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'This is not the first time and nothing seems to be changing'


Shadow minister for public health, Diane Abbott, wonders if there is a systematic reason why neglect of older people in the NHS continues to happen

Everybody has been horrified this week’s report by the health service ombudsman which highlights the plight of elderly NHS patients. The report details harrowing stories of elderly patients given no help to eat or left in urine-soaked clothes.

It has been greeted with pious expressions of concern and well-worn clichés about “the need to learn lessons.”

But the truth is that this is not the first time that poor care of older people in the NHS has been exposed and nothing seems to be changing. What people seem reluctant to discuss is the possibility that there might be systematic reason why this might be happening.

One issue might be the increasing “professionalisation” of nursing. In principle this must be a good thing leading to increased status and respect for the profession. But as we move to an all graduate profession, there must be a danger that sheer kindness and the willingness to take time out of your day to help your patient finish their dinner,  will gradually seem less important than being able to take formal tests and exams. After all, nobody ever got promoted to be a “nurse consultant” just by being super-efficient at cleaning up the incontinent. But, for the elderly and their families, it is the basic nursing skills matter more than the amount of exams a nurse has taken.

A generation ago nursing assistants or “ward maids” often took the time to help patients in little intimate ways. But these were permanently employed NHS staff who took a pride in their work and their hospital. Time and motion experts and the privatisation of hospital cleaning means that woe-betide the hospital cleaner who pauses to pour a glass of water or even exchange words with a patient.

It is also the case that there are increasing numbers of elderly patients on our hospital wards. They naturally require higher levels of staffing, but this is not necessarily in place.

The specialism that cater to the needs of the elderly are issues like: Alzheimer’s, incontinence and geriatric care. But these are not glamorous specialities. You do not often have spectacular “cure”. It is not surprising that care of older people is a “Cinderella” service both inside and outside the NHS.

And it should be remembered that neglectful care of the elderly is not a phenomenon confined to the NHS. For years we have had regular reports of the horrors that go in care homes. This is often a consequence of low paid staff who are not properly managed. But it also points to problematic attitudes in society as a whole about the elderly and their care. As a Member of Parliament, I often have to visit care homes. But I often struck by, even though they are perfectly clean and tidy, the inhabitants often seem to spend all day tethered to a chair staring at a flickering TV screen. The underpaid and overworked staff are too busy to talk to them. And somehow nobody ever comes to visit.

The totally artificial distinction between medical care and social care, promoted by successive governments does not help the situation. It helps reinforce the notion that feeding, bathing cleaning and just being kind to a patient is not “real” nursing care.

Sadly, despite the protestations of horror about the latest revelations about the care of the elderly in the NHS, things are unlikely to get better soon. Older people care is likely to be one of the victims of the combination of thoughtless re-organisation and big cuts in NHS funding. Already a hospital trust like the Barts and London has announced the loss of 250 nurses and a hundred beds. Up and down the country the NHS is freezing posts. With fewer nurses to go around, what is the likelihood that those left will be able to find more time and attention to give to elderly patients?

We know that, despite the horror stories, most people working in nursing and social care do a wonderful job. But the horror stories are too frequent to be ignored. My mother was a nurse. She nursed the mentally ill in a grim mental hospital in Yorkshire. Most of her patients were geriatrics. But she nursed them with a kindness and dedication that I can only marvel at. 

For her, each one was a special individual. When Alzheimer’s catches up with me, I will not be bothered whether the person nursing me has a degree or not. I will want someone as kind and dedicated as my mother. The job of politicians is to invest in an NHS where that kind of nursing care is valued and can flourish.


Readers' comments (5)

  • Thank you Diane for writting some common sense. The problem is now having people actually listen and take action. Fewer nurses + older/sicker patients = poor care.

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  • The problem is so big to cure this but it seems that it always comes down to nursing. Can one nurse really look after 20 patients and deliver all those elements to good nursing care-the answer is no. Budget cuts, targets,paperwork all contribute to poor service being delivered. Nurse "burn out" is common place. How can you go in day after day and face this. There are real nurses out there realising that there is nothing that they can do to change it-the accountants are responsible for the care of the patients. I was told in one of placements, that we had to "save on pads" and so each person was limited to 2 continence pads each day. Good care kinda goes out the window.
    The debate can go on forever but will it change nursing. The cold hard reality is that we need to pay more for the NHS if we want a service that respects us. No politician or accountant ever won an election if they say "to be honest we're gonna up taxes by 5p per £100 earned and put the money in the NHS" No, so here we go again "old folk treated terribly,no cancer treatment if you live in a certain postcode,6mths wait to get life saving treatment,no beds in the hospital as all bed-blocked by old people with nowhere to go-as some may have been "left" by their relatives"
    In a modern society, we need to protect the vulnerable and currently it doesnt seem that the UK is a modern society. Sometimes i think it would be easier for the govt to let the vulnerable "go"-save a fortune

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  • 'When Alzheimer’s catches up with me, I will not be bothered whether the person nursing me has a degree or not. I will want someone as kind and dedicated as my mother. The job of politicians is to invest in an NHS where that kind of nursing care is valued and can flourish'
    But what you will want Dianne is to know that someone will be there and have the time to do that rather than rushing at breakneck speed between patients in order that no calamities arise, resulting in the barest of contact least of all care.
    What you as politicians need to actually see is past the consultants, PR companies and dark blue dresses. If you really want to know what the reality of being a staff nurse today then you need to commission an anonymous survey and be ready to hear the answers. You need to demand to see and investigate the incident forms before they go missing. You need to address the staff to patient ratio as a necessity not a financial luxury. You need to commission a new structure within which power is less focussed on the few and more evenly held by the different professions involved in health and social care. We are willing to tell you, are you willing to listen?

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  • I think these are good observations. Particularly that no-one seems to come and visit. Should elderly care wards enter into an agreement with families as to what they will contribute? A relative may even agree to visit once a fortnight, or some may want to be there daily. In children's wards we expect parents to stay, I'm not suggesting that we expect a working relative to be there 24 hours a day, but we could be expecting something, and that could become a question on admission. We work in partnership with you - what would you like to contribute? Perhaps that would also alert the public to the level of cuts and realisation that one nurse cannot care for 10, 15 or 20 patients alone to any great standard.

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  • Peter Goble

    Excellent comments on Diane Abbott's well-judged article and relevant questions. One point though - I trained in the 1950s and 1960s at both general and psychiatric hospitals, and I assure all readers that many aspects of geriatric care in those days were horrific - back-to-back rows of mummified bodies in the foetal position (turned regularly, pressure areas soaped, rubbed with methylated spirit and dusted with talc), and given mince and mashed potatoes every day (minced fish and mash on Friday). I worked in a ward at a London hospital during training - there were fourty-four beds in one long-stay geriatric ward and three staff on each shift. All we did was an never-ending 'back round'. Soiled patients were washed with unbleached 'tow', a kind of rough wool torn from a roll - it had pieces of wood in it. We used the same bowl for each patient, topped up from a jug. Soiled water was poured into a bucket on the 'back trolley'. This was standard practice everywhere.

    Too many commentators have no experience of the 'good old days' - and they say with truth that if you remember the 60s, you weren't there!

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