Views & Reviews Acute Perspective

David Oliver: Welcoming carers on to the wards

BMJ 2015; 351 doi: (Published 18 September 2015) Cite this as: BMJ 2015;351:h4959

I’m dismayed whenever the wishes of mentally competent older inpatients go unheard or ignored, whether by practitioners or families. As experienced adults with very individual life stories, needs, and wishes, they have the right to take risks, to be partners in decisions, and not to be bypassed or patronised. Even when autonomy is impaired, their individual humanity should be respected.

But population ageing has changed the inpatient demographic.1 Dementia, delirium, sensory and communication impairment, frailty, and disability all complicate acute illness,2 3 compounded by a depersonalising institutional environment.4 5

Many patients depend on carers to stay at home or to return there. Many carers are themselves older, in worsening health, and poorly supported.6 Hospital admission can be as unsettling for families as for patients. Involving carers early and often is crucial. We learn more from them than they can from us. And they provide continuity in an often fragmented system.7

John’s Campaign, started by the writer Nicci Gerrard, has added momentum to a movement to welcome carers on to the ward as partners in care. Since 2014 around 100 UK hospitals have signed up to it,8 scrapping visiting restrictions or issuing “carers’ passports.”9 We’ve done this on my home ward, and we wouldn’t turn the clock back.

Gerrard told me, “Carers of people with dementia or frailty worry, with a frantic tenderness and a sense of letting them down, that they will feel abandoned, scared, bewildered . . . other people who don’t know them won’t understand their idiosyncrasies and practical and emotional needs . . . they’ll be alone in a world they can’t navigate.

“Carers can interpret and advocate; stay with the patient in a way nursing staff simply can’t; and reassure them in ways that no one else would be able to. They can liberate the hospital staff to do their job.”

Overstretched staff on understaffed wards might worry about this initiative. What of the potential impact on confidentiality; on other patients if wards are inundated; or on their own workload and ability to complete other tasks, if they are constantly in demand for information and reassurance?

Fortunately, the benefits can outweigh perceived risks. These have been described at other hospitals such as Heart of England10 and Nottingham University Hospitals,11 among others. Time spent communicating during rounds is time saved later. Complaints about poor communication diminish. And additional demands on hard pressed staff can be mitigated: for instance, “visitors’ charters” set out limits and expectations.12

We need to encourage this kind of approach if we want to make our hospitals fit for the older people who are now their main users. What’s stopping us from making it the norm?


Cite this as: BMJ 2015;351:h4959


  • Competing interests: I have read and understood the BMJ policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: Commissioned; not externally peer reviewed.


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