There are those who are mildly idiotic, a great many, for we all display that quality at times.

There are those who are very idiotic, and although their actions often induce harsh comment, we should always remember that we are all prone to being very idiotic on occassion, so judgement should be tempered.

Then, however, are those who are the fully paid up members of the Union of Idiots, whose repeated idiocy, in all its length, breadth, and width, never fails them; they never learn, for they are incapable.

Into this latter category seemingly and snugly fits NMC and RCN officials and their comments regarding the establishment of the nursing associate role.

The government inform us that the number of nursing associates will be in addition to planned nursing numbers – which have been cut, and will be slashed when nursing courses are paid for through debt.

The nursing elite inform us that nursing associates will “assist” registered graduate nurses.

This is like replacing police with cheap ‘special constables’, or an army unit with ‘reservists’; or a librarian with a ‘volunteer’.

They can not stop nursing associates being used as a cheap way to replace registered nurses. This is the end-game of neoliberal economics. The steps to this end-game are deliberately small, so as to conceal their ultimate direction.

Nursing associates will need to be regulated, of course, and therein is the 30 pieces of silver; for the NMC will extract a registration fee, and the RCN will tout for membership.

The old crew is being thrown to the sharks, gradually, almost unnoticeably, piece by piece.

The question becomes: Are NMC and RCN elites fully paid up members of the Union of Idiots?


Yet, a darker reality presents itself: they know what they are doing, and, wishing to continue to be the handmaidens of government, attendees of policy committees, and pat-on-the-back conferences, they take their pay and are nothing more than government propagandists. (As an aside, I am reliably informed that a nurse lecturer recently read out verbatim a government policy statement as if it were fact; without a semblance of analysis).

It then becomes the case that those who believe them are fully paid up members of the Union of Idiots – whether lecturers, students, or nurses.

Yet another possibility exists, to introduce the mandatory level of synthesis, for some of the nursing elite may have convinced themselves that nursing associates will only ever be a top-up to the ‘real thing’; the sort of Blairite delusion which had Saddam Hussein having weapons of mass destruction.

Whatever, nursing and the NHS is finished if you do not fight at a grass root level, and UNITE in a militant opposition to the forces of destruction and their Judas plague of idiots.
comrade lenin nightingale 2017




NMC agrees to regulate new nursing associate role

A new care role in the nursing family

The Nursing and Midwifery Council (NMC) has today formally agreed to a request from the Department of Health to be the regulator for the new nursing associate role.

Jackie Smith, NMC Chief Executive and Registrar of the NMC said:

“After a thoughtful and thorough discussion, the NMC’s Council has agreed to a request from the Department of Health to be the regulator for the new nursing associate role.

“The Council recognised that there is strong support for the regulation of nursing associates and I have always maintained that the public would expect any role with nursing in the title to be regulated.


Nursing is forced down the American route, and will soon be almost entirely populated by diploma-level nurse associates, who will be more flexible than Olympic gymnasts, running from ward to ward to maintain a modicum of staffing, being summoned by phone, not daring to refuse a split-shift or sudden call out. And in the most weasel words imaginable, the NMC again tries to hide from the abandonment of the degree nurse by saying it has ‘formally agreed’ to register the new model of nursing – pull the other leg, you have no choice, no more than any poodle who is forced to obey its master’s voice. ‘ After a thoughtful and thorough discussion’ –  stuff straight from the bed-pan!

The irony of ironies – those who are being thrown of the ship keep on paying the rabble who are doing the throwing.

Do you think that it will never be you, that it will always be someone else?

Is anyone really that thick?

Do you think that nursing is a 25 year, mortgage-paying career?

Is anyone really that thick?

Or Cowardly?

lenin nightingale 2017




As reported in the Daily Mail:  My comment in capitals:

Tens of thousands of allegations of abuse have been made against care workers but only 15 prosecutions.


Figures show there have been a total of 23,428 accusations reported to local councils in the last three years.

But these are only the tip of the iceberg as only half of authorities would supply figures.


According to the BBC’s File on 4 just 700 of the 23,000 cases involved the police and led to just 15 prosecutions.


BBC’s Radio 4’s File on 4 documentary through Freedom of Information requests to local councils across the UK.

Michael King, Local Government Ombudsman said: ‘What we see is just the tip of the iceberg’.


Bridget Warr, chief executive of the UK Home Care Association , which represents home care providers said: ‘I think that the challenges of too little money in the system from Government, through local authorities to providers’.


A Department of Health spokesman said: ‘The abuse of people who depend on care services in their own homes is completely unacceptable’.


Lenin nightingale 2017


This article is taken from Lenin2u, and is of immense relevance .

“Nurses, like Boxer, the workhorse in George Orwell’s Animal Farm, described as the farm’s most dedicated and loyal labourer, are being sent to the knackers’ yard in a van owned by private equity firms and driven by unions. The £15bn care-for-the-elderly market is expected to grow at 3.1% a year for the next 10 years. Everyone wants to be a part of it.”

Key political authors

We wish to display here, part of the works of key authors- many of whom have written it all before. The reading of such books and publications, is sadly becoming rare due to the political aims of today and reliance on technology or as Huxley called them “pleasure machines ”

A key classic is George Orwell, who was for  a time, a student of Arthur Huxley ” Brave New World “. Orwell’s book is said to be inspired by the book “We” (1921)  Y Zamyatin, which can still be found available on rare book sites.


Chapter iv

By the late summer the news of what had happened on Animal Farm had spread
across half the county. Every day Snowball and Napoleon sent out flights
of pigeons whose instructions were to mingle with the animals on
neighbouring farms, tell them the story of the Rebellion, and teach them
the tune of ‘Beasts of England’. ”




Nearly 1,500 of Britain’s care homes will close by 2020 because of the financial crisis facing the sector, a new report predicts. The National Health Service (NHS) will be left with an annual bill of £3 billion (US$4.55 billion) after 37,000 care home beds disappear over the next five years, according to think tank ResPublica.

“Yes, I think inevitably we will have to sell homes, some of which will stay as nursing homes, but some of which will end up closed and changing their use. It’s not something we want to do,” the founder of private equity firm Terra Firma, Guy Hands, told the Guardian.

One such study, by the Harvard University economists David Cutler and Nikhil Sahni, estimates that “structural changes” in our health-care system account for more than half of the slowdown.

In a sense, Brad Stuart is one of those changes. He is a leader in a growing movement advocating home-based primary care, which represents a fundamental change in the way we care for people who are chronically very ill. The idea is simple: rather than wait until people get sick and need hospitalization, you build a multidisciplinary team that visits them at home, coordinates health-related services, and tries to nip problems in the bud. For the past 15 years, at Sutter Health, a giant network of hospitals and doctors in Northern California, Stuart has devoted himself to developing home-based care for frail, elderly patients.

(i.e. the Uk version of this plan is really simple – you build a multidisciplinary team that visits the elderly at home, coordinates health-related services, then robs from their estate to pay for their care at death).

For years, many people in medicine have understood that late-life care for the chronically sick is not only expensive but also, much too often, ineffective and inhumane. For years, the system seemed impervious to change. Recently, however, health-care providers have begun to realize that the status quo is what Stuart calls a “burning platform”: a system that is too expensive and inefficient to hold. As a result, new home-based programs are finally reaching the market, such as one launched about five years ago at Sutter, called Advanced Illness Management. “It’s much more feasible now to make a program like this work than it was a few years ago,” Stuart told me. “There are a lot of new payment schemes in the pipeline that are going to make this kind of program much easier to support.”

This is good news. Generalizing from a small sample is always perilous, but if what is happening at Sutter is any indication, a more humane, effective, and affordable health-care system is closer than we think.

The problem that home-based primary care addresses has been well understood for years. Thanks to modern treatment, people commonly live into their 70s and 80s and even 90s, many of them with multiple chronic ailments. A single person might be diagnosed with, say, heart failure, arthritis, edema, obesity, diabetes, hearing or vision loss, dementia, and more. These people aren’t on death’s doorstep, but neither will they recover. Physically (and sometimes cognitively), they are frail. Joanne Lynn, the director of the Altarum Institute’s Center for Elder Care and Advanced Illness, says that this “frailty course,” a gradual and medically complicated downslide, was once exceptional but is now the likely path for half of today’s elders.

Seniors with five or more chronic conditions account for less than a fourth of Medicare’s beneficiaries but more than two-thirds of its spending—and they are the fastest-growing segment of the Medicare population. What to do with this burgeoning population of the frail elderly? Right now, when something goes wrong, the standard response is to call 911 or go to the emergency room. That leads to a revolving door of hospitalizations, each of them alarmingly expensive. More than a quarter of Medicare’s budget is spent on people in their last year of life, and much of that spending is attributable to hospitalization. “The dramatic increase in costs in the last month of life is largely driven by inpatient hospital stays,” Helen Adamopoulos recently reported on “On average, Medicare spends $20,870 per beneficiary who dies while in the hospital.”

Hospitals are fine for people who need acute treatments like heart surgery. But they are very often a terrible place for the frail elderly. “Hospitals are hugely dangerous and inappropriately used,” says George Taler, a professor of geriatric medicine at Georgetown University and the director of long-term care at MedStar Washington Hospital Center. “They are a great place to be if you have no choice but to risk your life to get better.” For many, the worst place of all is the intensive-care unit, that alien planet where, according to a recent study in the Journal of the American Medical Association, 29 percent of Medicare beneficiaries wind up in their last month of life. “The focus appears to be on providing curative care in the acute hospital,” an accompanying editorial said, “regardless of the likelihood of benefit or preferences of patients.”

Taler can attest to one of the more peculiar elements of this situation, which is that a better model—namely, providing care and support at home—has been known and used for decades. Taler himself pioneered an interdisciplinary house-call model in Baltimore in 1980, and in 1999 he co-founded a home-based primary-care program at Washington Hospital Center that has served almost 3,000 people. In the 1970s, the Veterans Administration (now the Department of Veterans Affairs) began  building a home-based primary-care program, which now operates out of nearly every VA medical center and serves more than 31,000 patients a day. This is not newfangled, untested stuff

The “frailty course,” a gradual and medically complicated downslide, was once exceptional but is now the likely path for half of today’s elders. Home-based primary care comes in many varieties, but they share a treatment model and a business model. The treatment model begins from the counterintuitive premise that health care should not always be medical care. “It’s not medical treatment, it’s helping meet personal goals,” Brad Stuart said. “It’s about ‘Who is this person, and what do they want in their life?

In Sutter’s Advanced Illness Management program, known as AIM, each patient is assigned to a team of nurses, social workers, physical and occupational therapists, and others. The group works under the direction of a primary-care physician, and meets weekly to discuss patient and family problems—anything from a stroke or depression to an unexplained turn for the worse or an unsafe home.

(This is not a freebie, and it is coming to the UK in a carbon copy form).

I sat in on some of these team meetings. A social worker and a nurse talked over a case and decided they needed to make a home visit together; a doctor suggested a medication change; the various members of the group compared notes on one patient’s hospitalization while discussing whether another’s 911 call might have been averted. Strikingly, patients were presented not as bundles of syndromes—as medical charts—but as having personal goals, such as making a trip or getting back on their feet. The team tries to think about meeting patients’ goals rather than performing procedures. An advantage of the multidisciplinary approach is that over time, as clients’ conditions change, the group can recalibrate the mix of services and providers, to avoid jarring transitions. “Once in AIM, always in AIM,” one coordinator told a patient’s family. Over several years, a person might move from independence and occasional social-worker visits to hospice care and finally death, all within AIM, and mostly at home.

One recent morning, while I was waiting at Sutter to accompany a nurse and a social worker on a home visit, the phone rang. It was a panicked caregiver whose charge had rectal bleeding. A case manager alerted the patient’s regular nurse so that she could make a visit right away, almost certainly averting a 911 call, and possibly an ambulance/ER/hospitalization ordeal. Later, in Washington, D.C., accompanying George Taler on house calls, I met a 92-year-old man afflicted with hypertension, blindness, gout, and diabetes, who had been in and out of the hospital before entering Washington Hospital Center’s home-care program in 2007, and who has not been back since.

Sutter figures that the program, by keeping patients out of the hospital whenever possible, saves Medicare upwards of $2,000 a month on each patient, maybe more. The VA, for its part, says its program reduces hospital days for its patients by more than a third and reduces combined costs to the VA and Medicare by about 13 percent.

But now we come to the business model, which has been problematic. For doctors, nurses, health systems, and insurers, providing in-home service costs money. Medicare pays for hospitalization, but it does not pay for much by way of in-home care, or for social workers, or for time spent coordinating complex cases and traveling to homes and talking with caregivers. Where in-home primary care has existed, it has tended to be a foundation-funded experiment, or a charitable project, or part of a vertically integrated system like the VA, which can capture any savings. The home-care program at Washington Hospital Center runs at a 30 percent loss. Meanwhile, hospitals lose “heads in beds,” and therefore revenue. Medicare—which is to say, taxpayers—may save money, but it has no mechanism either to track savings or to pay providers and insurers for hospitalizations that do not happen.

This is why Brad Stuart was frustrated for so many years. He could see the path forward, and others could see it, but it was blocked. Today, though, he’s feeling optimistic. The path is clearing.

(The path in the UK is extremely clear – sign over your house to us!).

lenin nightingale 2016


Could replacing nurses with nursing assistants pose risks to patients? Elizabeth Whitman, November 15, 2016:

While swapping professional nurses for nursing assistants might seem less expensive for hospitals in the short term, new research suggests it’s associated with lower quality of care, increased patient risk and thus higher costs in the long run. The study, published in BMJ Quality and Safety, examined data from hospitals, patients and nurses in Europe. The richer the skill mix of nursing staff, the lower the mortality rates and odds of poor patient ratings or quality reports, it found, although it did not establish a causal relationship or identify specific mechanisms by which outcomes worsened.“Trying to substitute lower level people in an increasingly complex area is bound to have adverse clinical outcomes,” said lead author Dr. Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania in Philadelphia. “Our study shows that it does.”

(Yet, the NMC welcomes “lower level people” into the “skills mix” of nursing, like the poodle of government it is).

(Suppose you were an idiot,  and suppose you were a member of the NMC, but I repeat myself).

(Their marketing is so good, they think they can get nurses to eat their own shit!).


  The NMC and Government – spot any difference?

The study drew on survey data from more than 13,000 nurses across 243 adult acute-care hospitals and more than 18,800 patients in 182 of those hospitals, and discharge data for more than 275,000 surgical patients in 188 of them. The hospitals were located in Belgium, England, Finland, Ireland, Spain and Switzerland.

“Nurses in hospitals with richer skill mixes have lower odds on reporting poorer quality care, lower patient safety, high burnout and job dissatisfaction,” the researchers found. Nurses were also more likely to recommend their hospitals and less likely to report problems involving patients including frequent pressure ulcers and falls with injuries. The researchers also found that substituting a nurse assistant for a professional nurse for 25 patients was associated with a 21% rise in the risk of dying.

(Please comment my dear NMC, you put on courses for  ‘nurse assistant  pretend nurses’ in nursing homes, to aleviate the debt problems of the private equity firms running them).

The study is salient at a time when hospitals are looking for ways to cut costs, including by changing the skill mix of nursing staff by hiring assistants with less training whom professional nurses would then supervise.

Those efforts have met with attempts at the state and federal level to mandate minimum levels of nurse staffing and skill mix levels. The Registered Nurse Safe Staffing Act has been repeatedly introduced in Congress, although it was never passed. More than a dozen states have enacted legislation or regulations governing the appropriate blend of nursing staff.

Changing nursing skill mixes is not the same as expanding scope of practice, which has also inspired proposals for changes in regulations. In May, for instance, the Veteran Affairs Department proposed authorizing advanced practice registered nurses to give care at the top of their licenses by providing services without clinical oversight from a physician.

The lowest-level credential in nursing is that of a certified nursing assistant — technically not a nurse — which typically requires a high school diploma and the completion of a state-approved program. CNAs provide basic care, such as bathing and transporting patients. In 2015, the median annual salary of a nursing assistant in the U.S. was $25,710.

Providers in the next tier, licensed practical nurses and licensed vocational nurses, must also complete a program, typically a year long. Their duties include registering patient vital signs and administering medications, earning a median salary of $43,170 per year in 2015 in the U.S.

Registered nurses must have an associate or bachelor’s degree, and they can assess patients, educate them and provide recommendations for care. In the U.S., their average salary was $67,490 in 2015.

Dump the bullshit. It’s all about cash!

“This is such an enticing idea, that we can solve our problems if we add lower-cost workers,” Aiken said. But, she added, it is “nurses that are driving not only the quality outcomes that hospitals are seeking, but these quality outcomes are associated with bottom-line performance.” She described nurses as “the surveillance capacity for hospitals,” the first to detect when something is not right with a patient and intervene before catastrophe ensues.

Joanne Spetz, a professor at the Institute for Health Policy Studies at the University of California at San Francisco, who was not involved in the research and had not read the study, pointed out that a variety of factors affect quality — financial problems at a hospital, for instance, or poor management — in addition to the skill mix of nurses.

“Maybe the registered nurses haven’t been trained well in supervising,” Spetz suggested, as one possibility. She suggested a deeper dive into data to see if any hospitals performed exceptionally well with a low skill mix — or exceptionally badly. That data could be more actionable, especially for hospitals whose budgets may leave them with little choice but to hire nurses with less training.


lenin nightingale 2016