Nurses lose their halo

These days all vicars are randy and all nuns are harridans. Is it really such a surprise that nurses

Nurses, having enjoyed an extended run in the national consciousness as angelic, selfless individuals, have suddenly started to get quite a bit of flak in the media about their shortcomings. It strikes me that there are a number of reasons why.

Apart from anything else, it would have been impossible for them to maintain their angelic reputation - which, thanks to Florence Nightingale, has been burned into the national consciousness - for ever. Before Florence N, nurses didn't have a great image: by all accounts they were a lazy, dirty and incompetent lot. Then the great lady swung her lamp and everything changed. Nurses stepped into line, washed their hands, stopped gobbing everywhere, put their fags out and earned themselves a ticket to heaven, which, until now, very few have dared to challenge.

Nurses' saintly image could only ever have lasted so long. Look at nuns and vicars. They were supposed to be altruistic and godly. But with the help of the tabloids, it didn't take too long for vicars to turn into randy old pervs, or for nuns to become sadistic harridans intent on terrifying children to death. Likewise, some chipping away at the unrealistic expectations we all have of nurses was bound to happen sooner or later.

Anyway, it is unrealistic to expect an entire profession to be completely good. There are bound to be some individuals who are stressed, who are unkind, who are a bit rubbish at their job, who are in the wrong career.

But what matters is where these individuals sit in the hierarchy of the NHS. A bad nurse on a back ward in a small town may not cause too much damage, whereas a bad nurse running a large teaching hospital can sully a huge section of the system.

In recent years there has also been a change in the way nurses are trained: they all study up to degree level now. I have been told that some people in the NHS feel this has caused a rift between qualified and unqualified staff, because some nurses feel that tasks such as changing beds or clearing up messes of various kinds are beneath them.

When I did a degree and a psychiatric nursing course, we were considered so bright (ho ho) that we didn't need the usual three months' training at a general hospital to brush up our physical skills. As a result, lots of us were crap in this important area.

Whenever there was a physical emergency such as a cardiac arrest, you could spot the degree nurses a mile off, legging it in the other direction - we were terrified of getting to the emergency first and not knowing what to do. And we were clumsy at injections and the like. One poor woman once said to me, after several appalling attempts to inject her bottom with a particularly viscous fluid: "Please, nurse, can't I take a tablet?"

As a nation we focus on the negative. Our newspapers are full of bad stuff, as we all seem to consider good news the epitome of tedium. So the nurses who do their jobs properly and care exquisitely for those in their charge will always be overshadowed by the ones who are incompetent, or worse.

Nonetheless, whistleblowing is punished, which sends out a mixed message to nurses who observe cruelty, neglect or downright sadism, but feel they are powerless to act.

I have seen good nurses and bad nurses. They existed along a continuum: from hard-working, kind and competent people, to office-hugging, bone-idle types, to apathetic, disengaged automatons.

A good culture in a hospital can absorb and manage a few bad nurses, but once the culture becomes bad in itself, bad nursing practice is much harder to hide. Filthy wards where cleaning staff - who earn a pittance and don't have enough hours to complete their work - set the tone are becoming too common. And unless you have some scary Hattie Jacques of a matron who comes down on dirt like a Valkyrie, demoralisation and pessimism set in at a very basic level.

All too often we hear stories of neglect in the NHS, particularly of the elderly. It strikes me that this is the product of an inability to empathise, to put oneself in the position of the patient. A lack of imagination. This may well be because the service emphasises pathology rather than humanity. Some of the most caring nurses I have met are the unqualified ones, who obviously aren't in it for the money and, I suspect, don't get a huge amount of respect from those higher up the ranks.

So it seems we can add a category to the stereotypes we already have of nurses - good-time girls and rigid, bulky old bags. Now we also have the uncaring, feckless neglecters.

But the most important thing is that we get to the nub of what is going wrong and change it. Rather that than throw out more archetypes for the media to seize on.

This article first appeared in the 21 September 2009 issue of the New Statesman, Citizen Ken

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No peace after progress

How the death of the industrial way of life gave us choice – and stoked resentment and fear.

Now that the making of useful and necessary things in Britain is only a shadow of what it once was, we can see more clearly the effects of the Manufacturing Age. The cost was high to the producers of prodigious wealth; a ten-year difference in life expectancy remains between people living in the richest areas and those in Glasgow. The (fleeting, it now seems) visitation of industrialism has made life more comfortable and its dismantling has liberated millions from choiceless occupations. The legacy is one of spectacular improvement, unequally shared.

Perhaps the most dramatic experience of the 20th century was the suddenness with which profligate plenty replaced a skinflint subsistence. Was it the speed of this that distracted us from wondering why, instead of the secure sustenance that generations of needy people had asked of an unyielding economic system, we were offered a promiscuous spillage of goods, promoted with quasi-religious zeal by the converts of a capitalism that had previously delivered to most of its captive workers a life of penury? Such a rapid reversal might have alerted us to changes beneath the surface that elided losses incurred.

The greatest of these was certainly not the extinction of the industrial way of life itself, release from which has been an unqualified blessing. But the transition from relentlessly work-driven lives (in the 1950s, two-thirds of Britain’s workers were still manual labourers) was marked by perfunctory obituaries for the disintegration of industrial communities, with no acknowledgement that, for a century and a half, they had represented the inescapable destiny of the people they sheltered.

Even less recognition was given to the fortitude with which they had borne a long, coercive labour. A way of life, buried without ceremony in the unmarked grave of progress, could not be mourned; and this has generated some social pathologies of our time: resentment over an arbitrary obliteration of industry, disengagement from a party of labour by those it called, like feudal lords, its “own people”, loss of memory of the economic migrants we also were, passing from the goad of industry into the pastures of consumption, and thence into the liberating servitude of technology.

Grief makes no judgement on the intrinsic value of what is lost. Absence of the known and familiar is the object of melancholy in its own right, even if replaced by something immeasurably better. Objectively, there was little to mourn in the vanished industrial way of life: insufficiency and humiliation, malice of overseer and manager, officiousness of poor-law administrator and means-test man. Male industrial workers exhausted in body and spirit, instead of protecting those for whom the power of their hands was the only shelter against destitution, visited similar punishment on their wives and children. There is nothing to be lamented in an end to the penitential life of women, scrubbing not only the red tiles of the kitchen floor, but even an arc of pavement outside the front door; their interception of men on payday before wages were wasted on beer and oblivion; the clenching against joyless invasion of their bodies in the boozy aftermath. But it was the only life they knew, and they adhered to it with grim stoicism and even pride.

There is much to be said for their resistance. The fragile lattice formed by women’s arms was often the only safety net against destitution. Trade unions and friendly and burial societies that shielded folk from economic violence foreshadowed the welfare state and the National Health Service.

The life of labouring people in Britain was strikingly homogeneous, despite diversity of occupation, dialect and local sensibility. There was the same collective experience: terraced house with parlour reserved for celebration or mourning; the three-piece suite, plaster figure on a stand behind the window, chenille curtain against the draught, engraving of The Stag at Bay on the wall; the deal table and Windsor chairs in the living room, the mantelpiece a domestic shrine with clock, candlesticks and pictures of soldiers smiling before they died; the music of cinders falling through the bars in the grate; cheerless bedrooms where husband and wife slept in high connubial state, more bier than bed, where sexual enjoyment was ritually sacrificed as flowers of frost formed on the inside of the window.

And everywhere photographs: wraithlike children with ringlets or in sailor suits, fated never to grow up; weddings in the back garden, a bouquet of lilies and a grandmother in boots and astrakhan hat; the smudged features of a kinsman no one can now identify. Identical memories, too: the shotgun wedding in the dingy finery of a Co-op hall; the funeral tableau around the grave, amid ominous inscriptions of “Sleeping where no shadows fall”; queues outside the ocean-going Savoy or Tivoli to watch Gone With the Wind; the pub where “Vilia” or “The Last Rose of Summer” was hammered out on a discordant piano.

The opening up of such sombre lives might have been expected to call forth cries of gratitude. Instead, a synthetic joy has emanated largely from the same sources that, until recently, offered people grudging survival only, the change of tune outsourced to producers of manufactured delight, purveyors of contrived euphoria to the people – a different order of industrial artefact from the shoes, utensils and textiles of another era.

***

A more authentic popular res­ponse exists beneath the official psalmody, a persistent murmur of discontent and powerlessness. Anger and aggression swirl around like dust and waste paper in the streets of our affluent, unequal society. As long-term recipients of the contempt of our betters, we know how to despise the vulnerable – people incapable of work, the poor, the timid and the fearful, those addicted to drugs and alcohol. Sullen resentment tarnishes the wealth of the world, a conviction that somebody else is getting the advantages that ought to be “ours” by right and by merit.

Rancour appears among those “left behind” in neighbourhoods besieged by unknown tongues and foreign accents: people who never voted for unchosen change, as all political options are locked up in a consensus of elites. “Give us back our country!”
they cry; even though that country is not in the custody of those from whom they would reclaim it. There was no space for the working class to grieve over its own dissolution. If, as E P Thompson said, that class was present at its own making, it was certainly not complicit in its own undoing.

Grief denied in individuals leads to damaging psychological disorders. There is no reason to believe that this differs for those bereaved of a known way of living. The working class has been colonised, as was the peasantry in the early industrial era. When the values, beliefs and myths of indigenous peoples are laid waste, these lose meaning, and people go to grieve in city slums and die from alcohol, drugs and other forms of self-inflicted violence. Though the dominant culture’s erasure of the manufacturing way of life in Britain was less intense than the colonial ruin of ancient societies, this subculture was equally unceremoniously broken. It is a question of degree. The ravages of drugs and alcohol and self-harm in silent former pit villages and derelict factory towns show convergence with other ruined cultures elsewhere in the world.

Depression is a symptom of repressed grief: here is the connection between unfinished mourning and popular resentment at having been cheated out of our fair share, our due, our place in the world. If we are unable to discern our own possible fate in suffering people now, this is perhaps a result of estrangement from unresolved wrongs in our own past. Nothing was ever explained. Globalisation occurred under a kind of social laissez-faire: no political education made the world more comprehensible to the disaffected and disregarded, people of small account to those who take decisions on their behalf and in their name.

Anyone who protested against our passage into this changed world was criminalised, called “wrecker” and “extremist”. The miners’ strike of 1984 was the symbol of this: their doomed fight to preserve a dignity achieved in pain and violence was presented by the merchants of deliverance not only as retrograde, but also as an act of outlawry. Resistance to compulsory change was derided as a response of nostalgics protecting the indefensible, when the whole world was on the brink of a new life. Early in her tenure of Downing Street, Margaret Thatcher, that sybil and prophet who knew about these things, warned that Britain would become “a less cosy, more abrasive” place: a vision confirmed by the Battle of Orgreave – redolent of civil war – and the anguish of Hillsborough.

It is too late to grieve now. Scar tissue has healed over the untreated wound. Though no one expects the ruling classes to understand the distress of perpetual “modernisation”, the leaders of labour might have been able to recognise capitalism’s realm of freedom and a gaudy consumerism that concealed hardening competitiveness and the growth of a crueller, more bitter society.

The ills of this best of all worlds, its excessive wealth and extreme inequality, are on show in hushed thoroughfares of London, shuttered sites of “inward investment”, where the only sound is the faint melody of assets appreciating; while elsewhere, people wait for charitable tins of denutrified substances to feed their family, or sit under a grubby duvet, a Styrofoam cup beseeching the pence of passers-by.

Unresolved feelings about industrialism, enforced with great harshness and abolished with equal contempt for those who served it, are certainly related to the stylish savagery of contemporary life. The alibi that present-day evils are an expression of “human nature” is a poor apology for what is clearly the nature – restless and opportunistic – of a social and economic system that has, so far at least, outwitted its opponents at every turn.

Jeremy Seabrook’s book “The Song of the Shirt” (C Hurst & Co) won the Bread and Roses Award for Radical Publishing 2016

This article first appeared in the 23 June 2016 issue of the New Statesman, Divided Britain