LONDON, England / The Guardian / Society / Health / May 26, 2011
Care Quality Commission says some NHS trusts do not provide dignity and nutrition for some senior citizen patients
The Royal Free Hampstead NHS trust is failing to meet
basic standards, according to the Care Quality Commission.
Photograph: Bruno Vincent/Getty Images
The NHS regulator today criticises the service for failing some elderly patients by giving them what the health secretary, Andrew Lansley, called "appalling levels of care" in hospital.
Inspection reports compiled by the Care Quality Commission (CQC) take the health service to task for not respecting the privacy of some senior citizens receiving treatment or ensuring they eat properly.
The reports reveal that three out of 12 hospitals in England where standards of dignity and nutrition for older patients were assessed in spot checks were not meeting the basic standards which they are legally obliged to deliver.
The three trusts were Worcestershire Acute Hospitals NHS trust, the Ipswich Hospital NHS trust and the Royal Free Hampstead NHS trust in north London. CQC inspectors had less serious concerns about three other trusts, but found the other six were performing as they should.
"While the reports document many examples of people being treated with respect and given personalised, attentive care, some tell a bleak story of people not being helped to eat and drink, with their care needs not assessed and their dignity not respected", said the NHS watchdog for England. It found examples of:
• Patients not being helped to eat meals, which meant some consumed no food.
• Staff not assessing or monitoring patients' nutritional needs, for example by not conducting regular checks of their weight or not identifying those who were malnourished.
• People having too little to drink because fluids were left out of their reach or they received no fluids for a long time. One clinician had to prescribe water to a patient to ensure they got enough to drink.
• Staff not treating patients respectfully, and patients being talked to in a condescending or dismissive way.
• Staff not involving patients in their own care, for instance by not explaining treatment to them in advance or not seeking their consent.
The CQC's findings come after the Patients Association exposed appalling care received by some older patients and the charity Age UK's Hungry to be Heard campaign, which revealed major weaknesses in NHS feeding practices, such as elderly patients becoming or remaining malnourished while in hospital.
At the Royal Free Hospital, for example, inspectors found that staff did not always respond to patients pressing their bells – on one occasion when the person was at risk of falling our of bed – and heard complaints from patients that they were rarely asked if they had enough to drink.
"The inspection teams have seen some exemplary care, but some hospitals are not even getting the basics right. That is unacceptable," said Lansley.
The NHS Confederation, which represents hospitals, said the failings identified by the CQC were "simply unacceptable". "We in the NHS cannot tolerate the failure to meet minimum standards in any way, shape or form," said Sir Keith Pearson, its chairman.
Staff do not always honour the pledge on compassion in the NHS Constitution to "respond with humanity and kindness to each person's pain, distress, anxiety or need", he added.
Dr Peter Carter, general secretary of the Royal College of Nursing, said: "Some of the concerns raised in this report are truly shocking and we are clear that there is simply no excuse for failing to treat patients with the respect and dignity they deserve." All staff should be able to meet every patient's and their family's physical, social and emotional needs, he added.
But Carter also warned that with ongoing job losses across the NHS, pressure on nurses' time and too few staff to ensure patient safety, "frontline care is inevitably going to be affected."
"It is extremely worrying that a quarter of the first 12 hospitals to be spot-checked were non-compliant in both areas", said Michelle Mitchell of Age UK.
"It is also wholly unacceptable that some of the anecdotal evidence in the reports reveal distressing stories of medical staff having to prescribe water to ensure patients are hydrated and of some patients receiving treatment with little or no communication as to what is happening and why."
Although hospital staff recognise the importance of such care, more needs to be done to translate their words into action on wards, she added.
Katherine Murphy, director of the Patients Association, called for the introduction of independent matrons – not employed by the NHS organisations where they worked – who could lobby on behalf of patients for changes to be made if they came across examples of sub-standard care.
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