Poor treatment of older people in the NHS is an attitude problem

This post was originally published on the Guardian’s Comment is Free.

Mrs H was an independent woman who lived on her own until the age of 88 and loved literature and crosswords. This picture of this strong, dignified woman contrasts with the appalling treatment she suffered at the hands of the NHS. After a spell in hospital following a fall, she arrived at a care home with numerous injuries, soaked with urine and dressed in clothing that did not belong to her held up with paper clips. She had several bags of dirty clothing with her, much of which did not belong to her and just a few possessions left of her own. She was highly distressed, dishevelled and confused and had lost 5kg (11lb) since her admission to hospital. She died in August 2010.

This is just one of 10 shocking stories of people aged over 65 documented in a new report by the health service ombudsman. It highlights a range of clinical and operational failures; people at the end of life being discharged from hospital without correct pain relief, failure to deal with infection properly, malnutrition and dehydration. These are by no means isolated cases – 18% of complaints to the ombudsman last year were about care of older people and they investigated more than twice as many as for all other age groups put together.

Yet, as the ombudsman, Ann Abraham, reflects, this report reveals that at the heart of the problem is an attitude – both personal and institutional – which fails to treat older patients compassionately or respond to their individual emotional and social needs. One family was not informed when their father’s life support machine was switched off; a husband was left in a waiting room, forgotten about while his wife lay dying in the ward next door; a man with advanced stomach cancer was left behind a drawn curtains desperate to go to the toilet and unable to ask for help because he was so dehydrated he could not speak properly or swallow.

It’s difficult to imagine us allowing any other group of people to suffer this indignity and neglect, yet when it comes to older people it’s commonplace; as a society we often fail to value or treat older people equally. History shows fundamentally shifting people’s attitudes to overcome discrimination isn’t easy – it takes time and concerted effort – but nowhere is this more important than in the NHS where people over 65 make up 60% of all admissions. Only by casting these prejudices aside can we start seeing older people like Mrs H as individuals and respond properly to their needs.

Equality legislation outlawing age discrimination – due to come into force in 2012 – will certainly help. But in a period of huge reorganisation, support needs to be given to translate this into action on the ground. We also need better training of health professionals to care for growing numbers of people living with multiple health conditions and frailty. To end the scandal of malnutrition, we are calling for a commission to bring renewed focus to this issue and a strategy for change.

But this report also demands answers to some difficult questions to those leading the NHS through the proposed set of reforms. Will this huge shake-up reduce the risk of older people receiving this sort of treatment? Do they promise any positive change for vulnerable, frail patients?

I remain unconvinced that, as the reforms stand, they will deliver the improvements to the health outcomes and care of older people that are so urgently needed. For the sake of all the people featured in this report and all of us who need NHS care now and in the future, the secretary of state needs to answer these questions.

32 responses to “Poor treatment of older people in the NHS is an attitude problem

  1. Pingback: Tweets that mention Poor treatment of older people in the NHS is an attitude problem | Age UK Blog -- Topsy.com

  2. But what are you going to do about it. We have heard all this before and nothing was done then.

    What is Joan Bakewell going to do about it. Up to now I don`t think she had done anything at all.

    And this should include old people in their own homes. Only allowed 4 pads a day when they are doubly incontinent – routinely put on a cathetar and then when that does not work given 4 pads a day.

  3. This report makes sad reading but I’m here to tell you that the neglect goes on at a hospital not too far from Heartlands. My mother, an elderly lady with dementia, has been left in bed for nine days instead of being mobilised following a hip operation. She has been left without painkillers for long periods and now seems to be dehydrated. My family have done everything possible to get the ward staff to treat my mother with what is no more than common humanity. We have made a formal complaint which they tell me cannot be accepted because I don’t have the permission of a lady who does not have the mental capability to give it, to make that complaint. I shall go to the ombudsman in due course but, meanwhile, my mother’s health is in danger from these so-called professional carers.

  4. Why doesn’t your article make it clear that this report is about the English NHS not the mythical “all in this together” UK NHS.

    How can “Age UK” help without addressing the fundamentals of this issue? English people get less per person per year health funding than the Welsh, Northern Irish or Scots do.

    Don’t the elderly of England deserve an AGE England to match AGE Scotland, AGE Cymru and AGE Northern Ireland? Isn’t AGE UK failing the people of England in exactly the same way as the UK government?

  5. When the sell off of national woodlands hit the headlines there were ways of adding our individual names to the fight and we won. This is a much more serious issue. Everyone with elderely relatives knows about the shocking behaviour of ward nurses, and many other health care staff – I have a raft of stories all mirrored by examples in the report. It is even more shocking to me as the generation so horribly neglected selflessly and courageously built the health service, the wealth and the relative prosperity of this country. Can those of us who have experienced the awful treatment of a generation not have a means of registering our views so nurses organisations cannot pretend any longer?

  6. we have had the same trouble as sheila, my mother inlaw went into hospital in with a with a broken hip and arm while they put a pin in her hip they left her arm when my brother inlaw complained about them not getting her out of bed they started and gave her physio for a week then stopped. she has had several infections while in hospital and now has a infection in her arm that is broken, she went into hospital with a broken hip and arm and is now disabled all thanks to the hospital that was supposed to look after her and get her back home something needs to be done,

  7. Ah yes….. YET ANOTHER smoke and mirrors job! YET AGAIN, no one is mentioning the elephant in the room, namely that this is exclusively to do with the ENGLISH NHS and old people living in ENGLAND!!!!!

    WHY IS ENGLAND and the ENGLISH never mentioned? Could it be that if the English ever wake up and start to notice the pernitious fiscal and democratic racism that is routinely dealt unto them (prescription charges, no free residential care for the elderly, tuition fees, no national legislative executive etc, etc) they just might demand an immediate end to this glorious unequal union of unequals…

  8. We know that this is an issue close to lots of people’s hearts and we are working hard to ensure that the NHS reforms deliver better outcomes for older people, both in terms of their treatments outcomes and their experience of care.

    In future the NHS will be held to account on the quality and safety of care people receive, we are working through the Bill and wider health reforms to ensure that the needs of older people, as the largest group of NHS patients, are at the heart of these changes.

    However change can not come quickly enough for many older people. There have been too many reports of this type each giving harrowing examples of what happens when basic levels of care fall short. We also need an immediate change of culture and attitude amongst NHS staff and those running hospitals and other services.

    Age UK activities currently include:
    • Hungry to be Heard aiming to tackle the problems of hospital nutrition, we are pleased that the CQC has now announced a series of spot inspections in hospitals.
    • Working with the Care Quality Commission to highlight the poor care that some older people receive in a range of care settings, including hospitals and care homes. We recently held a roundtable event with Cynthia Bower, CQC Chief Executive, where older people and their relatives were invited to describe their experiences directly.
    • Working with the Department of Health on improving dignity for older people receiving care and working to take forward the issues identified by people in later life in our 2009 report Waiting for Change.
    • Working with professional bodies to ensure that older people’s care is a key part of professional training and regulation and that clinical leadership is developed to address these issues.
    • More recently we commissioned research which highlights a range of issues around how staff are recruited and managed in hospitals. We will be working with service providers to address the shortcomings we have identified.

    However we are urgently seeking to expand our work with professional organisations and partners to address the root causes of substandard and unsafe practices.

  9. I am 68 years old,when I was admitted to hospital with severe pains in my chest, there was only sheets on my bed,I practically crawled up to the main desk, where the nurses were laughing and joking, and asked for 1 or 2 blankets as I was feeling the cold, I heard a grunt and returned to my bed with great difficulty, and about 20 mins later, the “nurse” came and actually “Threw” 1 blanket on my bed, and I was left to try and pull it over my self, in the end the patient next to my bed helped me.and she did with great difficulty. I honestly believe, that when we reach a certain age we should we supplied with a Cyanide tablet, so we can go quickly and with dignity. I do not want to get too old now.

  10. My own mother suffered similar problems of uncaring nursing staff at one of London’s top teaching hospitals 10 years ago (not being fed or tended to and being in agony from not being allowed to empty her bladder for over 24 hours). All the while this neglect was occurring within sight and (ample) sound of the nurses station where social intercourse took precedence over patient care.
    One of the causal factors, completely unacknowledged in this debate) is the relentless ambitions of the RCN to elevate the status of nursing to match consultants. The nursing ‘profession’ was at war with the consultants when the NHS was founded and it has slowly succeeded in withdrawing further and further from basic patient care. We now have such worthy positions as Nurse Consultant but patient care of the elderly continues to decline.
    My first wife (who sadly died) trained as an SRN in the 1960’s (again at a top LOndon teaching hospital) when patient care was a backbone of ward training. Student nurses were taught that even the most menial tasks provided an opportunity to monitor and respond to patient welfare – it’s now ‘not their job’ and handed down to nursing auxiliaries or doesn’t happen at all. Wards don’t get cleaned properly because it is an outsourced service, purchased centrally and no-one on the ward has any authority over the service actually provided.
    Society has wrung its hands since the second world war and sought answers to the question ‘how could ordinary citizens have become concentration camp guards’? Well, there is an ample source of study material available and working within the NHS today.

  11. I’ve seen extracts of the report and I’ve just read Liz Kershaw’s article in the Sunday Times today (20/2).
    My mother and father-in-law were in the same hospital as Liz’s relatives around 2005/6. They suffered exactly the same experiences as Liz’s relatives.
    My mother begged me not to say anything to the nursing staff when it was apparent that she was not getting the care she required. Why? Because the ‘nurses took it out on we patients when you leave’.
    My father-in-law was given a drink, according to his notes, at 6am but noone had come near him again for 5 hours; and that was my wife and I when we turned up to visit. A drink was left on the side but he could not reach it; he could not help himself by then. His pyjamas were blood stained and were all rucked up leaving him with little dignity. While we were there (2 hours) not one nurse or other carer approached him.
    We are not allowed to treat animals like this. these nurses will be old like this some day; is this how they wish to be treated?

  12. I am currently experiencing the dreadful scenario of my 89 year old mother changing from a very independent person living on her own, cooking her meals, dealing with her laundry, taking a keen interest in politics and various sports, into a bedridden person who is unable to speak, eating little, in pain from appalling bedsores which have been reported to the Care Quality Commission, all within a few months of being admitted to hospital following a fall. I would be in court for cruelty if I had allowed a pet to live in such circumstances. I have always been an advocate of the NHS (and have worked in it for several years in a non-clinical role) but cannot understand how these situations can be allowed to continue.

  13. This is such a deeply shocking situation, which many of us has seen or exprienced first hand. However, could we look at all the different aspects of the NHS and how our they interact with our elderly. Our local (Wokingham) district nurses and GP are providing the most amazing proactive and respectful care of my very elderly parents whilst they remain in their own home. It always appears that the minute they set foot in hospital the understanding and respect for their age disappears.
    Children are a priority in all A&E’s and I am thankful for the priority care they receive, but on arriving at our local A&E at 2 in the morning to find my then 89 year old father lying on a trolly cold where he had been for 2 hrs following a fall, I was quite honestly so astonished and appalled. The elderly have no voice in our society.

  14. Liz Kershaw is the new patron to our charity Age UK in Warwickshire and, having only commenced the role in January, her viguor and passion for championing a better later life has happily ripppled through the organisation and our service users.

    We are very proud of the stand that she has made concerning the quality of care for the elderly in the NHS and she has our full support .

    Reading Liz’s account of her own experiences of the NHS may be uncomfortable to digest but it did happen and looking at the thread above, she is sadly not alone. Worryingly, the quality of care is not the only problem the NHS is facing, but the quality of meals as well, according to the recent Dispatches expose. This at a time when patients are at their most vulnerable.

    I hope you will continue to support this matter and help Liz and Age UK champion a brighter future of older people.

  15. My Father was in hospital during the snow the weekend 18th December, Sister’s and Staff nurses hardly work with the patients e.g feeding those most vunrable which my Father was, the auxiliary nurses couldn’t get into the hospital, nor could I, simply stuck in the snow. During those two days he was hardly offered any food or water, he told me on the Sunday quote ‘I haven’t been offered any food or water for hours and hours’, he was desperate for water and literally starving. I approached the sister and she replied there are other patients in this hospital. Fortunatly I had brought some sandwiches and he ate them. Too late, he died 20th December, of pneumonia. Rubbish, he starved to death.

  16. This is a disgrace which has been going on a long time. I know old people who live with medical conditions they do not report to their doctor out of fear of being sent to hospital. They look on hospitals as places, not where they will be cured or relieved of pain, but as places where they will die.

  17. I could describe my shock and dismay at what happened to my elderly mother in hospital recently, but I won’t go into details at the moment as most things have already been covered above. However, my main concern is that, as she was in a good care home, with a care plan that has taken over a year to perfect, suddenly plunging her into a general hospital was a really cruel thing to do. She had a fall and only needed an x-ray, but I have been two weeks trying to get her out of the hospital and back to the more appropriate care of her nursing home – she arrived back in a sorry state, unable to eat as she was so weak from not being able to manage the inappropriate food produced, errors in managing the menu systems, failing to observe her allergy information, or from being inappropriately given sleeping pills which rendered her practically comatose and unable to eat, drink, take medication or communicate. If I had not been retired and available to monitor the situation and advise on her needs – not to mention keeping up her failing morale (or, heaven forbid, I had been away for some reason), I am certain she would have died. I hesitate to criticize the nursing staff, as they are really up against it. Many of them are really good and caring, and it must be soul destroying to have to do their job without adequate support from above and below.

  18. I was with my father when he died in hospital. I was fortunate because he was put into a side-ward. However, I am not sure how much care he would have received if I hadn’t been with him.

    Nevertheless, I am concerned about some of the issues that Liz Kershaw raises over her father’s end of life care, as I discuss in my blog Cause of Death: end of life. http://wp.me/pGhOe-me

  19. Doreen Caldecoat

    I might have to have a hip operation BUT i realy am frightened about it now after reading some of the mail and what happened to my husband last year . I have paid N /H all my life but for what?

    • Doreen, I think surgical wards are better, and I know of excellent results from hip replacement ops recently in two different parts of the country. They turn around patients and get them out quite swiftly. I think you can afford to be optimistic!

  20. Julia Nutbrown

    Last year my very active and intelligent 70 year old stepfather had a major stroke. He is now severely disabled with severe cognitive impairment. He has been in five hospitals and is now in permanent nursing care and during this time we have seen the full range of what the NHS and social services have to offer – from state of the art neuro-surgery and intensive care, fantastic consultants, nurses and carers to gob-smacking indifference, outright neglect and clearly ill-trained staff. Some memories of the last year include: a bag of soiled clothing left for a week next to my step-dad’s bed during a week-long ward closure due to c-diff or e-coli (he has MRSA!); having to arrange for a chiropodist to deal with his ingrowing toe-nails and having to cut his fingernails ourselves because nurses no longer can perform this task; nurses chatting at reception desk who clearly felt enquiries as to patient welfare to be an irritation; complete breakdown of communication regarding the provision of an specialised wheelchair – he’s still waiting; hospital and care home care staff not always properly trained to deal with patients who have brain injury so make inappropriate comments, cause pain on lifting, do not provide proper assistance with eating and drinking; during one hospital admission staff seemed to have no awareness or understanding of his complex needs and severe communication difficulties, I had to explain his full history to at least five different people plus he was left lying on a hospital trolley all day – an uncomfortable and painful experience for someone with severe disabilities; he had to return to the same hospital during the weeks of snow and we could not get there – on that occassion he was returned to his care home after a week in a dirty condition, dehydrated and clearly unwell. And these are just examples – I could go on. On top of this my mum has had to endure hours of meetings about funding and other decisions regarding his care, and we have had to learn to navigate the mysterious and complex worlds of health and social care including confronting staff about the quality of care on numerous occassions. There is not enough respect for the individual patient and family carers and communication between different professionals is poor. Lip service is paid to terms like personalisation and ‘putting the patient first’ but these terms are laugable to someone who has seen the system close up. The best care my stepdad received was in a community hospital where nurses and care staff took time to understand his individual needs and showed respect for the person he was, and still is.

  21. diana crawshaw

    This horrifying situation,where old people are treated worse than animals has to stop!I have seen a dignified old man reduced to a terrified,desperate man,starving and thirsty due to nurses’ indifference and pleading to have his soiled sheets changed.(When he had asked for the bed pan,he was ignored)Hoisted naked,in full view of the rest of the ward and spoken to like a naughty child,they changed the sheets.Feet going rotten because no one cut his toe nails or cleaned faeces from them until I drew it all to their attention.He lay,covered in a rash,which got worse.He begged for something to sooth the itching and begged for water as his mouth was dry from all the medication.This was a man who had served his country,worked hard and paid taxes all his life.He had only gone in hospital for observation when his kidneys were playing up.He died,infected and in pain..

  22. Further to my reply of Feb 28th at 10:09pm, I regret to say that my mother died peacefully last night, a week after returning to her nursing home, but at least she was comfortable and in a pleasant room with her own things around her, with people she knew who cared for her. I believe that the hospital substantially hastened her demise by subjecting her to this unnecessary ordeal, and she had had enough of it. What perturbs me is that I also believe that there was no real understanding or interest in what was happening to her. It seems that the staff go about their own jobs with blinkers on and are on duty for such short periods that they never have time to observe and get to know their patients, which I think is a major part of nursing.

    • Desperately sorry to hear the news about your mother. Our condolences to you and your family.

      • Hello, AgeUK. Thank you for the kind message of condolence. I have asked for donations to AgeUK instead of flowers for my mother. I have also written to the Primary Care Trust involved with a list of concerns, of which I listed at least 13, and I think I may still have left something out. If more people were aware of what goes on, perhaps we could get somewhere. Everyone I speak to seems to have witnessed or been told about something similar, or left their job in the NHS because they didn’t like what was going on. I am sorry for the nursing and physiotherapy staff. I will also be contributing to your Hungry to Be Heard survey, as that was a major factor in my mother’s demise.

  23. Hi,
    I recently broke my hip in a freak accident. I am only in my early fifties and found myself in a trauma and then a rehab ward with ladies aged between78-99.
    The trauma ward was nightmarish because many of the patients were clearly suffering from dementia as well as being in great pain.
    The following day on the rehab ward, all of us were fully aware and desperate to get mobile. As a relatively young, professional person – used to dealing with people and standing up for my rights – I was horrified to observe the way in which the older ladies were treated.
    I constantly had to insist on privacy – and was no doubt seen as a problem. The ladies were routinely ignored when they buzzed for help – so I found myself buzzing for them. They would sit in extreme discomfort -but be too afraid to say so for fear of being seen as ‘’difficult’.
    Very few of the nursing staff appeared to be qualified and we largely
    relied on Healthcare Assistants, some of whom were wholly unsuited to dealing with the public,- let alone people who have had a serious fracture. They would come in and moan about all the hard work they had to do and how ‘stressed’ they were.
    There were too many things wrong to mention in this brief message – some of which could well culminate in disciplinary action against a particular staff nurse, but I have fully documented my time in hospital – using notes, sound recordings of people in unheeded distress and photographs of the filthy toilets.

  24. Pingback: Equal Care for the Elderly: A Swing and a Miss? « The Academic Health Economists' Blog

  25. There are so many aspects to the issues with have with how our seniors are cared for and some of the stories above are heart breaking, and clearly a priority to deal with. It appears there is such a lack of respect for other people in general, and especially with the elderly because they are unable to demand otherwise. I recently took my father and mother to a geriatric clinic appointment at the RBS Hospital. We knew we were seeing a doctor and an Occupational Therapist. We were put in a room to wait – eventually a man walked in, sat down and boomed at my father – ‘Do you know where you are’, followed by ‘ Do you know what day it is’. I was absolutely mortified – where was the Good Morning Mr Blah, my name is Dr, Mr Blah, I am going to ask you some questions? This man it turned out was a consultant – I only discovered this when a month later we received a copy of the letter he had sent to our local Doctor. This letters first sentence was ‘Unfortunately this man can only score 3/10 on a mental status questionnaire” Knowing this letter was being copied to us, couldnt we have had. Mr Blah has scored 3/10 – rather than the anonymous and punitive approach taken. As I say – there is just absolutely no respect for our seniors.

  26. On Sunday 28th March my father fell at home in the early hours of the morning, the paramedics came to pick him up and he said he had a sore hip, they suggested an xray and took him to hospital. Whilst in xray he somehow fell from the trolly which has resulted in a broken neck, bruises and cuts everywhere including the requirment of 23 stitches in his head. He is in intensive care, and just 5 days on we have been told to prepare ourselves for the worst. This man was fit although not strong, he had no medical conditions other than athritis and walked with a frame and led a happy quiet life. He is 90 years old, and looked like he would just go on for ever. I am writing this as unemotionally as I can in this situation, but please can someone explain how it is possible in this day and age of Health and Safety, of education, of training given that someone could leave him unattended on a trolley with no sides up. If he started to roll he couldnt possibly have stopped himself, he didnt have the musculer strengh. He must have been absolutely terrified, and certainly the following 24 hrs before he was sedated and ventilated he was terrified. We do not know the circumstances of how it happened but it is clear it shouldnt have happened. Elderly people need protection and care which is different from the fit and able.

    • catherine cordiner

      Dear Carly, I am so sorry your father experieced such a terrible time,i send my warmest sympathy and am so saddened that he had to pass away in such a traumatic way.He was fortunate to have you there and even though he was sleeping he would of known you were with him. Catherine

  27. catherine cordiner

    my mother is currently lying in a general ward,she fell heavily down outside steps and broke her hip. initially A&E were great and we were told she would have an operation next day. It did not happen and when we went to visit her none was interested or even knew her as we asked what bed she was in and any update to when she would be operated on,the nurse chatting at the station said I dont know anything ask Sophie, we said who is she we will tell her to come and see you,but she did not know anything and said “probably get operation tomorrow,but she needed another XRAY but nothing planned and no Dr. seen her. She was an active 80yr.old full of life with slight dementia,she is currently a frail sad poor looking woman and has been left with no water had nothing to eat for 24hrs as was supposed be be operated today,she has been lying for 2days and nobody has told us what is happening and we are now frightened to ask as will be labeled difficult relatives who want special treatment. I feel so lost and sad and my mum to the nurses i spoke to is a non entity,due to her quit demure and elderly body,she still has feelings like you and I and I am afraid she is declining. Tomorrow i will be a difficult relative,and ask again what is happening. I cry for the elderly that do not have a voice and are confined to solitary confinement for their crime of age.

    • Hello Catherine, You have my utmost sympathy, and I am very disappointed to hear your story – I have twice experienced this particular problem of nobody knowing anything and not being able to be properly involved in my relatives’ care as a result (both now RIP). A problem has already been identified that the constant changing of different part time staff on shifts means that there is so much time lost trying to know the status of each patient, that there is not enough time available for good nursing and no one, constant person seems to be monitoring the patient so that they can see any change – the relatives most closely involved are best placed to know the patient – especially with dementia – and identify changes, so their input should be taken as invaluable. Also, the only nurses allowed to communicate information seem to be the staff nurses on duty, who are stretched to bursting, and they are not always the same individual on a regular basis. The best thing to do, is to raise your concerns with the hospital management, in writing, and copy this to the Care Quality Commission, who have to monitor the conduct of the hospital. The hospital will be obliged to investigate and report back to you.
      Regrettably, one feels that, to do this, means your loved one will receive even worse treatment, but there are good nurses as well, and this should be ironed out properly. I do hope you have a good outcome eventually – my mother was in her late 90’s when she fell and had her hip replaced, and they did that the very next day, but on her own request. This was, however, in a town where the population age is higher than average, so they were well used to doing the job (she lived to nearly 102!).
      It is helpful and essential (and therapeutic) for you to document what happens each day, and standing up for the rights of your loved ones should not be considered being difficult!
      Let us know how you get along.
      All the best,
      “I am worried”

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