shropshire's Help 2 Quit service, said the plan could help improve live birth rates, result in better health for newborn babies and cut NHS treatment costs. He added: 'We are dealing with an addiction and we are dealing with human behaviour and we know from studies that people are often not as motivated by the benefits to future health as they are by the here and now.'

Last year, 466 women - equal to 23 per cent of maternities in Telford and Wrekin - were still smoking up to delivery.


In Britain you now need a licence to dispose of your sandwich wrappings

Britain is beginning to make the Soviets look libertarian

Today's edition of Warden Hodges' Britain comes from Liverpool, where war has been declared on the illegal disposal of industrial waste. Every firm in the city is getting a visit from enforcement officers working for a public-private agency set up by the council. Last week it was the turn of Frank Hughes, who runs a small scaffolding hire company. The inspector asked him how he disposes of his waste.

Frank said he doesn't. He explained that scaffolding is a relatively simple business which doesn't generate waste. But you must eat lunch, the inspector retaliated. I bring sandwiches, Frank told him. And before you ask, I take the wrapping home with me. In which case, you're breaking the law, the jobsworth informed him. Sandwich wrappings are classified as industrial waste within the meaning of the Act. You need a licence to dispose of them.

And since you don't have one, you are committing a criminal offence. Frank would be hearing from the litigation department in connection with this heinous crime and could expect a minimum fine of $600. With that, the official ticked all the relevant boxes and goose-stepped his way out, another job well-done. Frank wrote to me in despair. 'I am not making this up,' he assures me.

I don't think you are for a moment, guv. It wouldn't have surprised me if the inspector had produced a roll of CSI-style crime scene tape, cordoned off the building, declared the whole business off-limits, called for armed police back-up and ordered Frank to cease trading immediately. 'Enviro-crime' is the new 'hate crime'. All must be punished, all the time.

Many councils have already hired teams of environmental crime enforcers. In Salford, they have started patrolling the streets looking for any emptied dustbins still on the pavement at 11am. Offenders are issued with fixed-penalty fines. This is particularly distressing for pensioners and for mothers with young children who return from shopping trips to discover they have been nicked. How are people out at work expected to bring in their bins before 11am? Has that occurred to the morons at the Town Hall?

I shouldn't have thought so for a moment. And even if it did, it would be considered a bonus, increasing the potential for punishment and revenue-raising. These are just two, tiny examples of the perverted manner in which those we pay to perform straightforward duties go out of their way to persecute us. By tonight, my inbox will be full of dozens more.

Prevention of illegal dumping is a noble pursuit. No one wants chemicals poured away in suburban gutters, or asbestos casually chucked over the fence of the local children's playground. Too many country hedgerows and city side-streets are besmirched by fly-tipping, an unpleasant but inevitable side-effect of scrapping weekly rubbish collections in the name of saving the polar bears.

But that's no excuse for the Sandwich Stasi. It takes a pedantry bordering on extreme mental illness to define greaseproof paper used for wrapping a round of cheese and pickle as 'industrial waste' - let alone demanding that someone has to possess a licence to dispose of it. Similarly, having the pavements cluttered with empty dustbins isn't particularly desirable. But fining people for not bringing them in by mid-morning is outrageous. What are they supposed to do - take an hour off work or stay at home until the dustmen have been?

Of course, none of this would be necessary if councils hadn't ended the traditional method of rubbish collection. Some of us can remember when dustmen came round to the back of your house, carried your bin to the cart, emptied it and then returned it to whence it came. Now you are expected to wheel your own bin to the front gate - and woe betide you if you don't leave it in exactly the place designated by the council. Even a few inches out and they'll refuse to empty it. Then the 'environmental crime' wardens will come along and issue you with a fine.

Those charged with waste disposal in Britain have taken leave of their senses. They have forgotten that they are public servants. They see themselves as evangelical environmental warriors and the rest of us are their enemy. They now exist purely to bully, fine and punish us.

It is nothing short of monstrous that hard-working, law-abiding small businessmen like Frank Hughes - the backbone of the nation - can be treated in this fashion. While he is doing everything he can to battle through a recession not of his making, his taxes are going towards paying the salary and pension of a jumped-up, otherwise-unemployable twerp who proposes to fine him $600 for 'illegal disposal' of a sandwich wrapping.

For two decades, this column has made a career out of exposing the unbending lunacy and sheer bloody-mindedness of British bureaucrats, but the monster marches ravenously on. At a time when we can least afford it, we are being bled white to finance the Sandwich Stasi and hundreds of thousands of index-linked, spiteful, self-righteous parasites. In another life, these are the very people who would have been loading the cattle trucks to the concentration camps. To the scaffold with the lot of them.


There's a God-shaped hole in Westminster

Today's politicians - whose favourite summer reading was The God Delusion - have never been more fearful of faith

The Archbishop of Canterbury likes to say that religion is getting increasingly political just as politicians become ever more interested in subjects that have traditionally been the domain of religion. For once, he has never been more right. This week the House of Commons will vote on government proposals to allow the creation of human-animal hybrid embryos for scientific research. At the same time, MPs are pushing for changes to the law on abortion. The assisted suicide of the rugby player Daniel James has reopened the debate about euthanasia. The rows over headscarves, the blasphemy law, science education and Lords reform all show how the boundaries have been blurred.

Meanwhile, in the City, Mammon has been exposed as a false god whose worshippers seem to have been sacrified on the altar of the credit crunch. There is a yearning for answers that go beyond interest rates, targets and the public sector borrowing requirement. The bishops have started bashing the bankers. Yet politicians, of all parties, have never been more fearful of faith. It was Alastair Campbell who famously told a journalist: "We don't do God." He forbade Tony Blair to end his television address to the nation in the run-up to the Iraq war with the words: "God bless you."

Certainly, politicians find it easier to "come out" as atheists than to profess that they have a religious faith. Nick Clegg, David Miliband and George Osborne have all said recently that they do not believe in God - something that would be unthinkable in the United States, where presidential candidates compete to win over religious voters. Although David Cameron sends his daughter to a church school, he describes his faith as being "like Magic FM in the Chilterns", something that fades in and out, as if he is rather embarrassed by the whole idea.

There is a curious mismatch here. MPs place their hands on a Bible when they swear the Oath of Allegiance on taking up their seats; prayers are said every day in Parliament - and yet the favourite book for politicians on holiday last year was The God Delusion, Richard Dawkins' atheist tract. It would be hard to find an MP who prefers the God-fearing C.S. Lewis to the divinity-baiting Phillip Pullman.

There has been a believer in Downing Street for the past 11 years. Tony Blair, the first prime minister since Gladstone who slept with a Bible beside his bed, once said that his Christianity and his politics "came together at the same time" - he even claimed that "Jesus was a moderniser". Gordon Brown, who keeps a moral compass under his pillow, regularly cites his father's sermons in his speeches. He wants the markets to rediscover the importance of ethics.

But the cynical hothouse of Westminster is dismissive of the idealism of faith. Most Labour MPs agree instinctively with Karl Marx, that religion is the opium of the masses. As for the new Tories, it is just not right for their Converse trainer image if the Church of England is still seen as the Conservative Party at prayer. It is as if the end of ideological divides has weakened the wider power of belief.

The creeping secularisation of politics was one of the factors that pushed Ruth Kelly, a devout Roman Catholic, into resigning her Cabinet position. It was not only that she disagreed with the Government's proposals on stem-cell research - and as a backbencher she will be able to vote against them tomorrow. She was also disturbed by the way in which her membership of Opus Dei was seen as something weird and even rather dangerous; and she disliked the way in which Mr Blair's Christianity was mocked during the war in Iraq. "The debate in Britain has become incredibly secularised," she explained earlier this month. "Religion is seen as something a bit strange, in the margins. Politics is much the poorer for that because you want people who believe in things to go into politics."

In policy terms, the assumption in Whitehall is that it is bad to believe. The Government's "statement of British values" is unlikely to make any mention of faith; the Department for Communities and Local Government guidelines for councils on what to tell new residents include lots about queuing but nothing on Christianity. A report published by the Church of England earlier this year accused the Government of "deep religious illiteracy" and of having "no convincing moral direction"

When Alice Thomson and I interviewed Phil Woolas last week, his comments on immigration hit the headlines - but it was his suggestion that the Anglican Church would be disestablished that got Downing Street in a jitter. The minister's claim that the link between Church and State would be broken within 50 years because "a modern society is multi-faith" was potential dynamite, with implications for the monarchy, the armed forces and the judiciary as well as Parliament. In fact, Mr Brown has already started to break the link between Church and State - he has given up the power to appoint bishops and is considering a plan to abolish the Act of Settlement, which ensures that only a Protestant can succeed to the throne - but he had hoped to move to the point of disestablishment by stealth.

It would be wrong to suggest that Britain is any longer a Christian country in terms of the population - only 7 per cent of people regularly attend an Anglican church. Yet neither is Britain a secular State like France. Its history, culture and constitutional settlement are based on the link between Church and State. Earlier this year, Nicholas Sarkozy criticised the French republic's obsession with secularism and called for a "blossoming" of religions. "A man who believes is a man who hopes," he said. It is ironic that politicians in this country have abandoned belief - at the very moment that the people need hope.


British government chasing after wind

Today, my old sparring partner, John Vidal of The Guardian/The Observer, writes a good piece on the impossibilities of meeting Gordon Brown's wind energy targets [`UK wind farm plans on brink of failure', The Observer, October 19]. John does not go far enough, however. The whole project is ill-thought out:

(a)The UK currently accounts for only 1.87% of world carbon emissions, a proportion that is falling quickly with the growth of the developing countries, and especially of China, India, and Brazil. Achieving one third of our energy from wind power by 2020 will have no effect, predictable or otherwise, on climate. Indeed, taking into account the massive amounts of steel, concrete, and transport required in constructing these vast arrays of wind turbines, the development of wind power will actually result in an initial rise in carbon emissions;

(b)Opting for wind power, especially offshore, is the most expensive choice, one that will impose huge costs on electricity generation and distribution, but more importantly on the general public and business consumers, who will be hit by high price rices precisely at a time when recession is already putting households and jobs under severe strain;

(c)Thirdly, an additional argument goes as follows: "Alright, (a) and (b) above might well be true [admitted through gritted teeth], but we must set an example to the rest of the world on climate change, and this will provide a great chance for us to lead the world in technology for a low carbon future." Unfortunately, where wind power is concerned, these points are hopelessly wrong. Meteorologically-speaking, the parts of the world where wind power is a serious option are limited, the UK being an exception, not the rule. Moreover, the idea that we are leading the world in wind-power technology is laughable, as most of the technology, equipment, and engineering comes from abroad, from countries such as Germany.

In essence, Brown's policy is lunacy. As John rightly reports, even the wind power industry itself admits that the targets are completely unrealistic: "A major threat to Britain's ambitions for renewable energy will emerge this week when wind industry leaders admit that targets set for 2020 are looking increasingly unrealistic. They will use a high-profile conference in London to warn Gordon Brown that there is little chance of achieving the government's goal - of wind generating one third of all UK electricity within 12 years - without a huge injection of public money."

I love that last bit - "a huge injection of public money." Of course! But just think of the costs to the consumer, and to the marginal poor in energy terms.

Gordon Brown will tell the delegates at the annual conference of the British Wind Energy Association (BWEA) that the UK industry is now a world leader. This is `pie-in-the-sky' politics. The harsh realities are that we have a severe shortage of engineers; the rising demand for wind-power equipment cannot be met; companies are currently pulling out of wind power because of rising costs; and two-thirds of proposals are rejected, with even the Ministry of Defence concerned over the effects on its radar coverage.

But most importantly of all, the programme will have no effects on climate change whatsoever. This is Gordon Brown at his Scottish blethering worst. The public should not be fooled.


British immigration boss: Labour Party responsible for string of failures

Just days after sparking a row by apparently calling for a cap on the number of immigrants coming to the country, Phil Woolas said the Government had implemented policies that had damaged both those moving to the country and the existing population. He said too much money had been spent on translating signs and documents into other languages and not enough on teaching migrants to learn English, leading to segregated communities. Mr Woolas, who only began his new brief two weeks ago, suggested ministers had wrongly shied away from demanding that people coming to Britain speak the language, and accused the country of having an "old world" attitude.

He also criticised Labour's failure to fund asylum removals properly which he said had caused "untold human misery and division".

But last night he was forced to make another embarrassing "clarification" of his latest remarks. He insisted the Government was now making progress but conceded that UK policy on immigration was lagging a decade behind that of other countries. It is estimated that 2.3 million people have moved to Britain since Labour came to power, 84 per cent of them from outside Europe, and a further 7 million are expected by 2031, putting pressure on housing, transport and public services.

Mr Woolas's latest outspoken comments come after he appeared to agree that there should be a limit on the number of people moving to the country from overseas in an interview on Saturday. The following day he denied new schemes were being developed and claimed the new points-based system, allowing only highly skilled or desperately needed workers from outside the EU, would cut numbers.

In a debate with the Dutch justice secretary, Nebahat Albayrak, hosted by the think tank Demos on Monday, Mr Woolas said Britain had "taken great heed" of her country's tough policies but added: "We are about 10 years behind." He admitted British policy had always been centred on how easy it is for people to move to the country rather than how much they integrate later. "Because immigrants have suffered from discrimination, because we have not helped people to earn citizenship, to integrate, we have ended up isolating people to the mutual dissatisfaction of communities."

On the Government's priorities in recent years, he said: "We have put resources into translation in order that people can access their rights. "When you do that, you lessen the opportunity to learn English and you send a message to the exclusively English-speaking population that the migrant doesn't want to learn English."

Mr Woolas went on: "One doesn't have to try very hard to convince a migrant that it would be helpful to learn English. It seems to be a problem once you step into SW1 [the London postal district that covers Downing Street and Parliament] but that's SW1's problem."

On the issue of imposing a limit on migrant numbers, he said: "We are, in this country, completely screwed up because we are asked the question about the cap without understanding what the question means." He said it may be time to rethink the Geneva Convention on how countries deal with refugees but admitted: "Our failure to resource the asylum processes has caused untold human misery and division within our communities," Mr Woolas said.

He insisted his criticisms of immigration and asylum also applied to Conservative administrations but added: "I do accept that the Government didn't provide the framework of policy that anticipated the problems well enough. "The former Home Secretary did say the Home Office was not fit for purpose. I believe it is fit for purpose now but we have had to go through some changes."

The Shadow Home Secretary, Dominic Grieve, said: "We welcome this admission by the minister. But the public will be sceptical that the Government which spent 11 years building up this problem, is the right one to solve it."

Hours after the Demos event, the Home Office put out a statement from Mr Woolas saying: "Britain's borders are now stronger than ever with asylum applications at an historic low and an immigration offender removed every eight minutes. "We have ramped up performance in dealing with the asylum legacy cases and are now resolving several thousand every month. "My comments put the current successes into historical perspective - making it clear why we have brought in so many of the changes we have."


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