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.