Should relatives be caring for older people in hospitals?

This weekend, Peter Carter, chief executive of the Royal College of Nursing (RCN), said patients’ relatives need to do more to look after their loved ones in hospital. Clare Gerada at the Royal College of GPs agreed. This is what Carter said: “If you have a 24-bed ward and have got five nurses and everybody is having lunch at the same time and half the patients need feeding, it becomes difficult to get it all done,” Carter said. “You get this business of wards, very, very busy people, [patients] dying to go to the loo, elderly people wetting themselves, then they lie there feeling embarrassed — and it is about helping gran get out of bed and go to the loo”.

For many people, the immediate response to this quote will be “so what are nurses supposed to be doing?” This question is even more pertinent when you consider that the majority of inpatient bed days are used by older people. Helping someone to eat and supporting them to meet personal care needs are essential elements of care. To suggest that such can be simply picked up by friends and family is to suggest it is care less relevant to what the NHS is there to do. Peter Carter may be asking the right question, but is coming up with the wrong solution. He is absolutely right in questioning why, in his example, a 24 bed ward is not able to offer an appropriate level of support to it patients.

However, the solution is not simply to defer responsibility onto friends and relatives. The wider question is why a hospital ward in a £100 billion NHS is unable to meet essential care needs for older people. Part of the solution may be more nurses, though this is often a simplistic answer. There are certainly questions around why so-called geriatric wards are generally resourced less than other wards (though “geriatric ward” is something of a misnomer as older people will likely be the majority on most wards). There are fundamental questions about the nature of training, something Peter Carter alluded to at the end of last week.

Age UK certainly believes all medical training most be far more grounded in the care of older people. Many health professionals can be woefully under-prepared for assessing and responding to older people’s needs. This is symptomatic of much bigger issues that NHS needs to resolve. As Carter and Gerada both point out, the NHS will spend an increasing amount of time helping to manage people with long-term conditions, the majority of these being older people. Already, 70% of the primary and acute care budget is spent on long-term conditions. If we continue to picture the NHS as there to simply cure and repair, then it will continue to make the mistake of making its core users second class citizens. In making that mistake, the NHS will remain organised around meeting the needs of the minority, (vital as this is), and framing the majority as an inconvenience. Carter and Gerada’s comments reflect such an attitude.

Age UK absolutely supports the involvement of family and friends in a person’s care. This can make a vital contribution to their wellbeing and sense of control in what can be a distressing period of their life. Some hospitals have even offered low-level training to family members to help with care, and we would support such positive steps to improve older people’s experience of care. However, this must never detract from the fundamental caring responsibilities of nursing and other hospital staff.

Age UK is currently running a commission with the NHS Confederation and the Local Government Group looking at issues of dignity and essential care. The commission will be seeking real solutions to these issues and we welcome the debate that these comments have sparked. However, there must be a must better understanding of what the NHS is for before we can start describing how it can best achieve this.

5 responses to “Should relatives be caring for older people in hospitals?

  1. The trouble in hospitals is that the sisters and staff nurses do NOT spend time with helping patients, its the juniors and auxiliary. I’ve seen this both in two welsh hospitals. I’ve seen elderly patients which cannot reach their meal and water and literally starve and I mean starve.
    Visitors are not allowed in Bangor hospital between visiting hours, the doors are locked.
    If families were to help then more lives would be saved. Bring back the Matron.

    • I agree Shirley. At our local hospital in Wakefield, there are only two visiting ‘windows’ a day. My mother died in this hospital and her last days were miserable, nurses didn’t understand Alzheimers, left her medication at the side of the bed instead of making sure she took it, food and drink were also left for her to get herself, which she was unable to. If it wasn’t for the family visiting, she would have been left to starve and dehydrate. Also, families never get the chance to be kept in the loop regarding treatment/diagnosis etc., as the consultants come round out of visiting times. When we go to visit, the nurses who are on the nurses station seem to miraculously disappear!

  2. In agreement with Shirley, I believe more people actually want to help but cant due to stupid policies and staff who are too by the book and strict. These are people not inmates.

  3. I don’t think it takes much expertise to help feed your own elderly Mother or Father! Honestly! I would rather know my parents are getting fed than going without food and water because of the stupid, overboard policies and staff who are so intent on keeping to the book that they overlook the patients real needs. Talk about violating human rights! These old people are human beings and it’s love that helps them to get better, not having the ‘right’ person feed them. I agree, bring back the matrons!!

  4. Michelle –
    One key point you leave out is that very often hospitals actively stop relatives even being on the ward, let alone encouraging them to assist with care. See http://www.dailymail.co.uk/news/article-2018084/Hospital-hoping-save-cash-tells-families-stop-visiting-sick-relatives-instead-SKYPE.html
    and associated comments, which I can echo from my own experience, that often nurses dont want relatives there because they don’t want to be subject to the relatives’ scrutiny of their care standards. From this perspective, Peter Carter’s statement is a radical move in the right direction.

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