This article is by an academic at one of the UK’s senior universities. The argument he raises is, in my view, of great importance and I am happy to reproduce it here, with permission. C.W.
It’s not the nurses
What is the root cause of the Stafford Hospital scandal? Nurses, doctors, the NHS are not the root. It lies deeper, feeding toxic ignorance into all the caring professions. The caring professions in my view are those that whose sole purposes was once to help others in need, so medics, nurses, teachers, social workers and police officers are all carers. I am a caring professional at a university, and I have been given the role of chief carer in my department. I have written this piece partly because I have that role, but mostly because I am one of those ordinary people who seems to understand what care is.
At the root of the caring professions’ problems are people who do not understand care. They understand counting. They can’t count care, no one can, but counting is all they can do, so they count what they can, usually money or heads. In doing so they try to count something that cannot be counted by counting something else at the wrong level of each caring profession. Immediately this sets our professions on the road to ruin, the disaster unfolding in exactly the same way in each profession.
You can’t count care
Because The Counters can’t count care, or respect, or professionalism, or anything else that ultimately matters, they count heads in and out of emergency wards, cancer patients through CAT scanners, children geting A*–C in their A-levels, number of criminals convicted. They think this is progress. But counting is not care and never can be. Numbers and caring lie either side of a line that divides the universe in two. Whether it divides it neatly or raggedly is disputed, in the manner of a dispute about at what point a man should be called bald. That dispute doesn’t matter. We all agree that Yul Brynner was bald.
The caring professions were once on the side of the line that is home to care, respect, professionalism, honour, integrity, love. Try counting things like that. On the other side are things like metres, ounces, proportions, all other yardsticks, money, efficiency, targets, league tables. These are all measures of stuff, and counting will do fine for them. That is why they are not so important and on the other side of the line.
We are not special. We just care for a living. Nearly everyone lives on our side of the line when it matters. Our side is where we don’t have targets or league tables for looking after our kids, or other people’s kids, or our friends, or our neighbours, or anyone else who needs help, because nothing could be more ridiculous than having targets for these things, and if people started thinking like that then it really would be time to give up.
Can’t see or won’t see
Politicians and their economists either cannot or will not see this. They don’t understand the caring professions, because anyone who did would not have imposed business culture on us. Business doesn’t care. That is not to say that people in business don’t care about their children or their neighbours. Of course they do. Care does not scale like that. It’s business that doesn’t care. It says so itself: ‘In the end, this is a business, not a charity.’ ‘In the end, business isn’t about making the world a better place.’ That is what we carers must remember, because we are in the business of making the world a better place.
The people who have imposed business culture on us are dangerous. Stafford showed us how dangerous they can be. Stafford is what happens at the extreme when The Counters take us from the side of the line where we belong to their side of the line. Here is how the disaster unfurls.
You’re not part of this week’s target, so bad luck, you die
Nurses, teachers, policemen, had their culture built around Rule 1. For the NHS, Rule 1 was care on the basis of need. For teachers, do your best by every kid. For coppers, get the bad guys. For social workers, kids shouldn’t suffer. There were other rules, but they all answered to Rule 1. Then The Counters imposed their targets and league tables on us. Immediately, care on the basis of need, do your best by every kid, get the bad guys, Rule 1, was replaced with one of their yardsticks. Their ruler doesn’t measure care on the basis of need. It measures waiting lists for the scanner. If the waiting list for breast cancer is the one that the yardstick says should come down, and you are closer to death but have colon cancer, bad luck, you die.
Sentencing people to death because they are on the wrong spreadsheet rips the heart out of a caring profession. When The Counters took over the NHS, some nurses and doctors resigned, others shouted, others were shouted down. But inevitably most said to themselves, ‘I’m a nurse, this is all I can do, and I have to feed my kids. And I can still care for Mr Jones and Mrs Smith just as I’ve always done.’ This honourable delusion goes on for a while, until Mr Jones dies because he is on the wrong list, or Mrs Smith in the next ward who you heard about from your friend dies, or word of the masses dying or lying in their own faeces at places like Stafford gets around, which it does long before the rest of us hear about it. Nurses still need to feed their kids, and they are nurses. So they carry on. Having first switched themselves off. I used to work with nurses in geriatric care. They really were angels. All of us in the caring professions know where the switch is. We have to use it, otherwise we wouldn’t be able to care tomorrow. The way the NHS has been ruined by The Counters, I’m not surprised that a lot of nurses found the big switch.
The yardstick doesn’t measure ‘get the bad guys’, either. It reckons clear-up rates, one way or another. And so now it is easy for the coppers who don’t care so much. Once on the outskirts of police culture, now they are the centre of it. Those who play the new game know which crimes they can solve and which will be troublesome. They know which conjunctions of crime and evidence the Crown Prosecution Service will let into court and which it won’t. Guess which cases the game-players spend most of their time on. Guess what happens inside the heads of the coppers who joined the Force to get the bad guys. Guess who will end up running the show. At least one police force has a list of local cons who will confess to flimsy evidence and those that won’t. Guess.
At one time there was no reason for a school to exist except to do its best by every kid. Now there are targets and league tables. Rather than the object of the exercise, kids are now the instrument. In the end, it is children who produce the school’s numbers. They are levers that can be pulled. Not all schools pull hard, but many do, and how hard is not the point. Children have become levers. They are called As and Bs and Cs in the staffroom. Schools have their target: A*–C. If your name is ‘C/D borderline’ you are probably worse off than if your name is A or F, because you are lever that might be connected to something. I know this because I get kids at age 18, 180 a year, and more each year are shattered. As carer-in-chief in my department, I meet a lot of young people who are troubled. No one comes to me to say that they are troubled by their toe. All the people I have tried to help over the last few years are troubled in the head. There are more of them each year. I am not surprised. If I had been subjected to unremitting pressure to perform for my school’s quantitatives, or been ignored because no amount of teaching would make my name C, I would be troubled in the head.
Mine is still a caring profession, but only just, and only because The Counters have been occupied ruining the NHS and schools. But they have caught up with us now. When I attend meetings, 40 PhDs gather in a room. But we are not smart enough to beat The Counters. The dead weight of their stupidity will drag us down.
And so to Stafford
There is no greater tragedy in my mind at the moment than the hundreds who died in Stafford Hospital or were belatedly liberated from spreadsheet rule. But there is a greater irony. It is politicians making speeches in the House of Commons about how incomprehensible the tragedy of Stafford was. How could it happen? How could patients be denied compassion? What is wrong with the NHS? What is wrong with nurses?
How dare you! It is your culture, the culture of the dead economists who animate you, the culture of your business friends. It was not our culture until you forced it on us. When a rapist gets away with it because coppers now have monthly targets and know that the CPS will want more than a month’s work for this one, do not blame them. At one time they would have gone after the bastard regardless. It is you and your army of Counters who are the problem, because you don’t know the difference between care and seven. You have dragged the caring professions into your cesspit. Do not blame us for the stink.
Associate Professor, School of Geography
Nottingham NG7 2RD