Tuesday, 9 October 2012

Care Standards


The Sunday Times contained an interesting article the other day on care standards for elderly patients in the NHS - the details of which apply only to England, Wales and Northern Ireland.

"Forty-three hospital patients starved to death and 111 died of thirst last year, according to figures from the Office for National Statistics (ONS) that have heightened fears about nursing standards in the wake of a series of medical scandals.

Another 287 patients were said to be malnourished when they died in hospital and there were 558 cases where people had died in a state of severe dehydration.

Nearly 22,000 people in NHS wards were recorded as suffering from septicaemia when they died, a condition normally linked to infected wounds, the ONS said. The report will also prompt concern about standards at care homes, where eight people starved to death and 21 died of thirst in 2011.

A further 78 hospital and 39 care home patients were killed by bedsores, while another 650 people who died had skin ulcers.

Michelle Mitchell, charity director of Age UK, said the figures were “deeply distressing” because the deaths were avoidable.

She added: “Hospitals and care homes must pick up on the warning signs of malnutrition and ensure that while older people are in their care they get all the help and support they need to eat and drink.”

On reading this article my immediate thought was that the same must be true in Scotland - and what do you know?

The following day I came across a report of an unannounced Inspection Visit (by Healthcare Improvement Scotland) to the  Royal Infimary in Edinburgh - part of NHS Lothian - some extracts of which are reproduced below. 

"Areas for improvement"

"We found that further improvement is required when providing care to older people in acute hospitals.

We are concerned about how staff are making sure patients’ dignity and comfort are maintained at all times in the combined assessment area. This is a mixed sex area and patients can be there for a number of days before being discharged or transferred to a ward. We had to intervene on three occasions whilst inspecting this area of the hospital. Due to the busy nature of the ward, we saw instances where nursing staff would start to care for a patient and then be called away before they were able to complete their tasks. Patients were interrupted on several occasions while treatment and care was given.

Some mealtimes seemed poorly organised. Patients who needed help with their meals waited for a long time before that help was provided. We had significant concerns about the provision of meals across several wards and how some patients were assisted to eat their meals. On a number of occasions, we had to intervene and ask staff to provide help for patients at mealtimes.

There is no routine screening for cognitive impairment taking place when patients are admitted to hospital. Staff in the accident and emergency department confirmed that they do not routinely carry out cognitive screening on all patients over 65 years of age.

We also found that risk assessments for nutritional care and hydration, and to determine whether patients were at risk of developing a pressure ulcer, were not being carried out within the correct timeframes.

We found no information in the care plans outlining the individual needs of older people. This means that there is no information for staff on how they can provide care to meet those individual needs.

Across the hospital, the ward environments inspected were not helpful for people with dementia and cognitive impairment.

This inspection resulted in four areas of strength and 23 areas for improvement. A full list of the areas for improvement can be found in Appendix 1 on page 20.

We expect NHS Lothian to address all the areas for improvement. Those areas where improvement is required to meet a recognised standard must be prioritised."

Now all I can say is that I'm not surprised - because my personal experience (via my mother) is that the standards of care for elderly NHS patients is very poor at times.

And if this kind of 'report card' had been issued to a private hospital or private care home - you can just imagine the subsequent row - with people calling for institutions to be brought under public control.

Which misses the point entirely - of course. 

My mother's experience in an NHS hospital was several years ago - so this issue or problem has nothing to do with resources or spending cuts. 

The best defence for patients lies with strong, independent regulators - who make regular and unannounced visits to NHS hospitals and elsewhere - and then publish their reports without pulling any punches.