Elder care and the NHS - a crisis revealed

Posted on: 16 February 2011 by Alexander Hay

The NHS needs better leadership if it is to properly care for older patients.

Can the NHS provide the care elderly patients deserve?

On paper, it doesn't look good. A new report out yesterday, care of the Health Service Ombudsman, reveals the at times appalling levels of treatment inflicted upon elderly vulnerable patients.

Some of the cases cited are too distressing or depressing to repeat here, but a clear trend is in place. Of all complaints accepted for investigation by the Ombudsmen, those involving elderly patients were double the number of those other types of complaint.

What does this reveal? The usual anti-NHS arguments, particularly over the water, will be trotted out at this point about the dangers of 'socialized healthcare' (always more alarming when it's spelt with a 'z'), while in the UK, much hand wringing will take place over whether the NHS will simply get worse as funding is cut or whether it is on an inexorable spiral of decline, or who to blame. (Often this is the only question anyone can be bothered to ask.) In doing so, however, they miss the report's real findings, that the NHS is suffering from a systematic crisis.

For example, at the heart of most of the case studies is a jobsworth mentality, a belief that the bare minimum of the job is enough and going any further is a gross imposition on the health worker in question. This odd sense of entitlement, sitting uneasily as it does with the needs of the patient, is technically correct but refuses to acknowledge that the bare minimum (or even less) isn't in fact enough in most cases. 

When dealing with ill, vulnerable older people, you need a certain degree of personal engagement and even loyalty to the patient. Many NHS staff do indeed have these virtues, but they sit uneasily with a national character rooted in cynicism and a sort of arrogant passive aggression.

There are also issues with how health professionals are trained. Certainly, as nursing has become a degree subject, it has become more technical and skillful, but there is increasingly something missing; a sort of humanity or common touch that often prevents us from becoming too callous or contemptuous towards those who are weaker or vulnerable than us. Doctors have always had this problem, of course.

We mustn't, after all, underestimate the damage compassion fatigue can do to people over the years, transforming once dedicated professionals into callous, bitter shells of their former selves. This is a genuine problem - there is only so much witnessed pain, suffering and horror some people can endure before it breaks them in one fashion or another. 

While the issue of PTSD and its effects on military personnel and victims of crime or disasters is widely discussed, a similar debate does not yet take place in regards to health professionals

Perhaps this is because losing the ability to empathise with other people in such a capacity is seen as a taboo, a dreadful slur on someone's reputation. Instead, of course, it is an inevitable result of over-worked or poorly supported nurses and doctors simply running out of what made them take up their calling in the first place.

This leads us to the central problem - a lack of leadership which would otherwise spot these problems and deal with them before they take root. We may certainly demand to know why nurses and doctors have left older people dehydrated, dirty, cold and malnourished, but we should also demand to know where their superiors were, if not on the ward and not taking the ultimate responsibility that should come with their high pay and many perks.

In a sense, however, this is an optimistic reading of events. Far from problems tied into funding or the notion of free (at the point of use) healthcare itself, the problem instead lies in how our hospitals are organised, who answers to whom and how best to make the most out of people. Sadly, many patients in hospital today will find such discussions academic - they just need the care they are surely entitled to.

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Alexander Hay

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