Apprenticeship nursing was always the plan, because lower cost nursing was always the plan.

The government do not accept the causal relationship between lower patient mortality and the advent of degree nursing; other factors may be implicated, such as the often touted advancements in medical treatments. To defend degree nursing by claiming it to have had a singular effect is, perhaps, like suggesting crops grow better when given nitrogen, and not mentioning they need water and sunlight.

Neither can the ‘toughness’ of the degree course be exhibited as a defence. No doubt it is very tough, with students working half of their time on clinical placements, including weekends, nights, bank holidays. Non-degree students of yore, of course, spent much more than half of their course on the coal face, but the study of nursing theory may not have been so intense. (Not all nurses of yore would agree).

Loans were always going to replace bursaries – the ball and chain of £50,000 of debt is the very mantra of a neoliberal government that sells this ethos as ‘taking a punt’, of being ‘aspirational’. Think about it, Frankie and Johny Nurse meet as care assistants on an NHS ward ( which will be the only route into apprenticeship nursing) and rake up £100, 000 of debt between them, not counting likely credit card debt (currently £10, 000 per household in the Uk), then decide to buy a house. Another £150,000 of debt (actually £450,000 over 25 years). A big Sword of Damocles, this, and one likely to induce fear, and unquestioning obediance to the dictates of the employer. A battle not likely to last very long. The current so called shortage of nurses is mostly a retention issue. “Stop the train, let me get off”, shout the 5 year qualified nurses, “enough Is enough”.

Unsocial hours payments will be stopped. The doctors are a test case. If the government breeches their defenses, the lesser ranks will be easy pickings.

A&E will be privatised, turn up Friday night to have your stomach pumped and that will be £1,000, nice little earner, eh? They are already licking their lips, a la Americano.

Nursing is following the dictates of ‘the market’.

The top feeders will look after their own interests.

In the mortgage paying world of reality, it will not count a bean who or what a lecturer teaches.

In the coffee and bun conference halls of the RCN, it will not count a fake nursing certificate who pays the subscriptions.

In the government attack-dog world of the NMC, nothing matters other than control and a business friendly ethos.

Nurses exist within a hypocrisy zone.

At this point, in many articles, I have entreated nurses to ‘rise and fight’, but I have come to the conclusion this is like asking sheep to lead the Charge of the Light Brigade.

lenin nightingale 2016




While most nursing homes are honest, a significant minority treat State funds as a license to steal.

They do not employ sufficient nursing staff to perform necessary or documented services.

They under-staff their facilities for financial reasons.

Medical records are tampered with. Adding to the existing record at a later date without indicating the addition is a late entry, placing inaccurate information into the record, omitting significant facts, dating a record to make it appear as if it were written at an earlier time, rewriting or altering the record, destroying records, or adding to someone else’s notes.

Detection of tampering. Fraudulent addition to a record for the purposes of covering up an incident can be detected by current technology. Expert document examiners will need the original medical record in order to analyze it for tampering. This will enable them to detect differences in ink, look for indentations caused by writing on sheets above the questioned document, and perform chemical analysis of the document. There are clues used to detect altered records.

Nurses are familiar with the information that should be recorded in the medical record and can quickly spot missing pieces, information out of order and inconsistencies in the medical record. For example, one hospital was asked to produce the medical record for a six-month admission. The patient was in an intensive care unit for several months. The hospital’s medical records department failed to copy a few pages of the multipage critical care plan that covered the first 24 hours after the patient was brought into the ICU. This time frame was critical to the the ensuing legal case. Two shifts’ worth of (admission) documentation was not copied.

Implications of tampering. If the plaintiff can show that a defendant is guilty of spoliation of evidence, the burden of proof may shift to the defendant. When medical records are missing for unexplainable reasons, a plaintiff is at a disadvantage in the legal process and should not be prejudiced because of the missing records. Pages, sections, and entire medical records have been known to vanish, as well as be altered or substituted.

Tampering with the records complicates the successful defense of a malpractice case and raises questions in the plaintiff attorney’s mind about the quality of care that was rendered. “Practitioners sometimes try to cover up pure errors in judgment that are not negligent and not subject to recovery of damages. The appearance of a cover-up is devastating in court. The changing of a record may require the defense counsel to settle the case out of court even if no negligence has occurred. Once the accuracy of the record is challenged, the integrity of the entire record becomes suspect. When records are destroyed, the plaintiff attorney can request sanctions against the defendants for failure to comply with the orders to produce documents. The plaintiff attorney can argue in court that the records were intentionally altered or lost because of conspiracy or fraud. Successful arguing of “aggravated or outrageous conduct” can result in the granting of punitive damages.

Adding to an existing record at a later date. In reviewing medical records, the attorney may find incomplete records. The temptation is high to alter the medical record. Healthcare professionals are taught that the correct way to add to an existing record is to document the time and date that the addition is being made. The addition should not be squeezed into an earlier entry but should appear on the next available line in the medical entry.

Placing inaccurate information into the record. False information in a medical record can sometimes be hard to detect after the fact. At times, common sense or the clinical knowledge of an expert witness will lead to the suspicion that the documentation is not entirely truthful. At other times, the plaintiff will convincingly assert that the information is inaccurate.

Omitting significant information. Omitted information in a care plan may be easy to spot. For example, some neonatal and pediatric flow sheets are set up with blanks to be filled in every hour to indicate that an intravenous site was examined for signs of infiltration. A plan of this nature would be an important piece of evidence in a case involving a child with an intravenous associated injury. The deliberate omission of significant information may be more difficult to detect. Often common sense is applied to identify the information that is missing. In one case, the medication records were used to establish that the patient had extensive pain even though the nurses’ notes did not comment on the pain.

Dating a record to make it appear as if it were written at an earlier time
Many people involved in malpractice litigation recognize that more tampering occurs in doctor’s office records than in the hospital, where it is easier to spot an alteration. There are clues used by attorneys and expert document examiners to detect fraudulent dating of records.

Rewriting the record. One of the most damaging admissions occurs when a healthcare professional testifies that a medical record was rewritten. There can be completely innocent reasons why a medical record was rewritten. Occasionally a page from a chart will be recopied if it is torn or liquid is spilled on it. The appropriate procedure to follow when this occurs is to identify the page as rewritten. The original page should be retained in the medical record. The deliberate rewriting of a record with attendant changes in the content, timing, and sequence of events is tampering with the record.

Destroying medical records. The destruction of pages, sections or an entire medical record creates a strong suspicion that the information in the record was so damaging that it had to be concealed. When a record or pages of it disappear, part of the discovery process involves determining who had access to the record. Large portions of medical record disappeared in a birth injury case.

Adding to someone else’s notes. Even though it is unacceptable for one health care professional to alter someone else’s documentation, it happens, and more commonly than attorneys would believe. Physicians have altered nursing records, and nurses have altered each other’s notes. Physicians may be very casual about editing someone else’s notes because of the practice of overseeing the documentation of residents.

Summary.  Tampering with the records can have profound implications for the attorney. It will make the defense of a malpractice case difficult and the pursuit of a settlement easier for the plaintiff. The attorney who suspects that tampering has occurred needs to obtain validation of these concerns in order to make the appropriate strategic moves.




A picture taken on May 27, 2015 shows patients sharing beds in a congested ward at the Nyeri County Referral Hospital.

Patients admitted to the Nyeri County Referral Hospital are sharing beds while others sleep on the floor as those available are not enough.

The Nyeri County Health Executive Secretary Charles Githinji said the number of patients seeking treatment at the hospital had increased leading to the crisis.

He said funds allocated to the hospital by the national government is not enough.

Dr Githinji appealed for an increase in the budgetary allocation to the hospital.

Sounds familiar?

But, you say, this could never happen in England’s Green and Pleasant Land (as it did in Victorian Britain); as you walk past the person sleeping rough, past the modern day versions of the ‘soup kitchens’ of the 1930’s; as London sprouts high rise apartment blocks, owned by Russian oligarchs, as investments, that remain empty; as the working class are driven out of London like latter day North American Indians were driven from their ancestral homes; to live in working class reservations of despair, beset with drug fuelled crime.

A report by David Fenton, BBC South Today, 20 November 2014, prophetically fortells the inevitable move to force families to give ‘social care’ to elderly parents, based on the doctrine of ‘individual responsibility‘. You will not be able to walk past the person sleeping on the street and hypocritically say that is nothing to do with you, at the same time as applying that doctrine to your parents. You have bitten the governments doctrinal sprat and you are the mackerel they have hooked.

A hospital is to give so-called “bed blockers” seven days to leave or face possible legal action, saying too many families are refusing to take elderly relatives home when they are fit to go.

On Wednesday, 70 patients at the Royal Bournemouth Hospital were medically fit to leave but were still on wards.

Nearly half had somewhere safe to go – either to a family home or care home.

The hospital said some families were giving spurious reasons for not taking their loved ones back.

Katie Whiteside, clinical manager for discharge services, said one family asked the hospital to “keep hold” of a relative while they took a two-week holiday in Turkey.

Eviction threat
“At the moment we have relatives coming back telling us they don’t like the decor of care homes, or they don’t like the member of staff who met them at the door,” she said.

“Sometimes they are decorating the house or having a ‘granny annexe’ built and they know that, while the patients are here, they are being fed, watered and looked after.”

Having large numbers of medically fit patients occupying beds causes problems throughout the hospital.

But, you say, this could never happen in England’s Green and Pleasant Land, as you walk past the person sleeping rough.

And you say this could never happen in England’s Green and Pleasant Land, as you swallow every damned lie about ‘public debt’ and the need for austerity.

They have you mentally hooked.

Start putting together a personal profile, so your hospital bedmate will be that ‘perfect match’.
lenin nightingale 2016



Politicians court the elderly vote as keenly as commercial predators tap into the £1.77 trillion equity of UK grey-haired-owned housing. Release your equity, they entice, and enjoy a lavish final few years. Your nursing home room will have its own shower, so no being wrapped in a blanket and wheeled down the very public hallway for you. Your coffee will be hot, and your toast will not be as crispy as a wet lettuce; that’s for the (derogatory tone) ‘State funded’ resident. Therein, hidden within the sales patter, is the real hub of an issue: not all elderly people necessarily want to cash in their equity to enjoy the comforts of massage rooms, and windows that give views of trees and a river ( rather than the backend of a disintegrating housing esate, where the brightest lights after dark come from police helicopters); it’s this alternative they fear.

The luxury end of the UK care home market will mirror image the model of its parent country, America, where a room with crispy toast can cost £10,000 a month. Though, their will be degrees of ‘luxury’, rather like hotels, where politicians, retired judges, and hedge fund gamblers will mingle in the 5 star version (like friends reunited), and those of lower status will inhabit a 2 star world of middle-range supermarket bread and plastic cheese. There will be a mixing of classes, though, as, when their cash runs out, those at the top will soon be on their way down, perhaps to that most feared of all places, a State funded brick shit-house; where people reside for free, but pay a heavy price in terms of inadequately staffed care and bargain basement diets.

These are the nursing homes for the rest of us. Government ideology creates a two-tier care home system, where good care is only available to those who can pay for it.

The elderly share the fate of working class youth.

We accept a culture of hidden euthanasia and discardment, as Pope Francis has said: “When the elderly are discarded, when the elderly are isolated and sometimes pass away without affection, it is a very bad sign! … A people that does not take care of its elders, that does not take care of its young people, is a people without a future, a people without hope. Because young people … children, the youth … and the elderly advance History forward. Children, young people, true, with their biological force. The elderly, by giving them memory. But when a society loses its memory, it’s over, it’s over! It’s sad to see a society, a people, a culture that has lost its memory. … And the elderly are discarded, with attitudes behind which is hidden euthanasia, a kind of euthanasia. They are not needed, and what you do not need, you discard.

And now the crisis is so great that young people are discarded. when we think of these 75 million young people aged 25 years and under, who are “neither-nor”, neither working nor studying. They lack it. It is happening today, in this tired Europe … . In this Europe that is tired; she’s not old, no, she’s tired. I don’t know what to do.

Today, I do speak of Europe. Europe is tired. We have to help her rejuvenate, find her roots. It’s true she has disowned her roots. It ‘s true. But we need help her find them anew” (June 15, 2014, colloquialism retained)

“A society likes this bears in it a “virus of death” due to elderly persons being “discarded because they create problems” (March 4, 2015).

This “virus of death” is slowly killing vastly indebted students who can not get a degree-type job, who are captives in their parent’s house, not able to afford to buy or rent their own, waiting for that day when the roof over their heads is ‘cashed in’ by a parent who fears the State funded brick shit-house.

As Pope Francis said: it’s a ‘hidden euthanasia’; a “virus of death” released by the political servants of Mammon.

The headlines may scream of viruses that devastate bodies, but the most virulent epedemic to destroy all generations is that of capitalism discarding the ‘the undeserving poor’ through infesting the minds of the ‘unthinking class’, that great army of “what can I do about it, anyway”.

But, of course, YOU will never catch this virus, which is akin to believing that cattle fed on scrapie-infected sheep will never become  ‘mad cows’.

lenin nightingale 2016