The NHS must be updated urgently, the government has said after a report by the Health Service Ombudsman outlined how elderly patients are not receiving "even the most basic standards of care" in hospitals. However, throwing money at the problem will not make it go away.
The report said that patients experienced such unnecessary pain, indignity and distress that they went from being alert and able individuals to people who were "dehydrated, malnourished or unable to communicate".
Age UK said the report's findings – which are probably "the tip of the iceberg" since only a minority of cases reach the ombudsman – were "sickening" and should send shock waves through the NHS and government.
Most complaints of lack of care received by the ombudsman centred around patients not being given enough to eat or drink, being left unwashed for over a week, left in their own soiled clothes, given the wrong medicine or simply forgotten about.
In one case, an elderly man was not able to be with his wife when she died because of what has been described as a "bewildering disregard" for patients and an inability to see them as human beings.
The ombudsman Ann Abraham said: "The findings of my 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.
"The reasonable expectation that an older person or their family may have of dignified, pain-free end of life care in clean surroundings in hospital is not being fulfilled. Instead, these accounts present a picture of NHS provision that is failing to meet even the most basic standards of care.
"These often harrowing accounts should cause every member of NHS staff who reads this report to pause and ask themselves if any of their patients could suffer in the same way. I know from my caseload that in many cases, the answer must be 'yes'."
The care services minister Paul Burstow said: "This report exposes the urgent need to update our NHS. We need a culture where poor practice is challenged and quality is the watchword. The dignity of frail older people should never be sidelined."
PDF version If the language in the report is new, the findings are not. We know that poor care occurs in health care systems everywhere. The fact that all too often it is older people who suffer may reflect wider societal values, but from our work we know that it can happen to anyone. The fundamental problem is that the quality of health care is not reliable: the more vulnerable the patient, the greater the risk.
The media always focuses on ‘what has gone wrong in nursing?’, but the Ombudsman’s stories are not just about nurses: they feature a wide variety of medical, nursing and support staff, in hospitals and in general practice, and many are about lack of continuity and coordination between hospitals and primary care.
The report is a clarion call to think much more deeply about how and why vulnerable people suffer at the hands of the people there to look after them. The failings in the Ombudsman’s report point to something more than callous attitudes on the part of a few ‘bad apples’. The stories are about personal and institutional failure. Reliable quality cannot be achieved by single individuals acting alone. If we have learned anything in the past decade about providing safe, high-quality care, it’s that it requires sustained, continuous effort and focus over a period of years: it cannot be fixed overnight.
So what kind of practical actions could prevent the harm occurring in the first place?
First, we should stop thinking and acting as if ‘patient-centred care’ and ‘patient experience’ are different from clinical quality and patient safety. The cases illustrate perfectly that it is nonsense to do so. The care these patients received was unsafe (falls and bruises), clinically ineffective (failures to diagnose, poor prescribing, lack of pain relief) and neglectful.
At senior level, board and executive team members should be out and about, talking to patients, visitors and staff and seeing for themselves what goes on in wards, waiting areas and clinics. In the best organisations, senior leaders demonstrate by word and deed that quality of care is non-negotiable, and take an active interest in what is required to deliver it.
Staff dont need more blame and condemnation; they need active, sustained supervision and support. In the high-volume, high-pressure, complex environment of modern health care it is very difficult to remain sensitive and caring towards every single patient all of the time. We ask ourselves how it is possible that anyone, let alone a nurse, could ignore a dying man’s request for water? What we should also ask is whether it is humanly possible for anyone to look after very sick, very frail, possibly incontinent, possibly confused patients without excellent induction, training, supervision and support.
We need to develop much more systematic approaches to supporting staff who are delivering care, helping them to re-connect with patients and avoid ‘case-hardening’. On our Point of Care programme we are currently working with one such practical method called ‘intentional rounding’ in a number of wards and hospitals. Instead of waiting for patients to buzz for help, with intentional rounding nurses take the initiative and visit the patients’ bedside every hour to do whatever the patient needs and see if s/he is alright.
The regular anticipatory ‘rounds’ at the bedside reassure patients they have not been forgotten and, tellingly, result in an overall reduction in patients’ demands. More importantly, by being ‘patient-focused’ rather than task oriented, staff can find themselves re-awakened to the needs of their patients as people. Rather than increasing workload as they had feared, the intentional rounds have encouraged productive relationships between families and carers and improved communications, leaving staff feeling more positive about the care they are able to offer.
Find out more about The Point of Care programme
This blog is also featured on the Health Foundation website
Age discrimination will be illegal when providing care services to the NHS, the government has announced, meaning that elderly people who feel they have been mistreated by the health service will have the option to sue.
The new rights will be part of the Equality Act and as well as protecting elderly people from abuse they will allow them to challenge hospitals who refuse surgery or treatment on age grounds. A consultation will be carried out in March with a view to making the change in April next year.
The news comes just days after the health service ombudsman Ann Abraham reported that too many elderly patients were not getting "even the most basic standards of care".
Pointing out that there will be exceptions to the new legislation – including limiting cancer screening to people under 70 years old – the Department for Health said: "A patient's age is never an excuse for poor care. The government is determined to end age discrimination, including in health and social care. We have been examining the best way of achieving it while allowing a person's age to be taken into account where it is right to do so. We will be launching a consultation shortly."
http://www.publicservice.co.uk/news_story.asp?id=15526