“Harrowing accounts” show how NHS fails to meet basic standards of care of elderly people

BMJ 2011; 342 doi: (Published 15 February 2011) Cite this as: BMJ 2011;342:d1064
  1. Zosia Kmietowicz
  1. 1London

Ten investigations into complaints about NHS care of elderly people in England have found that pain control, discharge arrangements, communication with patients and their relatives, and nutrition are often highly inadequate.

The health service ombudsman, Ann Abraham, says that her report shows the gulf between the principles and values of the NHS Constitution and the reality of being an older person in the care of the NHS in England. The 10 patients whose cases were looked into endured unnecessary pain, indignity, and distress while in the care of the NHS, she said.

The ombudsman, which deals with complaints against the NHS that cannot be resolved by individual trusts, carried out the 10 investigations that took place in 2009 and 2010. Nine of the 10 patients died during or shortly after the experiences investigated.

The report says of the patients, “Poor care or badly managed medication contributed to their deteriorating health, as they were transformed from alert and able individuals to people who were dehydrated, malnourished or unable to communicate.”

One relative told the investigation, “Our dad was not treated as a capable man in ill health but as someone whom staff could not have cared less whether he lived or died.”

Ms Abraham says in the report, “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.”

Care services minister Paul Burstow said: “This report exposes the urgent need to update our NHS. We need a culture where poor practice is challenged and quality is the watchword. The dignity of frail older people should never be sidelined.”

He said nurses would be carrying out new spot checks to root out poor practice in the care of older people and ensure patients are treated with dignity.

The 10 investigations are not isolated cases, says the report. Of the nearly 9000 complaints to the ombudsman about the NHS last year 18% concerned the care of elderly people. Altogether the office accepted for investigation 226 cases concerning elderly people, more than twice as many as for all the other age groups put together.

One of the investigations looked at the care of Mr D, who had advanced stomach cancer and wanted to die at home. When his daughter arrived to collect him from Royal Bolton Hospital she found him sitting behind a closed curtain in distress. He had been left for several hours, was in pain, and was desperate to go to the toilet but was unable to ask for help because he was so dehydrated that he couldn’t speak or swallow. The emergency button had been placed out of his reach, and his drip feed had been removed and had fallen and had leaked all over the floor. With Mr D at home the family discovered that he had not been given the right pain relief and had spent the weekend driving around trying to obtain the correct treatment before he died.

The ombudsman concluded: “These often harrowing accounts should cause every member of NHS staff who reads this report to pause and ask themselves if any of their patients could suffer in the same way. I know from my caseload that in many cases the answer must be ‘yes.’ The NHS must close the gap between the promise of care and compassion outlined in its Constitution and the injustice that many older people experience. Every member of staff, no matter what their job, has a role to play in making the commitments of the Constitution a felt reality for patients.”


Cite this as: BMJ 2011;342:d1064