When Tory peer Lord Mancroft criticised the standard of care he received at Bath’s Royal United Hospital, he not only stuck a rusty scalpel in the nursing profession, he twisted it:

The nurses who looked after me were mostly grubby — we are talking about dirty fingernails and hair — and were slipshod and lazy. Worst of all, they were drunken and promiscuous.

Until he emerged as a nurse basher in this way, hardly anyone had heard of Mancroft; and the fact that he turned out to be a former junkie and - worse - one of the ninety remaining hereditary peers in the House of Lords, meant that it was too easy to dismiss his point out of hand, and too politically dangerous to defend him.

That’s why, with barely moment’s delay, the Royal College of Surgeons lost all sense of proportion and accused Mancroft of hurling a “sexist insult about the behaviour of British women”; why Health Minister Ben Bradshaw used the episode to trot out a lot of statistics; and why Tory leader David Cameron quickly lanced the abscess in his party by asserting “My experience of the NHS is 100 per cent completely different”.

Personally, I’m quite certain in my own mind that there are plenty of nurses who (like doctors) drink too much, and probably more than a few who have dirty fingernails and poor hygiene. But I also think that the wider point of Mancroft’s rather ill-judged outburst was contained in this explanatory remark:

You see, if you are a patient and lying in a bed and being nursed from either side, they talk across you as if you’re not there.

In that, he’s absolutely spot on. Frankly, I wouldn’t care less whether the nurse giving me a bed bath had a hangover (though I would prefer her nails to be clean); but I would have little faith in any carer who treated their patients as though they didn’t exist.

It sounds prissy, but I’ve seen what such attitudes can do. Back in the mid-1990s, during some of my university vacations, I used to work as a care assistant in various old people’s homes. In the best-run one, staff would have been genuinely shocked if you accused them of not giving being up to their jobs; but the fact was that almost all of them routinely treated residents as though they were invisible, almost never used quiet periods in the day to talk with the people they were supposed to care for, and always - always - assumed an exaggerated and (sometimes) false veneer of concern and affection whenever a relative showed up to visit.

Worse still, staff would take shortcuts and - more dangerously - make decisions on behalf of residents who were powerless to resist them. Carers would pretend not to hear old people they regarded as ‘troublesome’, and would even quicken their pace in certain parts of the building to avoid encountering them. I remember one old man who could walk perfectly well with a zimmer frame one week, and who had been taken off his feet the next - never to walk again, and soon to die.

Those carers weren’t bad people: they just worked in a culture that placed more value on appearances than on the best interests of vulnerable people. The manager was keener on making sure the beds had valences (a sort of linen pie-frill that hangs off the base) than in making sure her staff learned to take pride in improving every aspect of residents’ lives - not just in keeping them fed, warm, dry and as compliant as possible.

Under such conditions, it was little wonder that most staff took the easy option and put their own interests ahead of those they were supposed to be looking after; and it was massively to the credit of the small number of carers who did the opposite.

Where you have a culture in which staff inclinations take precedence over patient care, then the quality of that care is bound to suffer. After all, Lord Mancroft isn’t the only person to have witnessed this (however clumsily), as this succulent quote selected by NHS Blog Doctor, Dr Crippen, shows:

A nurse who wanted to see her cardiologist gets fobbed off by a nurse:

A very rude nurse- who was all dressed up in a suit, decided she would speak with me, but refused to answer any of the questions I had other than “its not dangerous,” and then make assumptions about my mental state. “You’re a bit stressed aren’t you, Love. Maybe thats why it happens eh?”

Piss off- you’d be pissed off if you’d travelled half way across London for an appointment to discuss results and not only have they cancelled your appointment without telling you but the consultant who fucked it up isn’t even there to take a battering!

Turns out the receptionist had taken it upon herself to cancel my appointment based on the consultants letter to my GP which said that I don’t need anymore follow ups. Yes- follow ups after we’ve been through all the results and my questions you fucking… monkey.

Faith Walker at The Oracle

A classic example of I-know-bestism that reduces the patient to nothing more than a target, to be disregarded at the earliest opportunity.

I’ve seen it at first hand too. In the months leading up to the birth of our son in late 2006, my wife amassed an impressive collection of forms and paperwork, including a detailed birth plan. This bit of paper details all the mother-to-be’s preferences about the manner in which she wants to give birth, the pain relief she will accept and so on. The idea is that, when you arrive at the hospital in labour, the midwives, doctors and others can see at a glance what the plan is and act accordingly.

At least, that’s the idea.

When my wife and I rolled up to Homerton Hospital in Hackney at 1.30am and handed over the birth plan to a midwife, we might as well have handed her a piece of paper reading “do whatever the fuck you want.” Because that’s pretty pretty much what she and her colleagues did.

First choice in the plan was a water birth. We assumed that, on reading this, someone would have started running the taps. That was foolish: the Homerton method was to wait until labour had progressed exactly far enough to say “There’s no time to fill the birthing pool now.”

Other choice moments included the midwife pissing off for an hour-long break and leaving us alone, telling us to let the deeply uninterested woman in the corridor know if we needed anything; me fetching the deeply uninterested woman, who put her head in the door and said: “She’s not pushing hard enough, is she?”; the original midwife realising she was way out of her depth, and fetching the doctor; the wonderful rigmarole as they strapped my wife to a machine that monitored the baby’s heartbeat, only to send her into a complete panic every few seconds as the beeps continually flatlined; and the refusal to give her any pain relief when asked because it would “make the birth even more difficult”.

Within three hours we had seen our agreed plan of a supportive water birth exchanged for a get-on-with-it-and-do-as-you’re-told procedure, which ended up with the baby nearly strangling on the umbilical cord, foetal distress, epesiotomy and a newborn who needed to stay in hospital for 24 hours’ observation.

That was the easy bit. At 3pm the following afternoon, we were told we could get packed and get ready to go home. It then took me nine hours of pleading with the ward staff before mother and child were finally discharged half an hour before midnight. We walked off into the night anonymously - another statistic heading for the safety of home.

Of course, it would be as unfair for me to complain as it was for Lord Mancroft to grumble about the care he received. Crap service doesn’t - contrary to the evidence of my own eyes - translate into poor standards of safety. When maternity services at Homerton Hospital were recently slammed as being amongst the worst in the country, the Healthcare Commission Chief Executive, Anna Walker, reassured us all by saying:

“Being put in the least performing category does not mean that a service is unsafe.”

Yet another healthcare professional who knows best. Quite how her remarks square with the fact that infant mortality is significantly higher than it was ten years ago is quite beyond me.

So, what to do? When it comes to medical matters, I can’t pretend I know best. But from my observations of how organisations are run, how they prosper and how they fester, surely some of the following points are worth considering.

1) Nurses, as individuals, are no more beyond reproach than anyone else. If someone says they have not been treated as well as they hoped by one or more nurses, this does not constitute an attack on an entire profession.

2) Many human beings have a tendency to go with the flow, and to take the easiest options. If the culture of a hospital allows nurses to get away with putting their own preferences before the needs of their patients, then some nurses (though not all) will do exactly that.

3) Targets need to be qualitative as well as quantitative. If a hospital is penalised for failing to meet targets, and those targets can be more easily achieved by providing sub-standard care, then they need to be scrapped and re-thought.

I certainly believe that nurses, midwives, care assistants and the rest all have to do a very difficult job, for relatively little pay, and in difficult conditions. We just need to recognise that things won’t get any better for them until we can accept that no individual is beyond reproach, simply by virtue of their profession or standing.

And that goes not only for nurses, but peers, MPs and even the Speaker of the House of Commons.

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