'Lansley must listen to nurses on the front line' 
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Like Eileen Shepherd, I was appalled at the story of Elaine McDonald, who lost a supreme court appeal against the London Borough of Kensington and Chelsea’s decision to withdraw the night-time care that enabled her to use the toilet.
Instead Ms McDonald has been told to use incontinence pads – even though she has mobility problems rather than incontinence.
Of course it is dreadful that a woman who is not incontinent should be condemned to lying in her own waste throughout the night. Where is the dignity in that? But something else also angered me about the story.
Ms McDonald is a celebrated former ballerina with the Scottish Ballet, and received an OBE in 1983.
I know this, and a whole lot more, about her because her case was covered extensively across the media. From the BBC and the Guardian to the Daily Mirror and Daily Mail, the story was given huge prominence, particularly online. But the stories focused on Ms McDonald alone, and made much of her distinguished career and honour.
What about the many other people who may be affected by this decision? Councils are desperately looking for ways to save money and have just been given a clear message. It’s OK to stop funding night-time visits to people who need help to use the toilet.
Charities commenting on the case pointed out that the court decision had wider implications for some of society’s most vulnerable people. Michelle Mitchell from Age UK called the decision shameful and said it “opens the door to warehousing older people in their own homes without regard to their quality of life”. However, her comments and those from other charities came towards the end of the BBC’s and Guardian’s stories and were ignored by the Mirror and the Mail.
As far as the media are concerned the story is interesting primarily because Ms McDonald is, to quote the Mail “a once beautiful and gifted former ballerina”. Surely the real story is that tens, if not hundred, of thousands of older and disabled people may now be expected to lie in urine and faeces until their daytime carers arrive?
You don’t have to be a prima ballerina to deserve a little dignity.
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Readers' comments (20)
Anonymous | 14-Jul-2011 1:03 am
Disgusting for ALL these people, and who knows, we may become one of them, in the future
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Anonymous | 14-Jul-2011 7:16 am
nothing short of barbaric. all the physical and psychological dangers of this are obvious and have been discussed elsewhere but what about the bad odours and hygiene, and especially in hot weather bacteria, flies, spread of infection, etc.
surely money can be saved on other less important services such as administration, offices, and on the highest salaries of the administrators, etc. it should all be transparent and open to public scrutiny where savings can be SAFELY made.
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mike | 15-Jul-2011 1:30 pm
This is what happens when healthcare becomes a business. Money and profit are placed in higher esteem than care, compassion, dignity or human life.
Absolutely disgusting, and it will only get worse when the consortia and private companies take over.
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Anonymous | 15-Jul-2011 2:02 pm
it is just unthinkable and unimaginable that any human could pronounce such a decision on another, and just for the sake of money! it just makes one wonder where some people's values lie, and especially those in positions of power and authority who should be leading by example. no wonder the country is losing direction with no decent role models to guide it.
no apologies for moralising!
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Anonymous | 15-Jul-2011 9:32 pm
this is shocking and will become the norm as more councils cut their budgets
surely there is other ways of managing cuts?
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Anonymous | 15-Jul-2011 9:47 pm
Anonymous | 15-Jul-2011 9:32 pm
that is the danger that it will become the norm. how can those responsible be convinced that this is not a humanely possible way to go.
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Anonymous | 16-Jul-2011 11:56 am
So what are we going to do about it?
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mike | 16-Jul-2011 2:55 pm
Guys, I'm sorry but what do you mean 'become' the norm? It is ALREADY the norm to sacrifice patient care for monetary interests or profit (a basic staffing level for instance, no money for that!) It is only going to get a LOT worse and a LOT more pronounced in the future. I have been calling for so long now for our reps and colleagues to lobby for strike action, but nothing evr gets done. The RCN have finally come out and said they are open to the idea of strike action, but then Peter Carter was very slippery about how he could say that without actually committing to it. I really do despair.
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Anonymous | 16-Jul-2011 3:23 pm
"Guys, I'm sorry but what do you mean 'become' the norm?"
the story of the soiled night pads is a new one, which runs a serious risk of becoming the 'norm' but I agree it is just another to add to the long list to prick some people's consciences, although I suspect more likely those of us who care rather and have to deny care rather than those who hold the budgets, make the decisions and make up new rules as they go along in the name of 'cost saving', whatever this means in terms of human dignity and basic need. each new story appears worse than the last!
we have talked above of all the detrimental effects this last will have on the individuals concerned and I, forget in a comment above (Anonymous | 14-Jul-2011 7:16 am) to mention, in addition to those in other articles, another very important factor, but will take advantage of mentioning it here. it is obvious (to us but apparently not to the decision makers) but I feel that my post would not be complete without it. That is disturbed sleep cause by the discomfort of being wet and soiled which, like all the other associated problems will have serious detrimental physical and mental affects. A slow and tortuous way towards the end of life which deserves, and has the right, to be lived out in dignity
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Anonymous | 17-Jul-2011 2:07 pm
totally agree with all above. however no one seems to have picked up on the ramifications of the removal of service. i would suspect that not just Elaine McDonald but all the others who have had this service removed have had much of their dignity removed and now fall into the higher risk category of needing hospitalised due to infection, broken limbs in an attempt to get to the toilet themselves. in the short term if this was deemed as a cost saving excercise i think we will see long term that that is not the case.
what happend to caring and dignity. the patient having the right to be at home and the fact that home is cheaper than a bed due to an induced infection or skin breakdown.
totally appauling.
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Anonymous | 17-Jul-2011 2:32 pm
Anonymous | 16-Jul-2011 3:23 pm
the problem is that we can all express our shock and dismay but is there anything we can actually do to prevent this from happening to Ms McDonald and others before the damage is done and before it is allowed to continue. Those making these decisions should be in full consultation with professionals and made fully aware of their actions which appears not to the currently the case.
I would suggest that these decisions are made by lay people who have absolutely no idea of all the damage this will cause. Although, on the surface, it seems to require little other than basic commonsense on how to treat others safely and with dignity and humanity. Such individuals seem to work with a totally different set of criteria which are not relevant to the purpose. Perhaps they should expose their rationale and make it totally transparent for future reference.
the same standardised quality service should be available everywhere and not a decision delegated to certain local councilors to stop at their own incomprehensible whim. They are probably out enjoying a round of golf whilst these old people are struggling with their loss of dignity,psychological and physical damage, skin damage and all the other consequences of this villainous act.
With high taxes, council taxes and lack of willingness to care for its residents and carry out work to keep the streets clean I expect to see our communities soon overrun with rats. I would suggest that lack of funding is an invalid excuse for all of these cutbacks or else they should be made where they are not detrimental to people or the environment in which they live, such as necessarily high salaries, costly administrative buildings etc.
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Anonymous | 17-Jul-2011 2:34 pm
Post above should have read
from
Anonymous | 16-Jul-2011 3:23 pm
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Anonymous | 18-Jul-2011 12:50 pm
Anonymous | 17-Jul-2011 2:32 pm:
You might be right, these decisions may be be being made by non-clinical people, however in some ways it's not relevant, in so much as the present govt is entirely and ideologically opposed to public services, and has announced its intention to open the whole of the public sector to private competition and the latest patient choice by voting who they potentially want to provide care.
http://nhsvault.blogspot.com/
worth reading.
It will get worse. Who are the private companies accountable to? How long has it taken to bring Murdoch to account? (the epitome of this ideology)
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Anonymous | 18-Jul-2011 1:04 pm
Anonymous | 18-Jul-2011 12:50 pm
from Anonymous | 17-Jul-2011 2:32 pm
I despair not only at this governments plans and ideologies but more so at the implications for the public and especially the most vulnerable like the above report. I, obviously misguidedly, thought that at least Cameron was humane and wanted the best for his country but he has failed to prove this so far. However, there seems to be enough opposition from the professionals to stall his plans for the time being, although as you say it will get worse, and the full story and further implications of the Murdoch scandal have yet to be revealed!
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Anonymous | 19-Jul-2011 8:59 pm
above, read this too, plans are moving forward as planned. No listening, no pause just ignored.
http://www.guardian.co.uk/society/2011/jul/19/nhs-services-open-to-competition#start-of-comments
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Anonymous | 22-Jul-2011 2:16 pm
Unfortunately this is already the norm in many parts of the country. In Leicestershire this has been the usual practice for many years now. Four social care visits during the day is the maximum, none overnight. If you need to pass urine in the night & can't get out of bed or use a urinal or other continence aids then its pee into a pad.
One hospital patient had the "audacity" as to state she didn't want to pass urine into a pad when she was discharged as, with help, she could use a commode in the night; she was told it was either that or residential care.
If we are looking at being cost effective, many people fall in the night due to nocturia and how costly can that end up being.
Bowel management already has to fit into carers visits not the bowels movement and if the carer is late and the bowel wants to move at is natural time then its tough!
A patient who was faecally incontinent everytime she was hoisted was getting distressed. we planned for her to have Senna at night to encourage the bowel to empty completely after breakfast. Her carers would not hoist her onto the commode after her breakfast as "toileting" was not in her care plan at that time. I complained to Social Services who stated that toileting was not a "basic need" because the patient needed the Senna, it was a medical problem needing to be dealt with by the DNs. The main issue was that it would cost more for the carers to be in there an extra 15 - 30 minutes in the morning.
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Anonymous | 22-Jul-2011 3:45 pm
are we nursing for the benefits of the patients or the convenience of the services and the the costs involved? surely it is the importance of the quality of life that is at
stake here?
"If we are looking at being cost effective, many people fall in the night due to nocturia and how costly can that end up being."
it is not the cost that is important here but the well being of the patient. imagine the pain, immobility, inconvenience and consequences to the patient of injury which may be sustained especially when it could have been avoided.
some organisations and individuals associated with them have totally warped and unacceptable ethical and moral values!
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Anonymous | 25-Jul-2011 8:31 pm
Anonymous | 22-Jul-2011 3:45 pm
Re:
"If we are looking at being cost effective, many people fall in the night due to nocturia and how costly can that end up being."
If you read my piece carefully you will see that I am not condoning the practice merely illustrating a point that organisations are looking at the cost not the dignity. This is not a representation of my feelings but details of a fact that is happening. By stating the above this shows how short sighted their "cost saving" exercise is in the longer term as people are more likely to fall trying to maintain their dignity getting to the toilet.
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Anonymous | 25-Jul-2011 9:12 pm
Anonymous | 25-Jul-2011 8:31 pm
Anonymous | 22-Jul-2011 3:45 pm
I perfectly understood what you said and was merely reinforcing it!
I apologise if this was not clearly expressed. It was intended as a criticism of the system and not of your opinion which I believe to be similar to mine.
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Anonymous | 25-Jul-2011 9:55 pm
"The Supreme Court is the final court of appeal in the UK for civil cases. It hears appeals in criminal cases from England, Wales and Northern Ireland. It hears cases of the greatest public or constitutional importance affecting the whole population."
Quote taken from the Supreme Court website accessed on 25.07.2011
http://www.supremecourt.gov.uk/
I am somewhat confused as why this case came to the attention of the Supreme Court. Surely nursing and social care services have a budget and have the responsibility to decide how this can best be spent to deliver care to their clients and patients. It would appear that those in these professions rather than a court judge would be in the best position to decide how best to meet the basic and essential care needs of the elderly.
From my understanding, the NMC protects the public from negligent practice of individual nurses and the CQC investigates and regulates and protects the public from inadequate care and negligence in institutions which have been licenced to provide care to clients/patients, the elderly, the vulnerable and others requiring such care. Which regulatory organisation is responsible, especially in the community, for the protection of the public from inadequate and or negligent care such as that cited in this article before it reaches the level of Supreme Court!
Furthermore which organisation is responsible for protecting the sick and the vulnerable from inadequate and negligent care due to professionals being hampered or prevented from carrying out their work adequately, for example, by the authorities and management who are often not qualified to give an expert professional opinion of the level of care required by a patient/client?
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