Hungry, thirsty, unwashed: NHS treatment of the elderly condemned

Health Editor,Jeremy Laurance
Tuesday 15 February 2011 01:00 GMT

Elderly people treated by the NHS were denied even the most basic standards of care, according to a scathing report that reveals a health service rife with ageism.

Patients were left hungry and thirsty, unwashed, in soiled clothes, without adequate pain relief or an emergency call button in reach. Relatives were ignored or forgotten.

Investigations of 10 cases in which patients suffered unnecessary pain, indignity and distress while being looked after in hospital or by GPs, exposed a fundamental lack of humanity and compassion. The patients were selected from among 9,000 complaints to the Health Service Ombudsman. Nine of the 10 patients cited in the report died.

The shocking catalogue exposes the gulf between the principles and values laid out in the NHS constitution and the reality of being an older person in the care of the health service today, said the Health Service Ombudsman, Ann Abraham. Her report comes after a decade of investigations that have revealed an NHS riddled with ageist attitudes, in which elderly patients are neglected, poorly treated and marginalised.

The cases in the Ombudsman's report include:

* A man with advanced stomach cancer who was discharged on the eve of a bank holiday from the Bolton NHS Trust with too little morphine to control his pain, leaving his family to drive around most of the weekend, frantically trying to obtain more supplies.

* A woman admitted to Ealing Hospital NHS Trust with breathing difficulties whose husband was left, forgotten, in a waiting room for three hours, denying him the chance to be with his wife when she died.

* A woman discharged from Heart of England NHS Trust to a care home who arrived bruised, soaked in urine, dishevelled and wearing someone else's clothes.

Shortage of money and resources was not the problem, Ms Abraham said, but rather it was an "ignominious failure" to look beyond a patient's clinical condition and respond to their social and emotional needs.

"The findings of my investigations reveal an attitude – both personal and institutional – which fails to recognise the humanity and individuality of the people concerned and to respond to them with sensitivity, compassion and professionalism... The difficulties encountered by the service users and their relatives were not solely a result of illness, but arose from the dismissive attitude of staff, a disregard for process and procedure and an apparent indifference of NHS staff to deplorable standards of care."

The 10 patients selected for the report were "not islolated cases" she said. Of nearly 9,000 complaints to the Ombudsman last year, 18 per cent were about the care of elderly people and twice as many were accepted for investigation as for all other age groups put together.

Discriminatory attitudes towards the elderly in the NHS have been obvious for decades. The over-65s occupy almost two thirds of hospital beds but despite a decade of rapidly increasing spending on the NHS, they still receive second class care.

In 2006, a joint report by the former Health Care Commission, Audit Commission and Commission for Social Inspection criticised the "patronising and thoughtless" manner in which NHS hospitals and care institutions treated older patients.

Last October, the National Confidential Enquiry into Patient Outcome and Death revealed that two out of three older patients admitted for emergency surgery received poor care with many left in pain. In December, the Patients Association published an investigation into 17 cases showing serious failings in hospital care from among hundreds it had received. Last month figures from the Office for National Statistics showed more than 1,000 patients died in hospital with dehydration or malnutrition.

As the Coalition Government prepares to launch the biggest reform in the NHS's history, managers have been told to find £20bn of savings and medical and nursing staff are being cut, which will reduce the time available for those who remain to provide basic care.

Ms Abraham said it was clear from her caseload that many patients were suffering in a similar way to the ten described in her report.

"The NHS must close the gap between the promise of care and compassion outlined in its Constitution and the injustice that many older people experience," she said.

Katherine Murphy, chief executive of the Patients Association said: "Yet another damning report confirming what we already know. How many reports do we have to have before anything will change?"

Dr Peter Carter, Chief Executive of the Royal College of Nursing, said: "There can be no hiding place for inhumane treatment or poor care. The overwhelming majority of nurses will join us in condemning the failures outlined by the Ombudsman. However, we know that the NHS is expected to save up to £20bn in England alone, and with 27,000 posts already earmarked to be lost, it is inevitable that there will be an impact on frontline care. Last week, 80 per cent of RCN members surveyed told us that they did not have enough staff to deliver good quality care to patients."

The Care Services Minister, Paul Burstow, said spot inspections by nurses and measures to improve patient involvement would hold local NHS services to account. "This report exposes the urgent need to update our NHS. We need a culture where poor practice is challenged and quality is the watchword. The Coalition's plans will free front-line staff to focus on what matters most to patients and carers."

Case studies

Mrs H's story: When Mrs H was transferred from Heart of England NHS Foundation Trust to a care home, she arrived bruised, soaked in urine, dishevelled and wearing someone else's clothes.

Mrs N's story: While doctors at Northern Lincolnshire and Goole Hospitals NHS Foundation Trust diagnosed Mrs N's lung cancer, they neglected to address the severe pain that she was suffering.

Mr W's story: The life of Mr W, who had dementia, was put at risk when Ashford and St Peter's Hospitals NHS Foundation Trust stopped treating him for pneumonia and dehydration and then discharged him to a care home on Christmas Eve. His life was saved by another hospital.

Mr C's story: Mr C died two hours after undergoing heart surgery at Oxford Radcliffe Hospitals NHS Trust. His family was not told that his condition had worsened and staff turned off his life support, despite his family's request to wait while they made a phone call.

Mr and Mrs J's story: Hospital staff at Ealing Hospital NHS Trust left Mr J forgotten in a waiting room, denying him the chance to be with his wife as she died.

Mrs R's story: Mrs R suffered nine falls while in Southampton University Hospitals NHS Trust but only one was recorded in the nursing notes. She was left with a big bruise on her face which distressed her family when viewing her body after she died. She was not offered a bath or shower during her 13-week admission, her family claim.

Mr L's story: Mr L had Parkinson's disease and was in a disturbed mental state when he was admitted to the Surrey and Borders Partnership NHS Foundation Trust and treated with excessive doses of an anti-psychotic drug. He developed pneumonia and died.

Mr D's story

Royal Bolton Hospital NHS Foundation Trust discharged Mr D with inadequate pain relief, leaving his family to find someone to dispense and administer morphine over a Bank Holiday weekend.

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