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.