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NHS failing to meet care standards for older people

In a new report, Health Service Ombudsman, Ann Abraham, says the NHS is failing to treat older people with care, compassion, dignity and respect.

The report, Care and compassion?, is based on the findings of 10 independent investigations into complaints about NHS care for people over the age of 65 across England. It serves to illuminate the gulf between the principles and values of the NHS Constitution and the felt reality of being an older person in the care of the NHS in England.
The Ombudsman's findings show how 10 older patients suffered unnecessary pain, indignity and distress while in the care of the NHS. Her investigations highlight common failures in pain control, discharge arrangements, communication with patients and their relatives and ensuring adequate nutrition.
The Ombudsman explains: '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.'
The 10 investigations covered in the report are not isolated cases. Of the nearly 9,000 properly made complaints to the Ombudsman about the NHS last year, 18% were about the care of older people. The Ombudsman accepted twice as many cases for investigation about older people as for all other age groups put together.
Care and compassion? recounts the Ombudsman's investigation into the care of Mr D, who had advanced stomach cancer and wanted to die at home. When his daughter arrived to collect him from hospital, she found him sitting behind a closed curtain in distress. He had been left for several hours, was in pain, desperate to go to the toilet and unable to ask for help because he was so dehydrated that he could not speak or swallow.

The emergency button had been placed out of his reach, his drip had been removed, fallen and had leaked all over the floor. At home, the family discovered Mr D had not been given the right pain relief and spent the weekend driving around trying to obtain the correct medication before he died. 
Also included is the story of Mrs H, who was admitted to hospital after having a fall at home. She suffered further falls while in hospital and broke her collar bone, but her niece, who was her only relative, was not told. Mrs H was transferred by ambulance to a care home. When she arrived at the home, she had numerous injuries, was soaked with urine and was dressed in clothing that did not belong to her and that was held up with large paper clips.
The Ombudsman concludes: '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 NHS must close the gap between the promise of care and compassion outlined in its Constitution and the injustice that many older people experience. Every member of staff, no matter what their job, has a role to play in making the commitments of the Constitution a felt reality for patients.'
Care and compassion?

Your comments (terms and conditions apply):

"I think I had very good nurse training (qualified in 1981) - treat the patient with respect and dignity, imagine your mother was in that bed etc. I am so depressed by all the stories I hear about poor nursing care. No one seems to get washed any more! As for nutrition! You also don't need to be elderly to not be able to reach your drink. Today I had to gently ask the sister on the ward where my mother is staying to ensure that someone offers to give her some help when she gets her diarrhoea as no one has offered so far in 5 days and she had a
shoulder repair so only has one hand! I would have been embarrassed to have a relative ask for such basic care. Also no one has offered her analgesia; my father has to ask when he visits. What has gone wrong with the training? I only left nursing 9 years ago and some of my colleagues still carry out brilliant care but it is certainly not the norm anymore" - Fenella Maddison, Sussex

"I agree that families should be more involved in care, however is this always as realistic as it sounds? Also, the same approach to the elderly as to children should be employed and a good standard of quality care should be given to all whatever their age" - Louise Baker, Warwickshire

"Professor June Clark had an excellent letter on this (The Times newspaper, Fri 18 Feb p29). She points to the lack of nursing leadership at all levels as the prime cause of poor nursing care. The NHS concept of care has been dominated by management rather than professionalism. Totally agree - well worth a read" - Catherine Gleeson, West Yorkshire

"My father is at present in a south coast hospital after being
misdiagnosed by his GP, he very nearly died and is still at risk of losing his legs. All this has been very distressing to my father, my brother and myself, but to make things worse, the care he has received in hospital has been awful. Up until three weeks ago he was an active and energetic man whose greatest
love was walking for miles every day along the sea front, last week he was left unable to walk and his bell ignored until he wet himself, he was so ashamed that the next time he needed the toilet and the nurse told him to wait, he attempted to walk to the bathroom himself with the aid of a walker and he fell. This is not all of it, his medical treatment is fragmented and inconsistent, they are treating his symptoms and not the
cause and I feel he is becoming confused. We feel he is being treated like he is a bother by the nursing staff and have had to issue complaints about the medical staff to the hospital
trust. How would the nursing staff feel if that was their father? We understand the wards are short staffed but the elderly patients should not be made to feel like they are unimportant or an unwanted burden" - Jackie D, London

"The report is shocking for NHS staff. Achieving safe care for all patients has been compromised for complex reasons including - domination of targets to reduce waiting times, discharge too soon resulting in readmissions. Our nursing profession should be using the evidence from last year's Commission on the Future of Nursing and Midwifery in England - to use this to support improvements" - Catherine Gleeson, West Yorkshire

"I strongly agree with Jeanne Fry. Specialist elderly care wards means that the staff are aware of the specific needs of the client group, and are in general there because they wish to care for elderly people!" - Jackie, West Midlands

"I strongly suggest that a 'Trojan Horse' practice be introduced by governments in which covert observers are placed, in a patient role, within care settings - hospitals/care homes. Bad practice would be quickly recognised and the 'threat' of this system should keep care practitioners on their toes. Additionally, I strongly agree with Jeanne Fry's recommendations" - Mike, Cornwall

"Children's nursing philosophy is that of "family-centred care" where the children's care is negotiated with the children and their families. The families are actively encouraged to participate in fundamental aspects of care. I am mystified as to why this philosophy is contained to the domain of children's nursing!" - C Poole, Birmingham

"Encourage all the relatives and friends with their well meaning opinions to come in and help with the important tasks such as feeding and quality personal care that understaffed NHS wards struggle to keep up with. More volunteers helping would mean a better environment and outcomes for these often frail and vulnerable elderly patients, older people have more needs
and most need at least 1:2 nursing and in fact receive 1:9 nursing care. Even the most caring and hard-working nurse cannot give gold standard care to all 9 or 10 patients" - Sarah, Southampton

"We are no better in Scotland. My relative was left covered with soup for hours which also was on the ward floor. When staff were advised they suggested that I should clean her up. This same lady was discharged from hospital without prior notification to myself or the care home. She arrived by ambulance taxi and was walked with assistance despite still having metal clips in her femur unknown to the care home at that time. Of course our hospitals do contain some decent hard working staff but at this time some staff would prefer the work if there were no patients around to bother them" - G Yates, Scotland

"Bring back nursing training in hospitals and let the students learn 'on the job' as we did and we learned from older and caring nurses. Also bring back the special wards for the elderly instead of putting them in with all age groups - having worked on a medical ward I know how disruptive one older and confused patient can be to other age groups. They need to be
nursed with people of the same age!! Then you will get better at nursing elderly people" - Jeanne Fry, Surrey