21 September 2011

Care of the elderly can be shocking.

For most people their first experience of seeing Geriatric care can come as something of a shock.
I was speaking to a retired NHS manager who told me about the geriatric hospitals he saw in the 60s. Nightingale wards with 90 patients. At night there were two staff. The beds were around 2 feet apart.  It was part of the night staffs duty to get the ward up, dressed and sitting out by the time the day shift took over. In order to achieve this they began getting patients up at 4.30 in the morning.
This style of ward is perhaps ideally suited to being able to keep an eye on vulnerable and confused patients at minimum expense. The cost is that there is no peace, and no privacy.
I remember visiting geriatric wards in a converted poor house in Edinburgh in the 70s and seeing  40 or 50 elderly confused people sat round the walls of the day room. The television was on, but no one was watching. Sometimes an old lady would try to get up from her chair, and would be sat down again by an assistant, fearful of falls. This kept old people safe, but denied them their most basic freedoms.
By the time my own mother was suffering from dementia some 30 years later things had changed. The improvements to medicine and surgical care meant that people were surviving much longer, so that many of the patients were dependent in ways that were quite new.
Patients who suffered strokes, could be treated with very effective drugs to prevent a second stroke, and could survive for years in a highly impaired state. If they could no longer swallow then they could be fed through peg tubes.
Operations for Cancer and for broken hips, that would have killed patients in the 70s were routinely survived, leaving patients alive but in very poor health.
When you see care in action you see the casual indignity of the use of incontinence pads, for people who would rather be helped to a commode. You see people being dressed in clothes that are not theirs. You see all the small choices that we take for granted stripped away.
The press now has an interesting relationship with stories of care of the very old. It is something that does touch us all, because we can so easily see this could be our parents, our friends. It could be us.
The convention is that we do not see faces, because this could be exploitative, so we tend to see pictures of withered hands.  In many cases this is all we see. Our elderly are locked away in nursing homes. They are invisible. The connection is not there.
We have had, perhaps especially since the Midstaffs Healthcare commission report hit the press, something of a vogue for bad care porn, where we hear in all the shocking detail the highly uncomfortable facts about management of bodily functions.  Perhaps I am not as shocked as many are by this. After nursing my mother for many years, changed many wet pants and seeing her pretty dramatically covered in faeces on three occasions I am aware that on occasion s*** happens.    
Our willingness to accept that on many occasions these indignities are no one’s fault, is a little further eroded by every new press scandal or undercover television special that we see.
The willingness of decent caring people who are really suited to providing the compassionate care older people need to become nurses, is probably also eroded by every emotive story we hear of cruel and uncaring staff.
What has bothered me as I listen to the evidence from the #midstaffsinquiry is that we have wasted so much precious time in seeking to find out “the truth” and who is to blame.
There have been real benefits from the Stafford process.  Valuable systems to help judge the quality of care better have been created over the last four years.  The Dilnot report on Care funding which is this government’s response to the work on Care funding done by the Labour Government in its last term has now reported and may be offering us better ways to fund the quality of care that we want, in different settings. This is a separate issue, but essential to make hospital care work.  All this is good – but there is so much more to be done.
One of the distinctive features of this government is that it is decentralising and cutting, so we in our communities will now have the responsibility of specifying and taking the financial decisions on the care that we want for our older people.  For all the people who have been watching the #Midstaffsinquiry the level of responsibility that will now fall on local people without the expertise to do this job is terrifying.
Will the press who brought us the care porn, and relished the search for people to blame now turn its hand to helping communities work together, putting party barriers aside, to find solutions to our shared problem.