Thursday, 13 October 2011

Neglect Of The Elderly

Today we have learned of the unannounced inspections by the Care Quality Commission (CQC) of one hundred hospitals and the disquieting news that one in five are neglecting elderly patients to the point of breaking the law.  (The report is here).                  
We hear of unacceptable hospital cultures where unacceptable care has become the norm, where the elderly are treated with a lack of respect, stripped of their dignity, are ignored, are talked over (by doctors and nurses), where basic needs (eating and drinking and going to the toilet) are not met.
How many times have we heard something similar or seen ‘undercover’ reporting on TV documentaries of the disgraceful care of the elderly this year, last year and the years before?  How many times will we hear and see it again – for we never seem to learn from it?
It appears to me that the blame culture firmly scapegoats nurses and fails to look at the real issues.  Of course there are indeed bad nurses as there are bad doctors, bad politicians and bad governments and I have come across some cruel nurses and doctors in my time but would add that they are few and far between.
The report notes that care has been broken down into a task-based culture where doctors and nurses are held to account for every box they have or haven’t ticked and I would agree that this is indeed the case.  Although not working in a hospital but a care setting there are so many boxes to tick (even the photocopier has to be risk assessed), so many authorities, agencies and professional bodies to which you are accountable, so much damn paperwork (often duplicated for aforementioned authorities, etc) that there is less time to offer patient/resident care.  These boxes have to be ticked, no ifs or buts or it is your job down the swanny.
Of course staffing resources play a part and the report states: ‘Many people told us about the wonderful nurses in their hospital, and then said how hard pressed they were to deliver care.  Having plenty of staff does not guarantee good care (we saw unacceptable care on well-staffed wards, and excellent care on understaffed ones) but not having enough is a sure path to poor care.’   (Bold type mine).
Understaffing does matter, more so when the patient group is more needing of staff input.  If you really want to know why understaffing matters read this excellent and frightening post by Nurse Anne at Militant Medical Nurse.  (It is important that you are aware that most of the nurses you think are nurses on wards are untrained healthcare assistants – that said there are many damned good healthcare assistants who cannot, I repeat cannot do the work of a qualified nurse).
I can only report honestly how understaffing affects the environment in which I work.  We have excellent staffing levels which are above those legally required.  If one member of staff has to accompany a resident to hospital during the night we are 20% down on staff and therefore 20% of residents will not receive the individualized input of that member of staff.  (Hospitals tend to ‘hang on’ to our staff member for hours on end (anywhere from 2-10) and are quite reluctant to let them go (as in effect they increase the hospitals staffing levels).   Staffing levels do affect care whether the DoH agrees with it or not.  (Oh what fine meaningless statements the DoH  make: “…. Ensuring that providers have sufficient qualified, skilled and experienced staff and patients are protected from the risks of inadequate nutrition and hydration.”)
However it would be foolish to pretend that all bad care is related to bad staffing for indeed there is a culture where bad care/practice is the accepted norm, that said if you work in an environment like this (and are good) it is almost impossible to effect change especially if bad practice is top-down.  I worked in a care home such as this (owned by a hospital consultant) and as my ‘whistle blowing’ to management met with indifference I and a residents relative informed the JIU (which has morphed across time into the CQC) and I had to leave and the nurse in question kept her job.
This is the lot of a whistle blower who are regarded as troublemakers and at best ignored and at the worst vilified and lose their job.
So the question needs to be asked “How can change be affected if nothing changes in that wards remain under resourced, staffing levels are in the main made up of healthcare assistants, bad practice is allowed to continue and whistleblowers are vilified?”
What say you?

Anna :o]


Jenny Woolf said...

One of the hospitals that was assessed had moderate problems with feeding and slight problems with dignity. Yet both my parents have spent long periods in this hospital and at ALL times, for weeks on end, they've had nothing but the kindest and most conscientious care from doctors and nurses. It's so striking that when my mum came out the last time I actually sent them a donation.

As a non medical person, it would seem to me that (at least in that hospital) a large part of the problem is the healthcare assistants. The ones I've met behaved like cleaners. When I ever spoke to any of them they seemed really surprised to be addressed by anyone, and quite ill at ease. They did exactly what they were told, nothing else, and were very, very obviously not on equal terms with the nurses.

Perhaps the hospital was to blame. But, it seemed to me that if selected properly and trained properly, the healthcare assistants could be doing all the things that nurses haven't time to do.

And it comes down to the question, which I'd love to know the answer to - who decided to scrap SENs, and why? They seem to be what is required here, and it's hard to imagine how losing them was justified.

Manzanita said...

Bad care for the elderly must be happening, especially in large care centers and probably in larger cities. The small towns that surround where I live (in the US)appear to have care units that are cheerful and run by a caring staff. I've visited many of them and our dance troupe entertains these people on a regular basis. Because of this I got to know the staff.

ADDY said...

I do not know enough to be sufficiently critical about this subject. I read an article that said that nurses are too over-qualified these days (getting university degrees which put them somewhere between a doctor and a traditional nurse)so they do not want to do the messy jobs any more and their roles are less well-defined. Maybe a return of the good old-fashioned days of nurses trained on the wards and a matron to keep things in check would be a good idea.

Cockroach Catcher said...

Nursing and doctoring is humanity first, money last but modern Health Care reversed that.

Regulators worked after the event and is costly with lawyers earning the most and better still if there is any official inquiry.

A few bloggers continue to defend what could be good but much needed fixing.

Hospitals were in fact doing what they were told to do: save money instead of saving patients.

In Health Care:Death is irreversible!!!

drphilyerboots said...

Dear Anna,

A very thoughtful post, as ever.

I was writing a comment, but it grew into a post, now on my blog with the same title as your own.

Thanks for the CQC link, very illuminating.

Dr Phil

HyperCRYPTICal said...

Thank you for you kind responses folks and looking at posts in the same vein by fellow bloggers, I have decided to write a futher (and more personal) post which you can find above,

Anna :o]