NHS fails to care for elderly?

No doubt everyone has heard by now that the Health Service ombudsman has published a report which is critical of NHS care of the elderly (Report available here)

I have not had time to read the full report but what I have seen is a grim catalogue of neglect and incompetence.

It is apparently based on ten complaints – not a big sample but big enough to make a major impact in the news ( BBC , Daily Mail , Express , Guardian )

Would many people be prepared to argue that these cases are unrepresentative of care – and that we really do have good standards of care?

I know a lot of people in NHS health care and of course I get to speak to our students about care –  I am sure that people still want to do a good job and strive for high standards.

Rather than pontificate for ages about this I really wanted to ask you all – what do you think?

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Comments

I recently went to visit a family friend at a hospital near Birmingham. As I drove in there were customer care promises on a huge banner down the side of the building. These were:
I will… make you feel welcome
I will… make time to listen to you
I will… be polite, courteous and respectful
I will… keep you informed and explain what is happening
I will… admit to mistakes and do all I can to put them right
I will… value your point of view
I will… be caring and kind
I will… keep you involved
I will… go the extra mile

after I had been there a while I wondered why the person I was visiting had no idea about what was wrong with her or why she was in hospital and went to talk to a nurse. The nurse pleasantly told me he could not tallk to me as he was not her named nurse. He advised me to talk to someone else, but that person had gone home. I then had to insist on talking to another nurse, who informed me that because of the lady’s confusion they had not told her anything. I explained that she does not have dementia and advised they arrange an assessment of her mental health to confirm this. A few days later I returned, the elderly lady was still being ignored by staff and had no idea of what was going on. Again I went and had to insist on speaking to a staff nurse, who informed me that ‘she is pleasantly confused’. As I drove away I thought that the staff had probably broken all their promises and that this was probably pretty normal. They were not unpleasant and there was no hint of actual neglect, but they had made no effort to ‘see the person’ or relate to her at all.

The report states: ‘The investigations reveal an attitude – both personal and institutional – which fails to recognise the humanity and individuality of the people concerned and to respond to them with sensitivity, compassion and professionalism’.
That certainly tied in with my experience there. Yet teaching nurses at BCU both adult and mental health, I am always impressed with the determination and commitment to provide excellent quality care that people show. It is easy to get carried away in a blame culture and not analyse the structures within which these patterns can arise. I wonder how often nurses’ efforts are acknowledged and how much support for their own ‘personhood’ they receive. My feeling is that when people are treated with consideration and respect themselves it is natural to repeat the behaviour with those they look after. Should we be teaching how to look after each other before we teach looking after patients?

I woke this morning to my radio alarm, telling me of the deeply ditressing findings in this report. I wanted to retreat back under cover, cringing at what I heard and feeling some vague but associated guilt at being a nurse in the NHS.
Sadly I found I was not shocked or surprised that this level of neglect and inhumanity was there to be uncovered and embarrass us all again. I imagine whilst I am writing this exactly the same thing is being perpetrated many times over.
Thinking about things I have heard and experienced, synthesised into the following few,short comments may be part of the problem. I also think they will come across as biased and contentious – I agree!

1. What people say they do can be very different from what they actually do.
2. Elderly people are unimportant and insignificant to a lot of people working in care jobs – its potentially dirty, boring and unglamorous work.
3. Since nurses got their training in university they have lost touch with what the job is about and are all the worse for it.
4. Nurses make too many assumptions and only value their own opinion – what’s the point of asking the patient what they think – ‘When I know i’m right?’
5. Nurses are more bothered about fitting in with their colleagues than defending the patients needs and rights.

Now i’m sitting here – worried – wondering just how many times i’ve been guilty of all 5 points and not realised it or taken responsibility for it.

Anyone else there who should have a guilty conscience?

Shortly after I retired I sat alongsidean ill friend in the local hospital, who was very badly nursed. After he died I set out to try and understand why things had gone wrong.
Now, more than ten years later, I can recognise many factors that have made good standards of nursing much more difficult. In summary I can say that it appears that University based nursing education has failed to inculcate high standards of practical nursing skills, especially inter-personal skills: that the pressures of medical advances, the increase in patient numbers and speed of throughput have increased the pressures. But most importantly the political imperatives and management driven by ‘market economy’ policies have pushed out the caring imperative which used to be the hallmark of the NHS. Nurses are the cornerstone of the NHS and hospitals used to be judged by their standards. Now nurses are at the bottom of the pecking order and viewed as units of expenditure, and are not listened to and not made to feel appreciated, and are ready targets for blame.
This is obviously not the whole picture, and it surprises me that there are many areas where nurses manage to maintain high standards, but I would suggest that it is often against the odds and working beyond the call of duty.
The Nursing Standard gave me a platform for explaining about this aspect and it can be viewed on he internet.

Care of the older adult needs to improve considerably; we know this and are frequently confronted with bad reports of care. When I hear these findings I immediately wish I was back in practice to offer and deliver compassionate care and treatment that all our patients deserve. But it frustrates me that there already are many brilliant nurses out there that do their best striving above and beyond what they are ‘employed’ to do and passionately care about each individual but these nurses do not get the same attention. How about having equal media coverage to promote and celebrate great nursing practice which may encourage others to up their care delivery and take pride in their impact on the lives of many. Nursing is a hard job but there is no excuse for personal attitude getting in the way of good practice and care but it’s even harder when media coverage only portrays the negative side.

This report makes really disturbing but essential reading for any nurse or nursing assistant. One of the main themes is that of the neglect of basic hydration and nutritional needs. I am very fortunate to work as a deputy manager with a motivated team of psychiatric nurses, health care assistants and allied staff who view patients holistically as people with both physical and mental health needs. We are very pro-active at instigating food and fluid charts, tissue viability monitoring and bristol stool charts, where appropriate. We allocate staff each shift to look after specific patients, whether they have physical or mental health needs. Does this not happen on general nursing wards? Maybe they could learn a thing or two from their psychiatric nursing colleagues? I firmly believe that managers need to allocate patients to specific staff for shifts and highlight in handovers the basics – nutrition, self care, mobility and of course mental state (regardless of hospital setting). Is it really that difficult?

I have trouble with the whole argument that university nurses lack the initiative to notice that patients are dehydrated, starving or self-neglecting. You do not have to be a nurse to observe such issues….after all the carers in the report were often the people who raised their concerns. I have always felt that the university programmes do not include enought physical care training for the psychiatric nurses, BUT, it is very telling that the case studies in the study are in general settings. (Maybe they were the only places included in the sample ?)

I think that the general wards could learn from their psychiatric nurse colleagues. I think that named nursing systems promote responsibility and ownership of care delivery to the patients in a unit. But nursing is about understanding that everyone is a human being who deserves dignity and respect. Unfortunately, some people who work in this sector do not have this ethos. It’s not about where you are educated or even your experience, to some degree it is innate. Let me give you an example, my 92 year old nan is in a private care home. When I visit I often get into conversation with a 19 year old nursing assistant who has more nouse than nursing professionals twice his age. He relayed how one of his older (and, you wuld expect perhaps wiser) colleagues had berrated an elderly resident who had been incontinent. He found this unacceptable and complained to his managers who took action. He had commented that he wasn’t in the job to ‘make friends’ but to look after the patients. Inspirational.

I also do not accept the argument that nurses become de-motivated as they bottom of a pecking order and their pay does not reflect their efforts. Well, nobody enters this profession for the financial rewards do they? If nurses become so de-motivated they cannot be bothered to feed/hydrate/assist with the basic personal care of their clients, they need to be reported and disciplined, and ultimately, one would hope sacked. There are plenty of people who do have the motivation to take their places I am sure. Felicity Stockwell’s comment re: ‘working beyond the call of duty’ mystifies me, if ‘call of duty’ does not encompass the above tasks…….what exactly is the point of turning up for work?

Doesn’t it all boil down to treating each other the way we would like to be treated ourselves. During my training at BCU, one of the lecturers summed it up – if you imagine that the patient you are working with is one of your own family, would you happy with the care they are receiving.

Nurses (of all branches) – It’s time to stop naval-gazing and looking for sympathy, we know there are pressures, paper work ad-infinitum, staff shortages and cuts….if you can’t stand the heat..maybe it’s time to think about a different career path.

You stated

“We allocate staff each shift to look after specific patients, whether they have physical or mental health needs. Does this not happen on general nursing wards? Maybe they could learn a thing or two from their psychiatric nursing colleagues?”

To answer you question – yes…yes they could.

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