Tuesday, 15 February 2011

The Old

The Health Service Ombudsman's report refers to ten horrifying cases she considers to be typical.

In a damning report, Ann Abraham said the 10 complaints showed neglect of even the "most basic" human needs.

One woman described how her aunt, named only as Mrs H, had been taken on a long journey to a care home in Tyneside by ambulance after a stay at the elderly care assessment unit at Birmingham Heartlands Hospital.

Mrs H was described in the report as a "feisty" independent and dignified woman, who had lived at home until aged 88.

She arrived at the care home "strapped to a stretcher", soaked with urine, dressed in clothing that did not belong to her held up by paper clips, and accompanied by bags of dirty laundry, much of which was not her own.

A study of pensioners who suffered appalling treatment at the hands of doctors and nurses says that half were not given enough to eat or drink. One family member said the maltreatment amounted to “euthanasia”.

Some were left unwashed or in soiled clothes, while others were forgotten after being sent home or given the wrong medication.

The case of hospital staff in Ealing leaving a man in a waiting room as his wife died is one of 10 complaints used by the health service ombudsman to highlight how the elderly are being failed by the NHS.

The husband of Alzheimer's patient, who is only referred to as Mrs J, was "forgotten" by hospital staff at Ealing Hospital NHS Trust, denying him the chance to be with his wife as she died.

leading on to:
Yesterday’s shocking report from Ann Abraham, the NHS ombudsman, into the care of elderly patients is followed today by the disclosure that not a single hospital manager or worker has been disciplined for the failure to provide even the basic standards of care. No one, it seems, is to be held accountable for leaving these vulnerable people, close to the end of their lives, dehydrated, underfed and unwashed.


I wonder how much of this neglect is due to four things:

1. Pressure to be getting on with bureaucratic tasks;

2. Brutalisation of staff due to over-exposure to helpless distress, leading to half-conscious contempt;

3. Embarrassment at loss of human dignity, leading to fear and unconscious contempt;

4. The attitude that the old patient might as well die and clear a bed, the quicker the better, leading to fully conscious contempt.

Such lack of human care amounts to more than neglect - it is distinct cruelty. It is cruel not to offer water to the plainly thirsty, not to help the feeble to eat, not to help the crippled to move, not to clean the bed of the stinking and horrified.

In effect it is dehumanisation, something the concentration camp guards of the last world war got used to. The contempt is, I suspect, mostly unconscious: it is locked deep into the psychological system so that on leaving the hospital the key can be turned, the sick locked away, and normal life can resume. It is as if the old were guilty of dehumanising themselves. It is as if they had never been not old, had never been clean, had never been quite human. Their history drains away from them until they become no more than waste.

I was watching the author Eva Figes give an account of her own recent dreadful experiences. But I have heard nothing at all from the professionals, not a word about this state of affairs that did not amount to a useless, perfectly heartless platitude. It does not speak well for what pleases to call itself humankind. I expect it to go on.


Anonymous said...

Dear George,

Having watched the care my recently-deceased, aged parents received in hospital in Portsmouth during the last 15 months, two things struck me. One is that older patients require more attention but staffing levels on geriatric wards seem to take no account of this. The other is that nurses tend to be young - 30 at most - and have no appreciation of the unique problems / needs of frail 90-year-olds (or even, for that matter those in their early 60s - like myself and yourself).

One other thing: my recently retired cousin, a GP for many years, is of the opinion that as long as hospitals are run as businesses rather than centres of excellence, care quality will deteriorate. I cannot disagree with him. Regards,

John Godfrey.

George S said...

I am glad your parents' experience of care was not of the kinds described, John. And I quite agree about hospitals as businesses. But my hunch is that something more is going on. It is partly the increasing number of the aged, partly their greater age and the possibility of keeping them alive still longer; partly their isolated, vulnerable status; partly their perceived uselessness in a fast changing youth-focused society - and partly the factors above. Neglect leads to neglect leads to contempt.

Gwil W said...

It used to be commonly said that you could judge a society by how it looked after its children and its elderly. Perhaps this truism is not said any more?
In the UK I believe there will soon be more than 2 million people aged over 90. Many are cared for at home by their families until they can no longer cope.
People who are aged 90 today were born around 1920 and so most of them were involved in some way or other in defending or feeding Britain in the events known as World War II, a war caused like all wars by greed and political short-sightedness (if you don't believe me read Major General Smedley Butler at Poets Against War - there's a link on my blog).
These people who were bombed out of their houses, who carried ration books to the shops, were finally rewarded with a free National Health Service - something the Cameron-Clegg coalition wants to destroy and run on a shoestring for the benefit of bankers, drug companies, investors and their ilk rather than the patients. It can only get worse.

panther said...

One relative likens this to euthanasia. I can only say that euthanasia (strictly of the genuinely voluntary kind only) appears to be dignified, whereas this is not.

I hear what you're saying, George. And I don't feel it is "just" the elderly who find themselves at the receiving end of NHS callousness. The number of people I have met who go under the term "health professional" who seem to lack basic human empathy staggers and depresses me. Nurses, midwives, my son's paediatricians (my son is diagnosed with autism and complex learning difficulties), more than one GP. And, Ombudsman or not, there is very little accountability. I have made two formal complaints against the NHS in my time (I'm in my early 40s. And I'm not a professional complainer-I know they exist). In one case, the complaint against a GP was "investigated" by guess who ? the GP's junior colleague. In the other case, the people responsible hid behind lawyers. No apologies, not even an attempt to apologize, not even a shrug. No evidence that they had learnt anything at all from the experience. And why would they, if there's always an entire army of NHS employees (at various grades, from the highest paid to the lowest) backing them up ?

In neither case was I intending to sue. I didn't want MONEY. I wanted a certain amount of compassion. The one thing they seemed utterly unable to offer.

Anonymous said...

Hello George
Amen to that!

Having worked as a nurse for many years, this report doesn't surprise me, but it does saddens me to think that little has changed, or worse, has indeed, got worse.
There are many reasons for this, some of which you've highlighted. I'd like to mention others here if I may.
With the advent of new technologies in terms of care, it is far less attractive to tend to a patient's 'basic needs, far more attractive to be at the cutting edge of technology. This leaves the basic nursing care to 'carers' with little training and/or supervision, who are poorly paid and often unemployed one day and caring the next. They don't see their work as a vocation, more of a job! Their own standards of what we expect are not as we'd like, hence, standards fall, become the norm and they're able to continue unchecked.
In my role as trainer and inspector of care homes in the past, I have reported several instances of abuse and poor practice. These do get picked up by Social Services, but at a great cost to the dignity and basic human rights of our elderly.
The dreadful neglect highlighted here really does have to be placed firmly at the door of those in a position of responsibility for "caring", otherwise we have lost the whole sense of the meaning of the term "to care".

With good wishes
Chris Hoskins

George S said...

Speaking entirely personally I have never found the medical profession particularly human (with one or two - literally just one or two - extremely honourable exceptions).

And yes, one relative of an elderly mistreated patient talked on the radio of the nurse at her desk trying to do something on the computer without much success, rather than attending to the ward.

It is an old doctor's joke that medicine would be a great career if it wasn't for all those sick people. And, horribly enough, I can imagine how the endless stream of bodily malfunction might become deadening.

But there is no excuse for this. None. I have long come round to euthanasia. Human dignity is tied to the power of decision.

Gwil W said...

re George's doctor's joke the punchline might be true if it was said of the doctors themselves. I think they have one of the lowest life expectancy rates of any group don't they? Physician heal thyself, is not without truth.

panther said...

Another joke about medicine : it's the only job with a 100% failure rate.

stephentjcross said...

I have spent this week at work caring for elderly men and women who have been in varying states of ill health. Each morning I have helped one particular gentleman to get up. Each morning I have helped him out of bed, to wash, shave and dress – often he is soiled with faeces – and have emptied his urinary catheter bag of foul smelling, infected urine. He is in pain. He is recently bereaved. He will no doubt die soon. I help him to the breakfast table where I make sure he has food and drink and that he gets the medicines he needs. I spend time with him, sometimes talking to him, sometimes sitting quietly with him. My colleagues (care assistants, nurses, physiotherapists, occupational therapists, doctors - yes particularly doctors - all very human) help others in similar situations. I could go on and list a variety of caring interactions which I and my colleagues enter in to throughout the day and night with elderly men and women who are in turns frail, in pain, psychotic, deluded, aggressive, sexually disinhibited, frightened, anxious, depressed, suicidal, and also with their relatives who are worn out, anxious and fearful for the future. I don’t recognise the dehumanisation, such as the guards in the concentration camps of the last world war got used to, where I work.
The ten horrifying cases -there are times when I am acutely aware that things could be done better, that bureaucratic tasks frequently get in the way of caring - but there are no horrifying cases to draw anyone’s attention to where I work. I don’t dispute the ten horrifying cases are out there - are they typical? Not where I work I think – or have ever worked in the past thirty years. Perhaps our personal experiences don’t count for much, are not reliable.

Best wishes,

George S said...

Stephen - You are doing marvellous work. I have no doubt many are. Clarissa's mother is now in a musing home where she is being well looked after. Before that she had been in hospital twice and each time she got rapidly worse. She was badly neglected there in some of the ways described. She was wearing faeces stained clothes at visiting time, someone else's clothes, and was missing some of her things. Once out she improved. We don't know why and the nurses were friendly enough but chiefly occupied with forms.

I am trying to account for the reasons that cruelty occurs, because the Ombudsman made it very clear indeed that the ten cases were not isolated but represented a serious trend.

stephentjcross said...

I too have had direct experience where friends and relatives have been neglected in hospital - I too know it can be very bad. Neglecting basic needs is inexcusable. I guess I meant it is not all like that - which you know. I know the neglect and cruelty is there.

How to account for the cruelty? Bureaucratic tasks have certainly multiplied and multiplied - oppressively so. Pressure to complete senseless forms and other tasks combined with the daily exposure to others’ suffering is very draining. Care workers themselves need support with the effects of dealing with others‘ distress. Clinical supervision is supposed to meet that need. I wonder if it occurs in many areas. Where it does it can merely be a catch phrase, something being done for the staff (just in case one of them decides to sue in the future). But care workers should take responsibility to protect themselves from the effects of the work - rather than moan amongst themselves about their lot and do nothing. (I have had experience of some excellent support organized by individual staff - I know that is unusual). Generally though it is not a healthy, supportive system that carers work in. The volume of work can be overwhelming - at times it can simply be impossible to do everything that needs doing. If you are to be audited at the end of the month on whether your paperwork is in order rather than on whether your patients’ basic needs have been met will, I guess, influence the way you prioritise your work. Yes, it all leads to the dehumanising of those in need of care.

Perhaps the pace of life has changed in the nursing home where Clarissa’s mother is now cared for - I expect the priorities of the staff are quite different. Presumably the care is more focussed on her as a person with her own individual needs rather than a set of symptoms to be ‘cured’ and moved on from hospital at the earliest possibility.