ANGELS IN CRISIS; at Birth and at Death We Rely on Their Care: Nurses ARE the NHS. but This Three-Part Series - Written after a Year of Research - Reveals How Bureaucracy and Political Correctness Are Now Destroying This Noble Calling

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FORTY per cent of us will die in an NHS hospital bed. Exactly what kind of experience that will be depends largely on the quality of nursing care we receive.

For most patients nurses are the NHS. They are the people who colour our experience of hospital and who make the difference between basic medical treatment and high-quality health care.

But there is a huge gap between what the Government tells us is happening in the NHS and the experience of patients on the ward.

Much of this is due to the state of nursing.

The Government claims to be transforming our health care system, but in reality it has yet to tackle the fundamental issues that beset its foundation stone - nursing.

We must have good nurses, we must have enough nurses - and we must have a system and culture that allows nurses to nurse.

In this special investigation for the Mail, I have built on my previous experience of the NHS through extensive interviews, over a yearlong period, with patients and staff at every level.

Here are just a few examples of the kind of scenes I came across regularly during my research - scenes that illustrate the sheer scale of the problems facing the NHS.

IN one ward, a second-year nurse was looking after six patients unsupervised. An old man in an oxygen mask was sitting in bed staring at a wash bowl, left by the nurse so he could 'do what he could'.

His uneaten breakfast lay on the tray next to him. Next to that stood a pot overflowing with his phlegm. A full bottle of urine dangled beneath the bed.

The basics of care seemed to have eluded the nurse: she needed to clear everything away, replace the urine bottle and then check why the old man had not eaten breakfast before helping him to wash.

In a North London hospital, I came across a ward of elderly stroke victims. The nurses were clustered around the nurses' station eating chocolates while the Rolling Stones' Let's Spend The Night Together blared out across the ward.

On yet another ward, I stopped in front of an old lady. Her face was such a mass of bruises that I assumed she had been brutally mugged.

An embarrassed senior nurse explained that the women's bruises were the result of her falling out of bed.

The old man in the bed next to her - the Government's promise to end the scourge of mixed wards is yet to be fulfilled - piped up: 'People fall out of bed all night long. They do it so much they wake me up.' Why, I wondered, did the bed lack the cot sides available in private hospitals to safeguard patients? The senior nurse was affronted: 'We believe physical restraint is inappropriate to our patients' dignity,' she reproved.

Anyone wandering around an NHS hospital will encounter similar scenes of overstretched staff, neglect, incompetence and a system beset by political correctness.

They will also come across excellent nursing. It is not the quality of the care that is at issue but its randomness. A patient will experience in one day, often in one hour, disorganisation and indifference side-byside with first-class care and illuminating kindness.

Nursing in the NHS is defined by a series of such paradoxes. The pressure from the Government is to increase activity to show the benefits of increased investment - yet my investigation shows over and over again that there are still not enough nurses.

We are told by the Department of Health that 318,856 nurses worked in the NHS in 1997. Since then 48,000 extra nurses have

been recruited. But the hospitals in and around London that I visited had 20 per cent vacancies. Half their total budget is being spent on agency nurses to cover the shortfall.

At the same time, it is only with great difficulty that bad nurses can be sacked for incompetence. Low pay, staff shortages, the strength of the nursing union and the culture of the NHS insulates the profession from the disciplines of normal working life. …