T oday was a most beautiful autumn day. As I walked with my dog past newly ploughed fields and along farm tracks, I enjoyed the warmth of the sun and the beautiful colours of the autumn countryside. On such walks, my mind often wanders across personal and professional things. Today as I thought about how quickly the year was passing by, I thought about how quickly my career is passing and that I must now be in my own autumn. Next March will mark 30 years since I started my nurse training at The Nightingale School, St Thomas Hospital in London. Some of you might think that puts me into the winter of my career but I hope I have a few years left in me before I retire! Was it really that different 30 years ago? Have we made much progress in the NHS? Have we done much to improve the nursing care we give to our patients in acute settings? Sometimes, I think not. Some things are very different. Stop for a moment and think of three innovations in the last 30 years that have changed your life personally or professionally... My three were the internet, mobile phones and cash machines but having had a bit more time to think about it, I would also add computers, emails and GPS technology. All of these relate to my working life as do MRI scanners, genetic testing, fibre-optic technology, non-invasive surgery, stents and pharmaceutical developments. We are also faced with more targets and standards than I could ever have imagined, as well as rising public expectations. Yet, some things remain very much the same. Despite numerous restructures at national and local levels, the organisation of nursing is not much different to the day I first set foot on a ward or to a few years later when, as a sister of a medical ward, I thought I had the best job ever. More importantly, the care patients need is essentially the same. Patients then and now want to know the people looking after them are capable, competent and caring, and will respect their privacy and maintain their dignity. They need the same help with hygiene, elimination with food and fluids, and help to prevent complications such as infections and pressure sores. Patients then and now want this care to be given in a kind and thoughtful way which recognises them as individuals and offers some comfort during a time of distress—and they need this from a primarily registered nursing workforce. These things that patients want don’t seem too sophisticated given the technological developments that have taken place in last few decades. These things don’t seem too much to ask and, yet, we fail to consistently deliver them. This failure is not limited to being current phenomenon—through the last 30 years, a variety of reports chronicling failures in nursing care confirms this. Melanie Hornett Nurse Director NHS Lothian Health Board There are some nurses delivering kind, thoughtful, safe and effective care, but is that good enough? Even if I said most nurses are delivering this level of care, which I think is a fairer representation, that still would not be good enough, would it? I know this only too well as my own organisation recently received a report that was critical of the care we give to older people. We were inconsistent in our assessment of need, our planning and delivery of care and in our communication and attitude. We were also inconsistent in the facilities we provided.