I would suggest that there are three insidious forces which have given rise to this parlous situation:
1) The NHS has become a political organization more than a healthcare organization and it promotes people with political rather than technical delivery skills into positions of authority.
2) Nurse training has become more academically orientated rather than patient orientated - a consequence of the half-baked notion that every subject has to be studied as a "degree" now.
3) The "me, me, me" malaise that pervades society these days undermines the idea of professionalism. You get your degree certificate, call yourself a "professional" and expect the world to respect you. Well sorry, but respect has to be earned through actions, not passing exams.

All this applies elsewhere in society too hence we have new MBA graduates all thinking they can (and expecting to) run a major business!

There are, of course, still very good people who do a splendid job but they are a dying breed.

Mel, Bath,

Good article and good letters. I agree the key is discipline, accountability and the fear of the consequences of failing to do the job. There is also something else going on here........too many chiefs and not enough Indians, as we used to say. Today these chiefs never have been Indians! Senior nurses don't climb from the bottom up, experiencing all the work a hospital affords on the way up. Experiencing is so different from reading about it. Ask any patient, they will tell you that the modern nurse is sat in front of the computer not actually nursing. They are not always working on that computer, I saw one checking out holiday sites, another shopping. Then let us look at the non executive board members. Well intentioned they may be but too often they do not have the background to question what they are fed by managers. If they do question they will quickly be labeled as troublemakers and frozen out. The NHS needs 'predators' to snap and cull to keep the service healthy.

Jane Prior, Whiteway, Newfoundland

Well done, Minette Marrin and all the other nurse bashers out there, for you are one of the reasons why myself and countless experienced nurses like me have left the profession. I walked out the hospital door, never to look back because everyday nurses face an avalanche of blame and finger-pointing from the media in particular and the mis-informed public. You would think that nurses are the only individuals who staff a hospital and are single-handly responsible for the spread of MRSA and other community-acquired infections. I would like to know why nurses have become the scape-goat, why not the policy makers and management who made the budget cuts that have led to dangerous staffing levels and the inabiltity of nurses to do their job in the first place. In California, they have recognised the importance of minimum nurse to patient ratios, and until the powers that be are willing to put their hands in their pockets and staff appropriately nothing will change.

Victoria, Portsmouth, Hants

largely accurate. Just as our police service is now strangled by bureaucracy and "elf n' safety" so is our health service,with thousands of enforcers paid handsomely to interfere.
Of course, the image of nurses as healing angels was never true, but even as normal human beings many are driven to despair by the pressures, while management seem indifferent to the conditions on the wards caused by perpetual overcrowding and understaffing. Remember, too, that there were very few resistant organisms in the early days of antibiotic use.

D.Henry, Edinburgh, Scotland UK

I would like to respond to Jill of West Sussex,
I trained in the 1950s at the Kent & Sussex at Tunbridge Wells. Although not a teaching hospital my training there was much as Jill has described of hers. Extremely high standards of cleanliness, both personal and on the wards were at the forefront of our training. I have seen first hand unacceptable standards of cleanliness now in many NHS hospitals including where Jill trained. Turning to the matter of nurses wearing uniform outside hospitals, can one be sure that all those seen are actually nurses from NHS hospitals? Only yesterday I saw two women in Tescos wearing what looked like nurses' uniforms. On closer inspection I could see the name of an agency embroidered on them. An agency providing what was not signified, it could have been a cleaning company or the uniform of a private care / residential home . In my opinion, employing more qualified nurses and fewer HCAs would solve many of today' s problems in the NHS.

Peggy Pryer, Canterbury, Kent

I'm fed up of everyone blaming nurses! Your comment about being "slaggy" is both unjustified and slanderous to the vast majority of hard working, underpaid nurses. Despite several studies directly linking poor infection control to low staffing levels NOT ONE journalist has bothered to make that headline news!! I totally agree with what "John" wrote above - I trained in that style & it workd on mre levels than one. STOP blaming nurses and start supporting our need for adequately staffed wards!!

Rebecca, Chingford, London

Good professional nurses of either sex cannot be brought down by pretenders. Only by non-empathetic managers in suits who’s only function is to achieve a target – and the target is not the patient.
It’s the same sadly in all parts of society.
A plan for change anyone?

Retired Male District Nurse, dorset,

..great article. All that needs to be done now is to add the other service departments (police, education, local councils etc) failings due to government micro-management and we will have a full history of the last 10 years.

CD, Epworth, UK

In my experience as a lay person who was involved with the infection control team I can confirm they want to do the best they can for patients,their role is to educate and inform both the NHS staff and the general public.They need more support from Boards, Chief Excs, and Non Excs.alike(IC) Is everybody's business.Infection Control teams are key to the current situation!!!!!!They have expert knowledge and are really willing to share good practice,just give them a chance!!! Until you work with these IC teams,you can have no idea just what they are up against!!!!!.Their job speck is enormous,and I have the utmost respect for them. Educate,Educate,Educate.Learn from past mistakes. Lay involvement is key to making sure these teams have proper support.The NHS Trust I was attached to had only about 7/8 people leading IC for a population of over 700 thousand!!!How can anyone expect patient safety under these conditions? 2006/7report reflected serious failings the worst in the country,WHY!!!

Mary E Hoult, Leeds, Yorkshire

It's all too true and there are too many hospital workers who don't care. Having elderly parents, I've seen a fair bit of the inside of hospitals. Although I've seen some very fine care, I've also seen a dreadful lack of it too. There seems to be a slovenly lack of attention on some wards to the needs of the elderly - patients who can't feed themselves having food taken away uneaten, dirt left uncleaned, staff with extraordinarily poor English in abundant supply, no information for relatives. It is a disgrace. My parents didn't fall prey to Clostridium or Staff A, but I can't say that I was always happy with their care and neither do I look forward to my own old age if what they had awaits me.

Joe, Newcastle upon Tyne, UK

What happened to the infection control nurse employed by the NHS working in the Kent Hospitals?
Why was she not sacked?
Also,why is there no mention of disciplinary action by the Nurses' Council.
May I suggest we start a College of Real Nurses.
It seems any authority a staff/charge nurse had, has been eroded.The ward cleaning staff and care assistants are not accountable to them.But why should they be as
without practical and theoretical training nurses are not qualified to nurse.Simply learning procedures from books and reflecting on the worth of the text is not enabling a student to practice and become experienced clinicians.
Are present day nurses unwilling to respect and care for they patients because of the current trends in training or in spite of it?
Our training establishments have lost the vision and responsibility they owe to society to provide a safe environment for care and healing.The standards achieved in Hospice nursing need to be carried through to all areas of care

Ann Pearse, Houghton, New York, USA

Another fear has characterised this crisis and actually helped cause it: it is the craven fear of doctors and nurses to draw public attention, loudly and inconveniently, to something they all know is wrong. Doctors are a timid bunch when it comes to rocking the boat and most will get privately frustrated but remain pretty docile when it comes to leaking scandal. I know: I'm one.

It's a shame. In the face of selfish and dishonest managers (and politicians), the only real weapon that clinical staff have is publicising bad things as loudly and as much as possible. It works a dream: I wrote an article 2 years ago which resulted in our Trust CEO being relieved of her job (of course, not before I had to endure all sorts of silly threats about me losing mine if I didn't retract things). We need more of this attitude if management are to be held accountable at the time rather than after it's too late.

Whistleblowers of the world, unite!

Roddy Campbell, Christchurch,

My wife and I were warned a couple of years ago about this NHS trust. We were told if anyone in the family was ill forget ambulances, put them in a car and drive to Brighton.

I think the Kent hospitals were run on fear - fear that management would not make the bonus cut-off and sod the patients.

Clive S, Near Tunbridge Wells,

It's much the same in education. Before I retired from university teaching I lived under constant "fear" that I would be found lacking, not up to the job, etc. But that was because, although an atheist, I had been brought up in the stern protestant ethic: "as ye sow, so shall ye reap" and all that. Looking back I realise I was a mug. Colleagues who used their research leave to paint their houses, who refused to work more than a 35-hour week, who said they were unavailable at weekends because the latter were reserved for their family, who kept their telephone numbers ex-directory in case (as happened to me) they were awoken at 3 am by a mentally disturbed student, or who without a qualm stood students up without notice over tutorials set up weeks in advance - all such colleagues never suffered censure, let alone disciplinary action, and as for dismissal, robbing the finance officer at gunpoint was about the only thing that could have got you the sack. No wonder standards have slipped!

JF, Canterbury, UK

There is no question that the lack of accountability is resposible for the demise of pride and pleasure in doing well and is, in many social and public services, destroying professionalism
This no blame, no shame culture has resulted in a neglect to care and is responsible, in many cases, for an ability to be enabled to mask bad practice, without any fear of exposure.
Lack of accountability and the driving down of standards is one of the paramount reasons given by many good experienced people, who are leaving the caring sector and the social services, in droves.

Darnthesafetynet, London ,

Absolutely spot-on article Minette Marrin. The NHS has been distorted by so many factors including government targets, nurse training, management attitude, senior nurse and doctor disempowerment.

However, to leave patients in soiled beds etc is beyond belief.... even in an NHS which is being flogged by government to reduce waiting lists. This has to do with the 'I can't be bothered' attitude knowing there are unlikely to be any consequencies.

At least the CEO involved has been sacked... but what about the others 'in the know' there?

Philip, Birmingham,

Having worked in the NHS for over 20 years I can say that thanks to frequent government interferences care is unable to be given. Patients are frequently moved from ward to ward to ward to enable the 4hour golden rule to move A&E patients to the wards. I was the only registered nurse looking after 16 acutely ill surgical patients. It was impossible for me to provide decent care. I often went home crying with frustration at the care I had given, not because I was lazy etc but because it is impossible for 1 person to feed 4 patients, impossible for 1 person to simultanously give out 3 bedpans. You get my drift? I did the old training, and I believe it was better, but that is my opinion. I am sick of nurse bashing. In the ward I worked on, no staff members took lunch breaks etc because we where too busy. No staff members got off duty on time because believe it or not we do have pride in our jobs and care about our patients.

Denise Havelock, Cheshire, UK

NHS hospital treatment has always been frightening and slightly insulting. Nurses are not angels! However, in the past the public didn't have to be afraid of catching killer infections because of poor hygeine. A recent stay in hospital was terrifying. Bags to drain off fluids burst and I was too afraid to draw attention to myself. Nobody came to clean up the horrible mess that had spilled onto the floor. I held my mobile phone under the pillow throughout one whole night because I was afraid of an aggressive male nurse. But PLEASE hospital staff stop being horrible to elderly people! It is the worst thing and I have witnessed it too many times. I believe some very unsuitable people are pretending they want to nurse but couldn't care less. This brings down the rest of the profession which is a pity for them and for patients.

S. Munden, King's Lynn, Norfolk

Yes this is one patient who is frightend of going in to hospital , after spending three weeks in intensive care with pumionia plus M R S A all picked up in hospital, necvernind c-diff. No thank you very much.

Theresa Parish, Kings Heath Birmingham, West Midlands

Good article. As usual the public spotted the problem at least a decade before politicians acknowledged they might have a point. Actually up until the mid nineties hospitals did have a disciplined workforce who were prepared to feed patients , clean commodes etc. They were called student nurses and most wards relied very heavily on them. Discipline was exerted by a report given at the end of a ward placement. Having this motivated ,young , compliant workforce tended to insulate hospitals from the difficulties in recruiting reliable staff, particularly in areas with low unemployment and high property prices.

John , Southampton, UK

I agree with that. Everyone has only so much 'fear' (stress)they can cope with in their daily and working life. The fear of failing the bureaucracy replaces the fear of failing the job. Look at the disaster in Education, with so many teachers leaving in high states of stress due to yet more governmental reforms and additional targets. The children, in the end, were failed. The patients have gone the same way.

Fran Nustedt, Beaumarches, France

Nurses were very fearful of getting anything wrong when I trained at Kings College Hospital in the 1960s: we were student nurses - in reality apprentices: we learned on the job with blocks of study and had procedure books that had to be signed off as we moved through our training, We even learned how to clean although we had an army of cleaners dedicated to each ward with a terrifying hospital housekeeper to ensure the hospital was clean. We learned how to wash hands and arms and scrub fingernails before embarking on a dressing or personal procedure - had outdoor uniform - it would have meant the death sentence if one wore ones ward clothes outside the hospital. Non-teaching hospitals did not have such high standards - and I remember eyebrows raised when I worked in another hospital, cleaned up a trolley and started a 'tidy round' - we did regular tidy rounds at Kings - going round to each bed cleaning the locker, removing rubbish and tidying up and chatting to the patient.

Jill , West Sussex,

It is not quite as simple. Ward sisters (or Modern Matrons) and indeed career managers are no longer chosen from the hard working ranks but are hand picked for for the understanding of the "health and safety, diversity, learning and diversity, and knowledge skills framework" and ability to sit through meetings ticking boxes. The abilty to change a bed sheet excludes them. This is as true in the operating theatres and the boardroom as the ward. Why have the Medical Director and Director of Nursing - (both of whom are Board Members) and the Consultant Microbiologist, all kept their jobs?

Mike, Denham , Middlesex

Well done Minette Marrin. This problem of lack of care etc has been brewing for many years and is not the fault of any one goverment. The NHS reflects much of what has happened in society with regard to standards and responsibility. I think everyone in the NHS, especially nurses have declined in professionalism. Sorry if I have said the unthinkable about nurses. But rose tinted glasses have to be removed or we will not have an NHS in the future. I am constantly being told by private medical perosonel that they left the NHS due to the standards of staff they had to work with. Lets be honest when someone is bad at thier job in nursing etc they cant sack them. So promote out of the way. Then hey presto the whole show could be run by the lesser actually abel. Good nurses are not desired to be lost into management. As the Americans say " go figure".

Shona, Canterbury, kent

Fear sounds good -- but fear of what?

I don't know anything about the NHS, but I work in a health-care delivery facility in the U.S.A. that has fallen under the spell of "managed care": I am increasingly micro-managed by "quality controllers", "resource utilization managers", and such. I have more and more boxes to tick, forms to fill out, and procedures to follow. Regularly (not too often, I am good) I am criticized for forgetting a signature, filling in the wrong time, or even for misspelling. I have fear all right -- but more and more not fear of failing my patient, but of failing the bureaucracy.

And the micromanagement starts eroding my professional pride. After a long day, getting tired and feeling that I cannot do right by my patient due to all the paperwork, I feel that my concern for my patient decreases. The fear of failing my professional standards takes a back seat to my fear of failing the procedures.

Maybe part of the NHS problems can be explained along these lines

I still need my job, Everytown, USA