We need a culture shift in patient care in England, the campaigning charity Patients Association urges in its latest report “We’ve been listening, have you been learning?” released on 8 November. The report details sixteen accounts of poor hospital care related by patients and their relatives on the charity’s Helpline. One of the harrowing accounts, that of a 96-year-old woman, is summarized below. Quite a few of the reports involve elderly and frail patients.

The report focuses on four key fundamental areas of care: communication, access to pain relief, assistance with toileting and help with eating and drinking.

Angela Rippon OBE, is Vice President of the Patients Association and launched the report with these words:

“This report raises serious issues about the quality of care that patients are receiving on our hospital wards. It’s not enough for hospitals to say that they have recognised care hasn’t been good enough in the past and promise improvements for the future.”

Chief Executive Katherine Murphy says in the Foreword to the report:

“This is our third compendium of patient stories highlighting experiences of poor nursing and medical care – vulnerable elderly patients left without a drink, no one to assist them with their food, call bells put out of reach and patients left in agonising pain.”

She told the press that accounts of care “shame everyone involved”, and like Rippon, that it’s not enough simply to recognise the report and then “carry on as usual”:

“There needs to be a culture shift in the way we treat patients on our wards,” urged Murphy.

One of the many stories detailed in the report is that of Mrs Grimwood, who was admitted to Southend Hospital after a fall in her care home. Her daughter, Hilary Paviour, writes about what she witnessed while visiting her mother in hospital, at this time and also at another time two years earlier. She complained to the hospital that her mother’s toileting needs were neglected by nurses:

“Often when I visited her I helped her to struggle to the toilet as she had not been helped regularly enough by the staff. She is a dignified, self-aware, old lady, proudly independent in her personal habits, and so rather than soil the bed she made herself get out of bed to visit the toilet across the room, despite being in a much weakened state. To do this, she needed to pull out her drip.”

On other occasions, Hilary helped her mother go to the toilet herself, as care assistants had not attended to her for a long time:

“My mother would ask me to take her to the toilet when care assistants had been dilatory. Each time (4 times) this was an urgent request, and not because she had an infection, or had been drinking a lot – she had not been toileted for a long time. Despite the pain from her fractured pelvis she controlled her bowels in order to stoically and painfully walk to the bathroom to use the toilet with me.”

“Incidentally, the toilet seat was smeared with faeces yet her need was so urgent she sat on it anyway. She couldn’t wait for me to clean it. Her frailty meant she used her hands to steady herself on the seat as she sat down.”

After her discharge from hospital, Mrs Greenwood’s sacrum was very red and sore. Her daughter describes how for the 8 days of her stay in hospital, her frail mother sat “without cushioning protection on a hospital chair for most of each day”:

“The fragility of an elderly person’s skin and the risk to it breaking down, should have merited preventative measures; for example, providing her with an anti pressure-sore cushion. There was an air mattress on her bed, which she occupied for around 10 hours overnight; she occupied her chair for around 12 hours each day with no protection for her bottom or lower back.”

At other times, Hilary describes how her mother was left “desperately thirsty”, and explains how she was either too weak to pour water from a jug, or had difficulty pulling lids off beakers, and rather than be a nuisance just suffered in silence. Part of her complaint against the hospital was they did not find the time to listen carefully to her mother’s concerns, and if they had, they would have realized some simple facts that could have vastly improved their care to her.

Other cases described in the report include:

  • Jessie Thayer, 91, was a patient at Frimley Park Hospital. Her daughters write of their despair at the failure of nurses to attend to her basic hygiene needs. This was their mother’s second stay in the same hospital, and they had complained before, but nothing appeared to have changed. However, the report describes how after this second complaint, the hospital responded, and gives this case as an example of the “value of a successfully handled complaint”. The sisters said their faith in the hospital is now restored.

  • Brian Smith, was a patient at Pilgrim Hospital Boston. His wife, Margaret, says she had to run out into the corridor screaming for help as Brian lay dying in his bed, because nobody answered the call buzzer. The report describes how she faced a constant “battle” to ensure that her husband’s medication was given at the right time, that he had access to his buzzer, and that he received basic comforts such as an extra pillow. The report contains two very moving poems by Margaret Smith, in memory of her husband.

  • Barry Woodward, a 68-year-old insulin-dependent diabetic, was a patient at Derby Royal Hospital. He had to wait seven hours for an ambulance, and then received no pain relief when he got to the hospital. In the report he complains how the nurses were not attentive to his needs, particularly in respect of giving him pain relief. He describes what happened when he was woken up to be told he had to have an injection for internal bleeding: “I did not have internal bleeding, and had not had any for the duration of my stay in hospital. I flatly refused to allow her to administer the injection. This episode left me greatly concerned.”

As well as these and other accounts, the report says the current Care Quality Commission system is inadequate, and there is a need for a “more detailed and comprehensive inspection regime”.

The report also identifies many problems with the current way that complaints are handled by the NHS, and this is highlighted by the accounts they receive from patients and their relatives on the Helpline.

“In each of our last two reports we have identified the complaints system as being an area where improvements need to be made, and prior to the reports publication the Ombudsman’s own report identified concerns with the complaints system.”

“Callers to the Patients Association Helpline continue to express no faith at all in the way complaints are handled within the NHS. Many callers complain that they have to jump through several administrative hurdles, such as lost complaint letters, incorrect permission forms or simply chasing an acknowledgement, before they even get to the stage of having their complaint considered by the hospital.”

Also, once the complaint receives some form of attention, the “quality and depth of the response varies widely between trusts”, says the report.

At one extreme, some healthcare trusts carry out a thorough, detailed investigation, address each of the complainant’s questions, and ensure that they are not left feeling that their complaint has been treated in a cursory manner. And, crucially, they offer an apology for any unacceptable standards.

At the other extreme, says the report, there are trusts that fail to respond, refuse to acknowledge fault and conduct short and superficial investigations.

There is also a suggestion that this could be the tip of the iceberg, because many of the people who contact the Helpline say they have had such bad experiences with trying to complain about incidents of poor care that they don’t feel it is worth it.

As a result, the charity is repeating its previous call for:

“… a national survey of all complainants, to allow for a better understanding of which trusts are providing a good complaints system and which ones aren’t.”

The charity is also, with the Nursing Standard, going to launch the CARE Campaign, with the aim of improving fundamental patient care.

The campaign will be launched by Patients Association Vice President Angela Rippon OBE, and “will also shine a spotlight on the complex causes of poor care and provide a platform for debate among patients, nurses, doctors, managers and politicians”.

Written by Catharine Paddock PhD