Posted by: Linda Proud | February 15, 2011

Inhumanity in the NHS

I’ve just been listening to the Today programme and reliving the horror of my mother’s final year, half of which was spent in hospital. Humphries was on top form, pressing contributors as to WHY such things happen as Ann Abrahams, the Health Ombudsman, has revealed in her report. There were various reasons given: the NHS is too bureaucratic and target-driven; things aren’t so bad as they’re reported to be; nurses are under stress and strain. But we get the picture: if an old woman dies of dehydration in hospital, the nurse is at fault and is displaying basic inhumanity. WHY? asks Humphries.

I wrote at length about the whole sorry business back in 2009 and don’t want to go over any of it: I’m still in recovery. I just want to add my twopennyworth to the debate.

1. Mum was in hospital far too long on each occasion. The rule is that an elderly patient can’t be ‘released’ until a social care plan is in place. Even though we were looking after Mum ourselves at home, we still had to wait until a ‘care package’ could be put together, that is to say, a team of people assembled who could fit her into their schedule for two visits a day. Given the strain on the hospitals to have so many elderly in their wards, this rule needs to be reconsidered and requisite help given to the social services.

2. Cottage and local hospitals used to care for the elderly comparatively well. The staff were trained in palliative care and rehabilitation. Here in Oxford the Radcliffe Infirmary closed a couple of years ago to make way for more cafes and everything was concentrated at the airport-sized  John Radcliffe Hospital. But there all cases are considered ‘acute’ even if they aren’t, and the training is different (cancer patients are cared for in a separate hospital). The nursing staff that had transferred from the Infirmary were in a permanent dither of confusion and, it has to be said, distress. ‘Acute’ deals well with A&E; it’s no good at all for an old lady. She had a heart attack in the hospital. She died. That should have been it. But some ham-fisted young intern brought her back, cracking a few ribs in the process, to give her six more months of increasingly harrowing life. That’s what he was trained to do.

As Humphries was at pains to point out, it’s not natural to be inhumane. If nurses are leaving patients to soil their beds and die of thirst, we need to find out why. But I doubt that the cause is in the nurses: we need to find out what it is that is dehumanising them.

My guess is that it’s a problem of scale. If you see too many people at once, you don’t connect with them as individuals. Imagine walking round Heathrow trying to find out if everyone has what they need. It’s not possible. The best you can hope for is orderly queues.

The debate this morning was shallow. We have very short-term memories. We need to rewind a few years and re-examine the decisions that led to the closure of geriatric wings and cottage hospitals. We’re all going to be old soon, and it will be sooner than we think.

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