Care and compassion: not for the elderly

As a nurse I am deeply ashamed of the ten case histories reported by Ann Abraham, Healthcare Ombudsman in her report on care for elderly people in the NHS in England. In fact, I can scarcely believe what I have read, especially in the light of the fact that in her foreword, the Ombudsman indicates that the stories may just be the tip of the iceberg. Every nurse in a position of managerial responsibility and those who care for patients every day, should be required to read and reflect on the report Care and Compassion? Every healthcare assistant in NHS care in England should also be expected to read it. Teams of health service workers should place a discussion on their next team meeting agenda, to ask “Could that happen here?” The Ombudsman observes in her foreword, that she knows from her caseload that in many cases the answer will be “yes”. The report is a severe indictment of the quality care agenda, of patient centred care and of ensuring dignity and respect for patients, which every healthcare professional purports to practice each and every day.

The Healthcare Ombudsman’s Report

The report, to both the House of Commons and the House of Lords is short (38 pages) but distressing to read and shocking in it’s entirety. It cites ten case histories of care investigated by the Ombudsman (after they had been investigated locally and some by the Quality Care Commission where relatives have found the outcomes unresolved and unsatisfactory). Each story is told in clear concise language, a report on the investigation by the Ombudsman’s office follows, and finally a short section concludes what happened next. The introduction by the Ombudsman is the only text, other than the case histories.1 All case histories relate to patients over the age of 65. Eighteen per cent of all 9,000 cases reported to the Office of the Ombudsman last year, related to older people. They accepted 226 cases for investigation, more than twice as many as for all other age groups put together. The issues highlighted in the case histories are specifically – dignity, healthcare associated infection, nutrition, discharge from hospital and personal care. “The nature of the failings,” says the Ombudsman in her introduction, “suggests that extra resource alone will not help the NHS fulfil its’ own standards of care”. She continues: “There are very many skilled staff within the NHS who provide a compassionate and considerate service to their patients. Yet the cases I see confirm that this is not universal. Instead, the actions of individual staff described here add up to an ignominious failure to look beyond a patient’s clinical condition and respond to the social and emotional needs of the individual and their family.” The Ombudsman’s findings show how ten older patients suffered unnecessary pain, indignity and distress while in the care of the NHS. Her investigations highlight common failures in pain control, discharge arrangements, communication with patients and their relatives and ensuring adequate nutrition. The Ombudsman explains: ‘The findings of my investigations reveal an attitude – both personal and institutional – which fails to recognise the humanity and individuality of the people concerned and to respond to them with sensitivity, compassion and professionalism. The reasonable expectation that an older person or their family may have of dignified, pain-free, end-of-life care, in clean surroundings in hospital is not being fulfilled. Instead, these accounts present a picture of NHS provision that is failing to meet even the most basic standards of care.’ The report recounts the Ombudsman’s investigation into the care of Mr D, who had advanced stomach cancer and wanted to die at home. When his daughter arrived to collect him from hospital, she found him sitting behind a closed curtain in distress. He had been left for several hours, was in pain, desperate to go to the toilet and unable to ask for help because he was so dehydrated that he could not speak or swallow. The emergency button had been placed out of his reach, his drip had been removed, fallen and had leaked all over the floor. At home, the family discovered Mr D had not been given the right pain relief and spent the weekend driving around trying to obtain the correct medication before he died. Mr D’s case history demonstrates abject failings by different members of the healthcare team.