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I am getting increasingly concerned for clinicians in the NHS who, having been battered by politicians and the media, now have their own colleagues turning on them (July 2001 JRSM, pp. 322-330). In their previous article1, I thought Dr Graham Neale and his colleagues were too hard in their criticism of the ‘failure to manage leg ulcers aggressively’. I now work for Age Concern and have been visiting a woman regularly who has bilateral leg ulcers that three weeks' inpatient treatment and all the resources of a teaching hospital have failed to heal. Some problems defy solutions.
Ten operations over the past decade have given me ample opportunity to observe the difficulties faced by nursing staff. On one occasion my neighbour was Elsie, 92 years old and confused. She absolutely refused to change her posture when a sacral pressure sore threatened: ‘I'm a poor old woman. Please, can't I sleep as I like’. She also regularly rose from her bed, ran across the ward leaving puddles behind her crying, ‘Oh, I'm so sorry’. Could the nursing staff be blamed if she fell? Can they be blamed for the readmission of Lily, sent out with a care package, but readmitted with an infected wound because the community nurse had failed to appear, or Lizzie, who was reduced to phoning her fishmonger when her carer defaulted. It is pleasant to record that he left her not a piece of fish but a full meal. (I have changed the names.)
Much of what Dr Neale and his colleagues write is valid criticism, but failures in patient care are too often blamed on the hospital staff without further enquiry. Readers might be surprised if they knew how many community workers not only fail to do the work they are paid for but also fail to inform their clients. My ‘ulcer lady’ has had no home help for several days, relies on neighbours and is considering going into a home because her present state is so difficult and stressful. Also, why is it assumed that the hospital staff are always responsible for infections? What about the children, some with patches of impetigo, running from bed to bed, ‘Come and give me a kiss, darling’. Couldn't visitors be asked to ‘take their litter home’ and ‘leave this place as you would like to find it’ as is done in other places. Overworked nurses should not be asked to clean toilets.