A SECOND report in a matter of weeks has expressed concern about the quality of health-care provision in this country. In October, the Care Quality Commission found that many patients, especially among the elderly and more vulnerable, were being neglected in hospitals (Comment, 18 November). Last week, the NHS Future Forum outlined a series of concerns, among them that “selection in nursing was a particular issue, with a sense that the focus has moved away from selecting students on their ability, capacity for compassion and caring, and desire to work in nursing.” Whereas clinical staff, by and large, support the move to make an academic degree a necessary requirement for training, patients who contributed to the Forum were not so sure. Nurses need to acquire the technical skills needed by front-line carers, admittedly, but without the vocational element that connects them to their patients, they will be able to do only half the job.
As Professor Stephen Field, the chairman of the forum, writes in his covering letter to the Prime Minister and the Health Secretary, an increasingly elderly population is going to require a mixture of medical and social care. And when that care becomes long-term, whether in hospital or at home, or in a nursing home, elements such as nutrition, spirituality, and mental well-being come into play. It is, of course, good that those nurses who want to improve their skills and gain expertise should do so, but there is another level of care that is in danger of losing its status, being “left” simply to medical assistants. As Jennifer Worth’s accounts of her life as a midwife show, common sense, experience, and a sense of calling can outdo academic learning any day.
Although attention has been drawn to elements in the Forum’s report that look at the quality and training of medical staff, perhaps the most significant elements are its remarks on the Health Bill, currently passing through Parliament. Professor Field welcomes it in general, but only if it incorporates the changes recommended by the Forum. These include a curb on competition (“a tool for supporting choice . . . never an end itself”), and the addition of safeguards to prevent private companies’ “cherry-picking” patients with the easiest ailments to treat.
The National Health Service is an incalculable asset to this country, but the increasing professionalisation of the service at a time when demand is rising will make it unaffordable. The danger of introducing more academic hurdles in the NHS is that it can give the impression that health care is best left to the professionals. The existence of last-resort health care is, of course, reassuring, but personal responsibility for one’s own health must not slacken in consequence. It is hard for nursing staff, however dedicated, to care for people who clearly do not care for themselves.