A large number of NHS hospitals are failing to provide quality care for elderly patients, according to a damning report by the Care Quality Commission (CQC).
The CQC carried out 100 unannounced inspections of NHS acute hospitals, between March and June, to assess whether the essential standards of dignity and nutrition were being met on wards caring for older people. Around half of the hospitals needed to do more to ensure that they were meeting people’s needs – with 20 of the hospitals visited failing to meet essential standards required by law. Of the 100 hospitals inspected:
• 45 hospitals were fully compliant – meeting the essential standards relating to both dignity and nutrition.
• 35 met both standards but still needed to make improvements in one or both.
• 20 hospitals did not meet one or both standards – with major concerns identified in two cases.
During the initial inspections, two hospitals were identified as having major concerns – Sandwell General Hospital, in West Bromwich, and Alexandra Hospital in Worcestershire. A followup unannounced inspection to Alexandra Hospital found that action has been taken to address CQC concerns and the hospital is now meeting essential standards. However, when CQC inspectors returned to Sandwell General, they found that, although standards around meeting people’s nutritional needs had improved, people’s dignity was not always respected. Inspectors visited two wards; the Emergency Assessment Unit (EAU) and Newton 4. Patients spoke highly of the care they received in EAU, but on Newton 4, inspectors observed incidents including a person who had been incontinent remaining unwashed for an hour and a half, despite asking staff for help. The key themes observed in hospitals that were failing to meet the essential standard relating to dignity (‘respecting and involving people who use services’) were: #
• Call bells put out of people’s reach or not responded to in a reasonable time.
• Staff speaking to people in a condescending or dismissive way.
• Curtains not properly closed when personal care was given to people in bed.
• Comments from patients and staff that there were not enough staff with the right training on duty to spend time giving care.
The key themes observed in hospitals that were failing to meet the essential standard relating to nutrition (‘meeting nutritional needs’) were:
• People not given the help they needed to eat, meaning they struggled to eat or were physically unable to eat meals.
• People interrupted during meals and having to leave their food unfinished.
• People’s needs not assessed properly, which meant they did not always get the care they needed – for example, specialist diets.
• Records of food and drink not kept accurately so progress was not monitored.
• Patients not able to clean their hands before meals.
Commenting on the report, Dame Jo Williams, chair of CQC, said: “Too often, our inspectors saw the delivery of care treated as a task that needed to be completed. Those responsible for the training and development of staff, particularly in nursing, need to look long and hard at why the focus has become the unit of work, rather than the person who needs to be looked after and how this can be changed. “Care professionals need to strike the right balance between ensuring that people get the care they need in a safe way – recording how much they have eaten and drunk, what medications they have taken and when – while not prioritising processes over people. Taskfocused care is not person-centred care. Often, what is needed is kindness and compassion…which cost nothing.” Responding to the CQC report into dignity and nutrition for older people, Royal College of Nursing executive director of nursing and service delivery, Janet Davies said: “There are some deeply troubling, indeed shocking examples of poor care in the CQC reports, which demand urgent and sustained action to improve care for vulnerable patients. Every nurse is personally accountable for their own practice and must act promptly to raise concerns if staffing levels or other pressures are getting in the way of delivering good care. Each Trust board and chief executive must take responsibility too. Decisions about the numbers of staff employed, the availability of senior, experienced clinical nurses and the whole ethos of the hospital are not issues that can be delegated.”
