Paul Vallely: How did care became a four-letter word?

Attitudes, not words, convey disrespect

Bugger, said the playwright Henry Livings, is only a swear word in the south of England. In the North, he argued, it is a term of endearment. As in you daft bugger, you soft bugger, and so forth.

It's some time since the late great Henry formulated this thought. It was embodied in a memorandum written 30 years ago to BBC policymakers in London by the esteemed radio drama producers Alfred Bradley and Tony Cliff, who died last month. The BBC mandarins accepted the logic, and the North was accorded a bigger bugger quotient in the BBC ration of allowable obscenity.

All that came back to me last week when the Commission on Dignity in Care pronounced that one way to improve the care of the elderly was to threaten nurses and others with the sack if they patronised elderly patients by asking, "How are we today, dear?"

Out here in the provinces we are largely inoculated against the intuitions of the language hygienists. The sophisticated urban elite can detect discrimination wherever they wish to see it, but we live in a world where everyday honorifics such as love, chuck, lad, dear, pet, kidder, duck, guv, babes, mate, flower, son, hen, hun or hinny are long-standing parts of the regions' linguistic heritage.

It is not words but context, of which tone is a vital part, which is the key consideration in the use of language – which is why care has to be taken in places where such terms can be used with the intention of belittling or harassing. The respective ages of the user and recipient are significant too, as are their stations as superior or subordinate.

But if older people are suffering humiliation and degrading treatment daily in our hospitals and care homes we need to look beyond language to find the source of our contemporary lack of respect for human dignity.

A poll of older people last week showed that almost half feel that society is not geared up to meet the needs of older people – in areas from housing and transport to health. So what happens in hospitals is rooted in attitudes towards older people evident in wider society.

Our increasingly materialist and self-absorbed culture has less and less patience with old people whose contribution to life appears less vigorous, whose ideas and values are out of joint with the times, and whose very existence is deemed a problem in need of a solution. We have forgotten that being is more important than doing.

But nor is it true to say, as the Dignity in Care report does, that our lack of care is only cultural and has nothing to do with public spending cuts. The report suggests that potted life stories for each patient should be given to staff to read along with their records. It wants nurses to be forced to spend time on every shift discussing feedback from older people. Ideas like that fly in the face of reality. Care takes time. And spending cuts have already shrunk the time staff have available for care without imposing extra burdens on them.

It was striking that the report found that in some hospitals, older patients received better attention from the cleaners than from the nurses. The cleaners were able to make the time the clinicians couldn't. Finding dentures or cleaning spectacles are little things, but they make an enormous difference to the quality of a patient's life. Now that older people make up 60 per cent of the patients on NHS wards this is no longer a minority issue.

For the past 10 years, I have lived in the North, after three decades in London. One thing people in the provinces have is more time for one another. You see that in shops, pubs, theatres, on the roads, and in hospitals too. There is more empathy, more tolerance, more warmth, even. Perhaps it is because we all call each other "love".