Pressures on health and social services in Scotland are “compromising” inpatient care for our older people, according to the Royal College of Nursing.
A new Frontline First briefing published by RCN Scotland has warned that demands on the system are compromising fundamental standards of care for our older people in hospital.
“Many of our hospitals just don’t have the right systems in place. They’re struggling to manage”
The briefing – titled Amber warning: RCN briefing on care of older people in hospitals in Scotland – is based on analysis of a series of 35 inspection reports from the Healthcare Improvement Scotland.
The RCN noted that the majority of patients had said the quality of care they received was “good”, but highlighted that it had also found other areas of concern.
For example, almost all of the inspections found hospitals did not appropriately screen and assess older people for cognitive impairment and three quarters needed to improve how they screened and assessed for under-nutrition.
In addition, over half of the inspections identified improvements needed in the assessment of pressure ulcers in older people.
The college added that its analysis also suggested NHS boards did not seem to be learning lessons from each other, or even within their organisation. A poor inspection report in one hospital may be followed a few months later by one for another hospital in the same board, it warned.
Theresa Fyffe, director of RCN Scotland, said: “Based on what we found from our analysis, many of our hospitals just don’t have the right systems in place. They’re struggling to manage.”
Two thirds of hospitals needed to improve patient flow, with older people moved from bed to bed, not treated on the right ward for their condition – known as “boarding” – or unable to be discharged, said Ms Fyffe.
Angiolina Foster, chief executive of Healthcare Improvement Scotland, noted that the regulator had published its own review of care for older people in acute hospitals in November.
She said it had identified good practice, including an increased awareness by hospital staff of the issues facing older people and patients being consistently treated with dignity and respect.
However, she acknowledged that it had found similar issues to the RCN, with patient flow identified as an area needing improvement, especially to reduce the practice of boarding.
“We’re committed to driving up standards in the care of older people in hospitals”
But Ms Foster also highlighted that regulator was leading a specific programme to improve care for older people in acute care, which had so far focused on the two priority areas of delirium and frailty.
“We will continue to work with all healthcare providers to ensure that all older people receive the best care possible,” she said.
However, Ms Fyffe highlighted that the Health Improvement Scotland elderly care programme was only guaranteed funding until March 2016.
“The government must commit to long-term funding and invest in sustainable services so our older people can be assured that their care will be effective, safe and person-centred,” she said.
In response, the Scottish Government said funding for such improvement programmes would “continue to help make a real difference for patients”, but did not commit to future investment.
“We’re committed to driving up standards in the care of older people in hospitals, said Scottish health secretary Shona Robison.
She noted that she had recently given Health Improvement Scotland an extra £2.5m and had also asked NHS boards to “proactively” look at services and report back to the chief nursing officer.