A report published on Wednesday revealed a horrifying standard of treatment of the elderly in some of our hospitals – horrifying but not shocking, in the sense of surprising. For this was not the first such report. Far from it. But could it be the last? Why is it that some hospitals are treating so many old people so appallingly? What can we do about it? And how does the scandal relate to the current rows over reform of the NHS?
The report was written by the Care Quality Commission which has been carrying out spot checks on a hundred hospitals. This report dealt with twelve of them and concluded that only half were fully compliant with legal obligations regarding dignity, privacy and nutritional standards in the treatment of the elderly. Three of them, a quarter of the sample, were exposed as failing in these basic standards.
The inspectors discovered some appalling examples of neglect and mistreatment. Elderly people were served meals when they were asleep, presented with food that had gone cold, left to eat meals with their fingers because they were denied the necessary help to cut the food up, suffered dehydration because water was left out of their reach and not offered the chance to wash their hands after using bedpans. In one case a doctor actually had to prescribe water to ensure that a patient got anything to drink. Inspectors also reported that staff were not treating patients respectfully, not having their treatments explained to them and not seeking their consent.
One of the three hospitals identified as failing was Ipswich Hospital where a 96-year-old, Mrs Muriel Browning, was treated before her death a couple of years ago. Her daughter, Angela Laurence, told me on the Today programme, how her mother, a dignified and educated woman, had suffered such an ordeal that she had said she just wanted to die. On her first night in hospital, she had fallen out of bed because it had not been supplied with cot rails, despite her daughter asking for them. She suffered severe pain from a rash developed from nappies she was required to wear because the nursing staff claimed they did not have time to help her use a commode. She was often left in bed in soiled nappies.
Mrs Laurence made constant complaints about her mother’s treatment both while she was enduring it and after her death. All Mrs Laurence received in response was what she called a ‘whitewash’ and no formal apology. Her mother’s case, along with many others, was taken up by the Patients Association which has been campaigning on the issue, as has Age UK. These campaigns followed the exposing of the treatment of the elderly at Staffordshire Hospital two years ago, so shocking that many people hoped the exposure would put an end to what was going on. The new report dashes such hopes.
Everyone, of course, has expressed horror at what the CQC has reported this week. The Health Secretary, Andrew Lansley, spoke of 'appalling levels of care'. Sir Keith Pearson, the chairman of the NHS Confederation, said the failings were 'simply unacceptable.' He added: 'We in the NHS cannot tolerate the failure to meet minimum standards in any way, shape or form.' And Dr Peter Carter, the general secretary of the Royal College of Nursing, said: 'Some of the concerns raised in this report are truly shocking and we are clear that there is simply no excuse for failing to treat patients with the respect and dignity they deserve.'
Such condemnations, however, don’t explain why it should be that such terrible things are happening in some of our hospitals or what can be done to prevent them going on happening. On this issue, opinions are predictably divided.
Some argue that the problem is one of resources and imply that things are likely to get worse as the squeeze on resources tightens within the NHS. Dr Carter warned that 'frontline care is inevitably going to be affected' by the ongoing job losses within the NHS, the pressure on nurses’ time and too few staff to ensure patient safety.
Others, however, argue that even if it is all going to become more difficult as budgets tighten in the next few years, lack of resources cannot explain the basic mistreatment of the elderly that has been reported. After all, the NHS has never had so much money as has been devoted to it over the last decade or so. The problem, they say, is how hospitals are managed.
One commonly identified problem is the failure of communication among staff in hospitals. This leads to such a dispersal of responsibilities that no one ends up being properly responsible for what actually goes on. Managers themselves, it is argued, are too reluctant to take responsibility themselves because they fear that in doing so they will upset producer groups, such as nurses and doctors.
Another charge commonly made is that nursing is no longer the caring career it once was. In order both to save money and to give nurses career paths that take them away from simple nursing, nurses have been promoted into other roles leaving no one to do the basic job of nursing adequately, it is claimed.
Whatever the truth of these explanations, how do they relate to the huge controversy raging at the moment about the Government’s NHS reform plans, which are currently on hold? One of the key proposals now up in the air is what function the regulator, Monitor, should fulfil and, in particular, whether it should encourage competition or simply collaboration and cooperation among service providers.
Advocates of competition say that problems such as those identified in the CQC report are the result of insufficient competition in health provision. They argue that lack of competition permits the sort of management laxness that leads to the scandals the CQC has discovered. They argue that to substitute what they regard as the woolly notions of collaboration and cooperation for the disciplines of competition would be to leave the NHS vulnerable to the sort of mismanagement which leads to the mistreatment of patients.
Opponents of competition argue that it would lead to cost-cutting as competitors fought each other on price. The result of that, they argue, would be worse treatment for patients, including the elderly.
What is clear is that how we treat elderly patients is one the major issues facing our health service however it is structured and organised. Already treatment of the elderly constitutes most of what the NHS does and that is going to be more and more the case as the number of elderly people in Britain soars over the coming decades. We need urgently to work out how to treat them with dignity and with real care.
What’s your view?
- Have you personal experience of how the NHS treats elderly patients and, if so, what do you make of it?
- Why do you think elderly people on some hospitals receive such shocking treatment?
- What do you make of the argument that their mistreatment is due to lack of resources?
- Do you think the way hospitals are managed is the root of the problem?
- Do you share the view or not that the way the career of nursing has been changed has had a damaging effect on the care of patients?
- And do you think more competition in the NHS would improve or harm the chances that elderly people could expect proper care and treatment in future?
