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Views & Reviews Personal View

An unsafe ward

BMJ 2013; 346 doi: (Published 25 February 2013) Cite this as: BMJ 2013;346:f1243

Re: An unsafe ward

I have received over 30 supportive personal comments on my article about the death of my father. It is striking how many people were not surprised by what I described and many shared their own sad personal stories with me. This suggests that poor basic care for elderly patients could be endemic within the NHS, with mid-Staffs only acting as a scapegoat for a widespread institutional malaise.

My experience and that of others is that food, water, cleanliness and simple human kindness are remarkable cheap and effective treatments for elderly in-patients. The modern NHS seems to have separated the concepts of basic and nursing care, so that catering services have been subcontracted out to private companies. This fragmentation may explain some of the difficulties. But expensive interventions and therapies are wasted unless the basics for human life are supplied.

There were some helpful suggestions about possible ways of addressing the problem; these included the “Butterfly Scheme” and “Intentional comfort rounding”, Neither of these schemes has been evaluated scientifically yet. It should be a priority to evaluate projects that could reduce suffering and harm in NHS hospitals.

The suggestion that relatives could help with basic nursing care is interesting and has been endorsed recently by the think-tank 2020health I was happy to help with my Dad’s care during the day. As I said in my article I wish I had stayed overnight; if I had, he would not have fallen. But the structure of wards often makes it difficult: beds are too close together and there is frequently too much “clutter”. In addition I did not have the impression that I would have been welcomed by the nursing staff.

The core of any change needs to be with nursing culture and practice throughout the UK. All clinicians need to feel able to challenge and improve poor standards without blame or reproach. I hope this is recognised before many more elderly patients die unnecessarily.

Competing interests: No competing interests

20 March 2013
Judy Shakespeare