The dirty truth on the wards
An Observer investigation has revealed how elderly patients are often left in squalor by overworked staff, reports Jo Revill.
Comment: Elderly people's basic human rights are frequently violated, writes Jackie Morris
Sunday October 14, 2007
The Observer
The debate over the poor treatment of elderly patients in Britain's hospitals will be reignited this weekend after an Observer investigation revealed that vulnerable people are being forced to use embarrassing portable toilets or wear incontinence pads rather than being taken to the bathroom.
The investigation found that nurses and healthcare assistants no longer routinely accompany elderly patients to the toilet, particularly when wards are busy. The revelation comes days after Maidstone and Tunbridge Wells NHS Trust, where 90 people died of the C. difficile infection, was criticised for allowing patients to go to the toilet in their beds.
A minister today promised that the government would not 'go soft' on nursing staff who fail to treat patients with dignity and respect. In a sign of how worried ministers have become about the quality of care, the minister for the elderly, Ivan Lewis, warned that staff would face negligence charges if found guilty of giving seriously substandard care.
There is growing concern within the NHS over the number of complaints about older patients being stripped of their dignity on the wards. The scandal of the hospitals in Maidstone and Tunbridge Wells, where patients were left in soiled sheets, revealed how the level of dirt and neglect contributed to two outbreaks of the C. difficile superbug.
Doctors are now saying that nurses must ensure that patients are taken to the toilet if they are able to walk there with support, instead of being left to use commodes, bedpans or even, in extreme cases, soil their own sheets.
The British Geriatrics Society, representing doctors specialising in care of the elderly, has launched a campaign, Behind Closed Doors, to highlight the bad practice it wants banned on the wards. Their warnings, seen by The Observer, suggest that for many patients the prospect of having to relieve themselves using a commode on a mixed sex ward with only a thin curtain around the bed is one of the main reasons why they fear going into hospital.
Dr Jackie Morris, chair of the society's policy group, lists practices which she says most people would find it hard to believe hospital chief executives still allow. Patients who need the toilet are being told to wait maybe for an hour or more. Patients can often hear a person who is forced to use a commode.
'It's a fundamental part of dignity, that you should be able to relieve yourself in privacy,' said Morris. 'But you often see this vicious cycle happening, where patients who may be recovering from an operation are not taken to the loo, but instead given a commode or even told to go in their pants.
'That can lead to pressure sores, which are very painful, but it can also do something else - patients begin refusing to eat or drink because they become very scared of needing the toilet, and then they can start to go downhill pretty quickly.'
The British Geriatrics Society lists other petty humiliations. Sometimes older patients are scolded by staff if they soil their beds. On a busy ward, patients can be left on a bedpan for a considerable amount of time. A patient may be using a commode behind the closed curtains when staff walk in, without checking first.
Worst of all the practices, say the society, is that many patients are just asked to go in their own underwear when the staff are busy. 'I've seen it myself so I know it happens,' said Morris. 'Believe me, it's really distressing for everyone. If you have a ward that is run by a very competent, good senior nurse, these things don't happen - but I would say that they do also need the support of management in the hospital. The neglect happens on wards which are badly run, where no one seems to really be in charge.'
Lewis, the minister with responsibility for dignity of care, said he is angered by the abuses. In some of the toughest language used so far by Gordon Brown's new government, he told The Observer: 'The government's commitment to support and value NHS staff should not be mistaken for going soft on practices which shame the nursing profession and brings the NHS into disrepute.
'All NHS staff, including those in management positions, must be in no doubt that a failure to respect an older person's dignity is professional negligence, and must be subject to disciplinary action.'
A report into the deaths at Maidstone hospital said: 'A particularly distressing practice reported to us was of nurses telling patients on some occasions to "go in the bed" presumably because this was less time-consuming than helping a patient to the bathroom. Some patients were left, sometimes for hours, in wet or soiled sheets, putting them at increased risk of pressure sores.'
The indignity suffered by some patients can be shocking. Jackie Brindle watched her father-in-law's health decline rapidly when he was admitted to hospital in Lancaster. The family believe this was directly due to what they say was a humiliating level of neglect.
The Rev John Brindle, 86, a former Church of England vicar, was taken to hospital after suffering a knock to the head. 'He was admitted for tests, but he was still healthy, and in fact, he had never been into hospital in his life,' his daughter-in-law said. 'He was put onto a ward where the care was appalling, and the nurse who dealt with him was actually quite intimidating.
'I came in one day to find him sitting in his room, completely naked apart from the incontinence pads on him. His feet were blue with cold.
'I quickly got him dressed and asked what had happened. One of the nurses told me that it was against health and safety rules to dress him, because he was resisting them. I was so shocked I could barely speak.
'I also asked why he wasn't being taken to the toilet, instead of being left in pads. The nurse looked at me, and said, "Oh no, he's incontinent", as if I was stupid not to realise. But I know he was not so before he went onto that ward.'
The family then made efforts to have him moved to a private hospital, but he died before they could organise it. 'He seemed to have given up completely. This man, who was proud and private, was treated like a child, like a no-hoper.'
The Brindles put in a full complaint to the University Hospitals of Morecambe Bay NHS Trust, where he was treated, in June. Peter Dyer, medical director of the trust, said that they were taking the concerns raised extremely seriously and would respond within a week. 'We are nearing completion of a very thorough and lengthy investigation into the allegations which included interviewing a large number of staff.'
Healthcare regulators are privately worried that some hospitals are blaming the government's waiting list targets for the pressures on the ward when, if they are properly run, all hospitals should be able to offer decent and dignified bedside care. A recent survey carried out by the Healthcare Commission showed hundreds of patients have complained that they were told to 'go in the bed' and not given full privacy when using a bedpan.