http://www.guardian.co.uk/society/2011/oct/13/nhs-hospitals-care-of-elderly

Too many hospital staff do not ensure older patients eat and drink properly, fail to respect their dignity and talk to them in a condescending manner, the NHS watchdog warns. In a highly critical report the Care Quality Commission said that more than half of all hospitals in England were not meeting key standards for dignity and nutrition in elderly people, a finding it called “truly alarming and deeply disappointing”. It castigated a handful of them for providing “unacceptable care”. Of 100 acute hospitals that received unannounced visits by inspectors between March and June, 45 met the NHS’s standards relating to both patients’ dignity and nutrition. Thirty-five did met both standards but needed to make improvements in one or both areas. And 20 – one in five – did not meet either one or both of them. Too often staff did not treat patients with kindness and compassion, it found.

This was all predicted.

We’re all doomed to obscurity unless you win the lottery before you lose your marbles

Pay peanuts-you get monkeys, and three monkeys can’t do the work of ten monkeys……
We need more nuts and monkeys
Oook!….

Privatise it! That’s proved the solution to the problems of every public service. I mean…. just look at the railways

Or spend £2 billion on a re-organisation that definitely isn’t privatisation. Oh no. definitely not that! Perish the thought

my uncle has recently been paralysed (knocked his motorbike)from the waist down and has two broken wrists & collarbones and has spent the last few weeks in HDU. both wrists are in casts and he cant feed himself.

some times the nurses have not been available to feed him.

mental.

Nice of that piece to tell us that 20% is one in five, shows the level of people its aimed at.

My first thought on reading that was – I wonder how many nurses/carers could be provided if we didn’t have to pay for a separate body of penpushers to roam the Country dropping in unannounced?

I’m pretty sure they won’t be on nursing grades!

^^^^^ agree with Woody^^^^^^

Nice of that piece to tell us that 20% is one in five, shows the level of people its aimed at.

Strange thing to say. Care to elaborate?

I’m sure we don’t need to worry about this though. David Cameron has said how much he loves the NHS so I’m sure he’ll look after it.

Oh shoot the messenger then. Desperate.

Has someone been shooting Guardian journalists? And why were they so desperate?

Nurseing and care staff always use the lack of staff as an excuse, yet the management who are paid to manage, never say theres not enough managers, despite half of them having no idea what a patient is and what their needs are, as long as they have a desk and a vdu screen theyre happy.

So if care standards didnt make unanounced visits, then who would protect the rights of the frail patients, perhaps when youve been to visit a freind or relative in a hospital; and seen the very good care and the very poor and useless staff that also share the same space, that get paid the same or even more, then just perhaps you will see the need for care standards.

Just imagine if nobody officially went into your local takeaway or curry house,to check on food hygeine standards, think of all the people who would get food poisoning,

Lets also scrap the Health and safety inspectors, they just stop buissnesses making more profits, by having safety rules.

Too many nurses in hospital are doing roles at used to be performed by docs and not enough nurses/ auxillaries/ hcsw are around to feed the patients. Tbh you dont need a highly qualified nurse to feed the patients bu you need carers to feed them. Or a relative even.

I often do housecalls at homes where elderly frail patients have been fed by their carers. What you find is that the carers have left a plate of food in front of the patient which has gone Cold because they cant feed themselves. Bonkers! carer visits puts meal in front of vulnerable old person but doesnt stay to feed them! Then they get admitted to hospital with weight loss/ dehydration. Great isnt it!

Think you find its the NHS bosses working with new government ideas
to make the NHS fail and use private contractors that will cost the NHS
out of existence.

doctornickriviera – Member

I often do housecalls at homes where elderly frail patients have been fed by their carers. What you find is that the carers have left a plate of food in front of the patient which has gone Cold because they cant feed themselves. Bonkers! carer visits puts meal in front of vulnerable old person but doesnt stay to feed them! Then they get admitted to hospital with weight loss/ dehydration. Great isnt it!Careful! It’s against the rights of the patient/client to force them to eat. This is a situation often encountered by carers (and nurses).

i spend too much time in hospital.. ( last time it was eight weeks..) as in all walks of life and jobs there are good and bad great and in different. when you experience this in health care it is frightening.. really frightening.
those less able to fend for themselves the very ill, ageded etc are frankly left to them selves there is no feeding no drinks offered no effort at stimulus or offers of support
i have seen patients ridiculed by being forced to walk up and down wards in soiled pyjamas and deliberatly missed by those delivering food
hospital is a real survival lesson you must provide for yourself food drink entertainment and only your resilance and attitude will mean you get a positive outcome.. dont complain as you may need that nurse to make a fair attempt at CPR on you one night ( this is a genuine fear )
nurses are far too high up the tree to nurse thier role is to work 9- 4 monday to friday and do as much decsion avoiding as possible and just enough practical work so that the next shift have still got plenty to do..
understaffed .. your having a laugh.. on the day shift for 36 patients there were 25 nurses, on nights 1.. guess when most people die?

fundamentally nurses should be nursing anne nightingalle led the way but that caring helping role so vital for recovery has been lost in the rush to educate to degree level a job that can be done by anyone with compassion and an understanding of maintaining dignity in adversity.

Then they get admitted to hospital with weight loss/ dehydration. Great isnt it!

No it’s not great, especially when you then see ward staff doing exactly the same.

druidh – Member

doctornickriviera – Member

I often do housecalls at homes where elderly frail patients have been fed by their carers. What you find is that the carers have left a plate of food in front of the patient which has gone Cold because they cant feed themselves. Bonkers! carer visits puts meal in front of vulnerable old person but doesnt stay to feed them! Then they get admitted to hospital with weight loss/ dehydration. Great isnt it!

Careful! It’s against the rights of the patient/client to force them to eat. This is a situation often encountered by carers (and nurses).

Posted 2 minutes ago # Report-Post

Let us all hope its documented on the patients/clients, visit sheet, and on their notes at the surgery/office, just to ensure that the staff are actually asking the patient if they want a meal, and the quality of the meal is of a suitable standard for them to eat, eg minced or liquidised, vegitarian, and it actually looks edible ,etc.

totalshell – Member

i spend too much time in hospital.. ( last time it was eight weeks..) as in all walks of life and jobs there are good and bad great and in different. when you experience this in health care it is frightening..

Yup. But I’ve experienced it far more in private healthcare than in the NHS.

Rubbish no ones forcing patients to eat!! I aggree that you cant force someone to eat but people are not being assisted with feeding on the whole. Food is placed in front of person who cant feed self and food goes cold and patient isnt fed! This happens widely at home in social care packages then the patient gets admitted with illnesses related to malnutrition.

Families could do alot more in hospital and at home too to help with feeding.

Lots of patients give up and lose the will to live. It would be wrong to force feed these patients against their wishes.

The ratio of nursing staff to patients in this country is a disgrace. I was amazed by how much time aussie nurses had for their patients then realised there were 5 or 6 qualified nurses per ward rather than the 2-3 in the uk.

Going by the above descriptions, there must be some other NHS which I’ve yet to encounter. Having had both parents in hospital in the last two years, I have to say that the standard of care was superb and the staff could not have been more helpful and attentive.

As far as I can see, the main issue regarding non-hospital “care in the community” is that we are now expecting society to look after our aged and infirm, whereas this was once a family role.

Nickriviera +1

Poor bed managment is also a factor: wards may have ‘cpapcity’ in terms of clinical comploication/risk, and manual handling needs but not how well the patients can feed themselves. You can cope with the medical and care (moving/handling/toileting) needs of a suprisingly ill and incapacitated bunch of people with three staff nurses and 3 health care assistants, but that does not translate to feeding what with the particularly small window of time you get with hot meals.

Typical ‘acute’ medical ward in a district general hospital:

-Six nursing staff (3 of each).
-35 patients.
-Meal trolley takes 20 minutes to get from one end of the ward to the other.
-Hot main course takes 10 minutes to get cold and is cleared up 20-25 minutes after it is served regardless of what is or isn’t left on the plate.

How many people unable to feed themselves do we reckon the six nursing staff can feed in that time frame, if they run to the next patient/feed as soon as they have finished the last one and follow the dinner trolley up the ward?

In practice, with the phone, the doctors, other hospital workers coming in and out of the ward needing help/stuff doing, the immediate/acute clinical needs of the poorliest few patients, and the magical process by which old folk sat in hospital beds all day always need an urgent plop about six forkfuls into their dinner, means those six nurses/HCA’s can feed about eight patients if they are really on it and the planets are all in alignment. On a ward like I just described in my experience, any more than eight that need feeding and you barter with housekeepers to be able to clear up cold dinners a bit later than they are told to, you bend the visiting hours considerably to draft in relatives to help or old folk go hungry.

I no longer work in general but was well used to having to move patients to adjacent beds so I could sit between them and feed 2 at a time, (literally, a spoon in each hand!) and then go to the other end of the ward and do the same again, and we still often couldn’t manage to get everyone fed. I really hope things ave moved on in those eight years, but in my old and overall really rather good hospital (lord knows what it was like in the Mid Staffs’ of the NHS…) we were still well used to having ten or twelve ‘feeds’ per medical acute ward and the numbers for mealtimes simply didn’t add up.

Take all your staffing budget and spend it on GPs consultants and NHS managers instead of the people who really make a difference day to day.

Tony Blair really did it when he decided to give all his Doctor mates a massive pay rise for working less. Oh how the doctors must have laughed.

the study found that some hospitals/wards/nurses were crap some excellent
it wasnt a blanket dissing of the nhs just that in some cases its very poor
fwiw my experience of the nhs has been pretty good, including when my gran was in for her final weeks

i really hope that lansleys reforms will address the inequality in service, i fear it will just lower it further, opening up the nhs to the private market means awarding contracs to the lowest bidders.?

and more bad news today
http://www.guardian.co.uk/society/2011/oct/13/nhs-waiting-times-rise-cuts

further cuts will only make the situation worse, good old tory government………….

Too many nurses in hospital are doing roles at used to be performed by docs and not enough nurses/ auxillaries/ hcsw are around to feed the patients.

True, because doctors are silly expensive! You can’t knock managers for trying to be cost effective on one hand, then knock them for not having enough staff. One thing leads to the other…

EDIT; julianwilson, nominated for best post of the thread award.

Druidh, some hospital staff perform a lot better than others,due to better management, or just more complaints, that rattles the cage that holds the pension pot of the management.

North Staffs and a few other hospitals seriously failed its patients and allowed them to die in such tragic ways.

Those staff know who they are, and every day that passes they get older, and approach the time when they will depend on caring staff to look after them.

phuckin tories . why not just Privatise the nhs, and take medical insurance paye, that way we can deal with the non-tax-paying population problem at the same time by letting them all die. get rid of those most vulnerable in society and we can all be much better off
“…the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life; the sick, the needy and the handicapped. “
Hubert H. Humphrey

Going by the above descriptions, there must be some other NHS which I’ve yet to encounter

Me too. Most of the nurses/ward staff I see are doing a very good job under difficult circumstances.

Re DrNick’s observation on carers/feeding – it is something I encounter regularly too but it is rarely the fault of the carer IME as they have usually tried everything to get that patient to eat/drink before they have to stick to their tight schedule and move onto the next patient. It is often them, as opposed to the family who alert the GP/medic that there is a problem. I have nothing but admiration for them as they do a fantastic and often unpleasant job for, more often than not, the absolute minimum the employer can get away with paying them.

Nurses now think they’re not there to nurse; that’s what care assistants are for, but in many areas care assistants are uneducated, unskilled & uncivil, not a great combination.
In a lot of areas medical training is becoming more clinical, whilst for the last 15 years nurse training has all been about less clinical time, more theory and “better” qualifications.
Time for more basic nursing care IMHO.
PS I’m a registered nurse at one of the hospitals criticized today by the CQC, so it is quite close to home.

It’s my belief that the public generally love it when they find a public service to moan about…moan….moan…moan, the media grab hold and then ram it time and time again down your throats endlessly until it’s becomes grossly blown out of perspective. I know >fact< that the health service is full of hard working care giving nursing staff that are really up against the odds, under financed, understaffed, underpaid, poorly managed, to then get home to be tarnished with the media broad-brush with the public lapping it up. It’s a thankless task. It’s like blaming the twin towers on the firemen!!

I heard on the news this morning a report criticising staff for putting paperwork in front of the patient’s lunch. I do fear that if the NHS was run like an all expenses paid glorified 5* hotel with room service on tap, the patient’s clinical need and the regulatory requirements for record keeping would suffer and the clinical risk (overall) would be greater, it’s a matter of prioritising with the resources available.

I would also add the nursing profession doesn’t get the recognition and respect it deserves.

…and no I don’t work in the health service

I’m going to get flamed here… but… a Dr’s view

Two Issues

1) Rapid patient turnover on many wards and increasingly technical treatments combined with shorter stays makes old-fashioned personal nursing difficult. But this does not explain malnutrition on wards full of elderly patients

2) The “Professionalisation” of all qualified nurses (no ENs, all students doing degrees, the “nursing process”, project 2000 etc etc) has enhanced the clinical and bureaucratic skills of nurses whilst not empathising traditional caring and “vocation” enough. And this has left a huge gap where underpaid, untrained auxiliary staff are left to do personal care roles which would have been supervised or performed by trained nurses.

I think highly trained autonomous specialist nurses are brilliant and I ask them for help and advice a lot. But equally many of the nurses who are now 25-40 seem to have difficulty seeing past the protocol to the patient, in a way that those aged 50 and above don’t. Ironically the training which was meant to make them autonomous has constrained their view by being too reductive.

I believe that just as not every 18 year old or even 50% of them needs to go to university, Nursing might have done better avoiding the degree model for all, and then encouraging the higher fliers/more technically minded/future independent clinicians to move on through a degree path later.

From the CQC Report,

“All too often, we saw variation within hospitals – where one ward got it right, another in the same building was getting it badly wrong. We saw cases where there was clearly some fault in the hospital’s culture that allowed unacceptable care to become the norm, where it should have been an exception. The responsibility for these failings lies with management and leadership.
In the second place, staff attitudes to people (and, by implication, the training and management that nurture these attitudes) are critical. Time and time again, we found cases where patients were treated by staff in a way that stripped them of their dignity and respect. People were spoken over, and not spoken to; people were left without call bells, ignored for hours on end, or not given assistance to do the basics of life – to eat, drink, or go to the toilet.

🙁

So, some people are crap at their jobs, some ok and some really good – pretty much sums up anywhere I’ve ever worked – plus add idle, impossible and a variety of standard behaviours.

For Managers, see above.

For Senior Managers, see above, etc, etc.

5 people i know who trained as nurses, actually working on the wards, training in the training school , taught by experienced nurses, not uni educated.

1 is a head of social services,

2 are univercity lecturerS, teaching nursing, and both say its so wrong to not have proper work based experience,working on the wards, as a job, and getting paid for it.

1 is incharge odf a mental health ward dept,

and the other one is now working on imigrant health issues.

Where was the bit in the report about the overworked underpaid undervalued nursing staff being demotivated and unable to offer patients the kind of care and attention we’d all like to see in an ideal world?

The NHS isn’t broken, it’s just sick. The Tory scum seem to want to let it get sicker, then switch off the life support, rather than working out how to keep it alive. Andrew Lansley should be imprisoned and/or executed for the good of the UK. Self-serving ****.

I’m a care worker, and strongly opposed to the introduction, of 15 minute calls, which seem to have crept in recently.

You can’t assess the condition of someone with dementia, ensure that they are safe, clean, happy and haven’t forgot to take their meds in 15 minutes, let alone check sell by dates, tidy up & load the washer.
Then record everything and ensure that the person is safe and happy before leaving.
Food prepared, assistance given if required & washing up as well, don’t forget.
Just not possible in a quarter of an hour.

Luckily, our company refuses to accept 15 minute calls, but some do.

Five days a week I am in various hospitals. You do not see more clinicians. You do not see more nurses or cleaners or porters. But year on on year for the last five years what you do see more of is the “Blackberry classes”. Professional meeting attendees.Sharp suit and an NHS ID card round the neck, and guess who they require to attend all their meetings? The lead clinicians, the ward Sisters who are therefore never around to see what goes on on the wards.

The only experience in the last few years as a customer was sitting in casualty for five hours with a child with a broken wrist. This is supposed to be a first word country. Bit off topic I know. But there was no major incidents. It was not a Friday night drunk tank. Just the fact that there was one AE Paediatric Doctor on duty. Rant over.

Elfin – I’d love to kick the tories – but this has been going on way longer than that. A lot of the stuff which wasn’t being done isn’t really in the remit of nurses any more. And that may be part of the problem.

In my above posts i am not blaming any carer or nurse fot not feeding – i am merely pointing out that people arent being fed. I can imagine it would take a good half hour to assist an elderly patient to eat a meal . In a 40 bedded geries ward that would take upt 20 staff hours per mealtime wihout other interruptions. My point is that community and hospital staff arent given this time.

As for funding gp practice funding has been decreasing since 2006 and i imagine this is being replicated accross he caring sector.

It’s often the families you never see on the wards that kick off big time when grandma isnt being fed. If your local and there are a few of you go in and help out!