A contagion of cruelty that taints the health service A different kind of Dickensian scene confronts us this Christmas, not associated with good cheer but reminiscent of the Victorian workhouse, as the appalling conditions that formerly prevailed at Alexandra Hospital in Redditch are exposed after a huge legal action by bereaved families of patients. Starvation, dehydration, cruelty and incompetence all feature in these shocking revelations. They are a far cry from the idealised image of traditional British nursing that was projected at the opening ceremony of the Olympics. At the same time, while deploring this lethal lapse in standards, we should bear in mind that it is far from representative. In hospitals across Britain, dedicated doctors and nurses are caring for patients with a combination of professionalism and compassion that is inspirational. That said, what happened to 38 patients at Redditch was an affront to the conscience of a civilised country. It is tragic that one of the victims was a former nurse, left unwashed for 11 weeks, according to her son, and put on medication so strong it deprived her of the power of speech. The cause of one 84-year-old man's death was so incontestable that on his death certificate it was given as starvation ("inanition"). A 35-year-old father of four died after reaching a weakened state because, his widow says, staff did not know how to insert a feeding tube. According to his widow, when the nurse found he was dead she laughed. The callousness of nursing staff is one of the most chilling aspects of this scandal. Trays of food were left out of patients" reach, then taken away untouched. Such conduct, in what should be the most caring of all professions, is deeply disturbing. These revelations lend credibility to the claims by Jeremy Hunt, the Health Secretary, that patients in NHS hospitals are exposed to "coldness, resentment, indifference" and "even contempt." In the current issue of the Journal of the Royal Society of Medicine, the Prince of Wales writes that "those age-old qualities of human kindness and compassion" are "palpably lacking" in health services today. While few institutions will be practising the level of abuse recorded at the Alexandra Hospital, any loss of basic human sensitivity in the nursing profession must be addressed. Compassion should be an essential part of the culture of a hospital. Redditch shamefully illustrates Mr Hunt's alarming contention that, in the worst instances, there is a "normalisation of cruelty." That contagion must be expunged from the NHS. What is needed is a return to traditional standards of caring. Values that were intrinsic to the nursing profession from the days of Florence Nightingale need to be reasserted. Ideally, recruits to that profession should already be characterised by a spirit of compassion, but it must also be reinforced by training. This is an instance where "back to basics" is the only correct approach. It must be enforced by strong management, with clear responsibilities. The highest standards of decency and respect must be reinstated as the prevailing ethos in every hospital, without exception. In a sense, medicine is the victim of its own success, with demographic consequences - an ageing population - that make maintaining standards ever more challenging. But that is no excuse for callousness. Doctors at Redditch were driven to prescribe water for their patients to counter dehydration caused by dereliction of duty by nursing staff. Did clinicians not feel an obligation to act as whistle-blowers? Where was the clear-cut chain of command, where the communal acceptance of the primacy of patient care? And why did it take so long for the inspection system to uncover such grotesque neglect of vulnerable people? Without properly hands-on management, and a universal return to age-old Hippocratic principles, we fear that more distressing cases like this may occur. Let the Redditch horror story serve as a spur to eradicate abuses in the health service, and restore the NHS to its place as the jewel in the crown of the welfare state.