Michael White on nursing standards

The Times and the Daily Mail, which compete for the most alarmist health stories, both thought the big news of the day was the new British Medical Association guidelines - drawn up in consultation with the Royal College of Nursing and the Resuscitation Council.

Alarmist isn't always wrong, although I was pleased to see The Times mocking one of its own recent leads, suggesting rampant middle class alcoholism. All that 21/14 units of drink a week stuff is guesswork, the paper now suggests.

But I think I know why the BMA's new guidelines alarmed me. As we have noted here before, most complaints I hear about NHS hospital treatment are about nursing standards. Only recently a nurse in his 30s gave Mrs White advice she knew was wrong - so did the doctor - on the basis of treatment he had as a child. Now they want to give these people the right to switch off the life support machine! Would any of us survive Christmas on the ward, I wondered?

I know what you're thinking. What an unkind thought! Well, yes. Also, shouldn't the NHS encourage pressure from nurses, many now highly qualified, for greater responsibility? And those new guidelines, aren't they about not resuscitating people who should best be left to die peacefully? TV soaps are usually wrong to show them being saved. The changes were welcomed by all sorts of grand bodies, although not by SOS-NHS - Patients in Danger, the group that thinks their elderly relatives were deliberately left to die.

To test my own reaction I rang several MPs who are also nurses or doctors. Alas, none was on Sunday-night duty until I got to Dr Richard Taylor, independent MP for Wyre Forest since 2001. At 73 he is still a sufficiently old-fashioned doctor to take weekend calls. I half-expected him to reproach me. Not at all.

'I'm absolutely staggered by it because I thought it was the consultant who had the ultimate responsibility for patients in his or her care, who had the final say,' he said.

Dr Taylor trained and worked in assorted now-defunct London hospitals (plus the RAF) before becoming a consultant in general medicine at Kidderminster General Hospital and the Droitwich Centre for Rheumatic Diseases (1972-95).

His late political career arose over a disputed closure at Kidderminster.He defeated the sitting Labour MP, who was still cross with Dr Taylor when I last bumped into him. The Doc now sits on the Commons health select committee, where colleagues seem to like him.

'In my day when we made decisions about resuscitation, the ward sister and I, the nurses if they wanted to be involved, and the junior staff, decided together if it would be the right thing and to make sure we were taking the family with us. In my mind the decision in a well-run hospital unit is a team effort. A consultant is no longer a god-like figure, though he or she carries the can,' Dr Taylor told me.

Old-fashioned? Maybe. He assumes that the BMA has acquiesced in pressure from elsewhere (is there a shadowy Non-Resuscitation Council?) because senior nursing staff now expect to be treated as equals by doctors.

'It's a symptom of the nursing profession flexing its muscles,' he suggests without evident enthusiasm. Nurses nowadays are too busy to listen, his constituents often tell him.

In next to no time we are discussing the loss of matron (he doesn't admire the modern version) and spot inspections on the ward, which once included royal colleges descending on them as part of doctors' training. 'That made sure they kept patient notes up to date.'

The kind of self-assessment (40 core standards, etc) now replacing the star-ratings will not do the job, he predicts. When I cheerfully report my recent experience of being made to use an alcohol rub on the ward (click here to read the article), the Doc says 'that's no good against C difficile, it's got to be soap and water'.

Oh dear. But he was boosted by junior health minister Lord Darzi's appearance before the select committee. It's all about leadership.