When the Care Quality Commission reported this week that a lack of “kindness and compassion” is leading to the inadequate treatment of the elderly in half of all hospitals, it was shocking – but not surprising. For years, older people have been forced to endure undignified and complacent care in the NHS.
Last year, we at Age UK produced a report called Still Hungry to be Heard, which highlighted the continuing problems with malnutrition, and prompted the CQC to carry out these latest inspections. Earlier this year, the Parliamentary and Health Service Ombudsman found – while describing more appalling cases of neglect – that more than twice as many complaints about the treatment of the elderly warranted closer investigation when compared with other age groups. In our social care system, it is acceptable for an older person to be put to bed while children’s TV is still on the air, because it is the only time when a carer is available for the necessary 15 minutes. This does not reflect a society in which older people are treated with respect or dignity, but one in which they are kept at the fringes of the community.
When it comes to the health service, how is it that an organisation with a £100 billion budget is failing to provide basic standards of care? Part of the answer lies with how the NHS is organised. Over the past decade, a huge amount of extra money has been poured into the health service, much of it tied to the drive to get waiting lists down to a maximum of 18 weeks. Reaching that target was a significant achievement – but in the process, hospitals were encouraged to move people through the system as quickly as possible. The result is that patients came to be seen as conditions or procedures to be processed, rather than people.
While this approach may be acceptable when dealing with someone who has a single, simple disease or injury, it is hardly appropriate for a frail, elderly person with multiple long-term conditions. The knock-on effect is that an older person using a hospital bed can be seen as a “wasted admission”, surplus to the hospital’s “real” work.
The fact that such older people are all too often ignored or patronised not only points to a failure in attitude, but also calls into question the ability of health professionals to assess their needs appropriately. It may also explain why so-called geriatric wards often receive less resources than others – even though the term is now a misnomer, since most wards are likely to contain a large proportion, if not a majority, of older people. After all, the elderly are now the largest users of NHS services, making up two thirds of the total. And that proportion is increasing: the number of stays in hospital by people over 75 has grown by 66 per cent since 1999/2000, more than twice as fast as for those aged between 15 and 59.
Despite this, the prejudice within the health service can be deep-rooted. You don’t have to look far to find examples of doctors and nurses, just emerged from training, who seem surprised to find themselves having to look after older people. Surveys of trainee doctors have shown that they hold geriatric care in poor regard: many actively avoid it, with the best and brightest preferring to move into more “glamorous” areas, such as A&E.
The cloud that hangs over this whole issue is the continuing negative attitude towards older people in society as a whole. If they are not valued outside hospital, how can we realistically expect them to be valued inside it? How many headlines have we read recently that complain about the “tsunami” of an ageing society, rather than celebrating the fact that people are living longer?
When it comes to the NHS, the health service is going through a period of massive change. Will these reforms improve the care of older people? In reaching an answer, the Government must undertake a full and comprehensive review of how the NHS can meet their needs.
Certainly, much more needs to be done to focus the minds of hospital managers. For example, we have been calling for mandatory publication of malnutrition rates, so that people can discover where the problems are occurring, rather than waiting for the Care Quality Commission to make an inspection. This isn’t a silver bullet, but it will certainly move the issue up the agenda at hospital board meetings.
The NHS must also work with patients and the public when deciding where to deliver services, and to find out where problems are occurring. Well before charities or quangos got involved, older people knew precisely which hospitals were delivering poor care to their friends and neighbours – but they didn’t know what to do with the information. The NHS must do more to seek out such feedback and make changes. And where care continues to be poor, there must beconsequences: it shouldn’t take a Mid-Staffordshire-type inquiry to drag incompetence out of the shadows.
Finally, the NHS must do more to support its staff. If doctors and nurses are under too much pressure, it is the patients who suffer.
Worryingly, the health service has the highest level of work-related sickness in the country, with many nurses being put in a position in which they cannot deliver the care they want to.
The NHS is there for everyone – but this week’s report shows yet again that it continues to perform poorly for older people. It is time to move beyond diagnosing the problem, and start looking at how to solve it.
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