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20 May 2008 : Column 27WH—continued
Mixed sex wards also continue to be an issue—my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the shadow Secretary of State for Health, has been talking about this today—affecting older patients’ sense of dignity. Despite the Government’s repeated promises to abolish mixed sex wards, there has been a
disappointing lack of progress, with targets being missed and many elderly patients being inappropriately placed in mixed sex wards. The Healthcare Commission’s 2007 annual inpatient report showed that one in four patients had to share a sleeping area with the opposite sex when first admitted to a hospital ward. In his reply, I hope that the Minister will talk about that and say, in particular, what defines a mixed sex ward. For example, we know that elderly people are concerned about walking past other wards containing people of the opposite gender on their way to use the lavatory. This needs to be looked at through the eyes of the patient. I am aware that Lord Darzi has started to retract the pledge given on mixed sex wards, but this remains a matter of great concern to elderly people.
Older patients are more likely to have health issues additional to those for which they are being treated in hospital, of which dementia is a leading example. The lack of training and knowledge in our hospitals for dealing with patients suffering from dementia is of very great concern.
David Taylor (North-West Leicestershire) (Lab/Co-op): I thank the hon. Gentleman for securing this debate and for allowing my intervention. The all-party group on dementia, of which I am a member, produced a report on the use of antipsychotic drugs in the care of dementia entitled “Always a Last Resort”, and last Wednesday, I introduced a ten-minute Bill on the same subject. One in three of over-65s—that includes us in this Chamber—will face dementia towards the end of their lives. Does he agree that his description of the inadequacies in training should include the inadequate training for dealing with dementia? Half of patients in private care homes being prescribed antipsychotic drugs had their prescription started in hospital. Too frequently, antipsychotic drugs are used because staff do not have the time or training to deal with some of the distressing symptoms associated with dementia. That is a really crucial issue that I hope will be addressed in the national dementia strategy, which will be published later this year. Does he agree with that?
Mr. Benyon: I certainly do; and I hope that the Minister will touch on the national dementia strategy and training.
I shall come on to the transfer of responsibility for the patient from the hospital to social services. The control of drug use by a patient with dementia is very important. That is particularly relevant to me, because someone in my community found themselves in that situation recently. The hon. Gentleman was absolutely right when he said that the work of the all-party group was vital. He will be much missed in the House when he hangs up his boots because he has great experience in issues such as this. It is vital that the Government listen to such views.
I was told about a patient who was suffering from dementia. She was left unfed for long periods of time, and often had full plates of food taken away because no one would help to feed her. Even if she had been able to feed herself, it would not have helped because the food was often left out of reach. The patient’s daughter was forced to go into hospital at meal times. That is not a one-off case. Patients’ families often have to make the time to go into hospital to feed a relative because no one
else is doing it. When the daughter asked a member of staff why they would not feed her mother she was told that the “demented”—she actually used that word—had a choice to eat or not and that it was not the job of the staff to feed them. That was in a hospital in Kent. Again, with my caveat that such examples are the exception rather than the rule and that much wonderful work is being done, the fact that that happens once in this country is something that many of us find deeply shocking.
Dementia sufferers need a completely different level of care from other patients. The fact that our hospitals often cannot provide such care is a matter of deep concern. The right hon. Member for Islwyn (Mr. Touhig) made a very good contribution in the debate on the Public Accounts Committee report last week. He said that
“between half and two thirds of people with dementia never receive a formal diagnosis at all, let alone an early diagnosis. Absurdly, many dementia sufferers are not diagnosed unless they go into hospital with another illness or an injury.”—[Official Report, 15 May 2008; Vol. 475, c. 1599.]
The PAC report said that the main obstacle that prevented correct and early diagnosis is GPs’ poor knowledge and lack of training. It said that compulsory training on dementia or older people’s health is not a statutory part of GPs’ training and there is no requirement in their continuing professional development to study older people’s mental health.
David Taylor: Would the hon. Gentleman further agree with me that in cases in which there has been best practice in the treatment of dementia in its early to middle stages—both in private care homes and in the NHS—non-pharmacological approaches are often much more successful because they do not damage the quality of life, shorten life or increase the risk of stroke and all the attendant problems that are associated with the use of antipsychotics?
Mr. Benyon: The hon. Gentleman makes a very good point. As a layman, I would like to understand why drugs are being prescribed in a different way in different parts of the country. For example, I would like to know why, in some places, treatments other than antipsychotic drugs are being prescribed. The fear is that a dementia patient can be put in a state so that they will not be any trouble in a busy ward. In 2008, in the fifth richest country in the world, that is a matter of massive concern.
The situation on training is no better for nurses. The Royal College of Nursing told the National Audit Office that student nurses have between two to five hours’ teaching on older people’s mental health. I know that anyone who wants to go far in politics should not criticise nurses. However, I am not criticising the nurses, but the system that allows only two to five hours’ training on older people’s mental health. The NHS should insist on dementia training for health care professionals; it should be a clear requirement in the NHS that all trainee doctors and nurses learn about dementia.
I have gone on for longer than I intended, but I want to cover two very quick points. The issue of nutrition in hospitals is very important. Some 97 per cent. of trusts claim compliance with standards regarding help with eating in hospital, yet, according to Age Concern, only 58 per cent. of patients say that they always get the help
that they need. A recent editorial published in the British Medical Journal found that about 20 per cent. of patients in general hospitals are malnourished, thin or losing weight. Up to 80 per cent. of those patients enter and leave hospital without any action being taken to treat their malnutrition because screening tools are underused and poorly enforced.
The National Institute for Health and Clinical Excellence recommends that all patients are screened for nutritional risk on admission to hospital. However, NICE estimates that fewer than one in three patients is screened on admission to hospital. One case that was brought to my attention was that of a stroke patient who was left for some 15 hours on a trolley without being given any fluids, despite severe vomiting the previous night. He was in such a state of dehydration that he was unable to talk due to the lack of saliva to lubricate his tongue. His family had to ask staff two or three times to provide intravenous fluids before anything was done to ease his discomfort.
I know that my hon. Friends have repeatedly urged the Government to do more to tackle nutrition. The amendments that they tabled to the Health and Social Care Bill would have created a statutory requirement for the proposed health regulator, the Care Quality Commission, to issue nutrition guidelines and to enforce them through new inspection powers and penalties. It was a great pity that those amendments were rejected.
I mentioned to the hon. Gentleman the handover from hospitals to social care. I believe that that process needs improving so that patients who need long-term care are given the best standard of service possible. It was very interesting to see the impact that a case, such as the one that I am about to mention, had on the community in which I live. An elderly person, whom I have known nearly all my life, was released from hospital and sent home without a proper statement of her needs being carried out. She was left in an entirely inappropriate way. She has no family and so had to rely on her neighbours, who have been quite exceptional in their care of her. They eventually got her readmitted to hospital, and she is still there today. The effect on the individuals around her was profound and it has stretched throughout the whole community. I cannot overstate the collateral damage that such a case does to the reputation of the NHS. Most people in my community, who have had a good experience of the NHS, were shocked when they heard of such an awful case. The damage done to the NHS, both locally and nationally, was profound. The Government must recognise that.
Help the Aged has reported a vast number of cases of inhumane discharge due to a desire to get rid of bed-blocking patients. The problems that occur in the transition between hospitals and social services seem to stem from a lack of consultation, lack of vital information, lack of clarity about options and a lack of choice for older patients. In the case that I just quoted, there was a complete misunderstanding of what drugs were prescribed and how that individual was supposed to understand when she was to take them.
There needs to be a change in the ethos of the NHS management so that nursing staff can provide the standard of care that they wish to give and that their patients deserve. Our nurses, health care assistants and carers do an extremely difficult job in incredibly tough circumstances. The job is made harder by bad management and a lack
of specific training in how to care for the elderly. Understaffing and a lack of strong management on a hospital ward inevitably lead to low morale among already overworked staff. That contributes to the low standards of care that some elderly patients are reporting.
In conclusion, poor management and a diminished culture of care are allowing the NHS to fail in its duty of care for too many elderly patients. There needs to be a change in the culture of the NHS so that those who are most vulnerable—whether that be temporary or permanent—are given the standard of care that they deserve. I am aware, as we all are, that a number of Government initiatives have recently been announced that will go some way to addressing care for the elderly within the NHS. I look forward to hearing the Minister refer to them. I welcome the initiatives but I would like to emphasise the need to take active steps in applying wide-scale reform to the culture and ethos of the management of the NHS so that treatment of the elderly is changed for the good. The Government need to recognise that there is a problem for that key group, and that they have an obligation to ensure that the elderly are treated with dignity and respect while in the care of the NHS.
11.30 am
Greg Mulholland (Leeds, North-West) (LD): I congratulate the hon. Member for Newbury (Mr. Benyon) on securing this important debate on a topic that is close to a lot of our hearts and which we all take seriously.
As we all know, the elderly are often the most vulnerable in our society and among those most in need of care. They are also the most likely to have the most complicated care and treatment needs. I think that we would all agree that how those needs are met in our health service must be a key indicator of how the NHS is fulfilling its role in society.
Like the hon. Gentleman, I acknowledge that there are many wonderful examples of care for the elderly in our health service. Unfortunately, as he said, there are still far too many examples not only of their needs not being met, but of people being subjected to treatment that is completely unacceptable and in some cases, such as those that he highlighted, absolutely scandalous and possibly criminal. Again, we would probably all agree that the societal attitude in this country still seems not to put as much value on older people as on younger people in all sectors of society. The Government cannot necessarily address that, but we all need to take it seriously and try to change it.
Turning to current developments in health, I say to the Minister that although the health agenda is changing fast, with a lot of initiatives and a lot of positive things happening, the debate brings into focus the fact that such things must not be pursued at the expense of the basics of care, which have been mentioned this morning. All health organisations must focus on simple things such as hygiene, nutrition and, particularly in the case of older people, dignity. Those values need to come to the fore a little more when NHS trusts release their mission statements, for example.
It is extremely worrying that 18 of the 23 hospital trusts studied in the report that the hon. Gentleman mentioned, “Caring for dignity”, were deemed to be failing to care properly for the elderly. That is a damning indictment of health care provision in NHS trusts. Doctors, GP consultants and staff grade physicians responding to a British Medical Association survey, the results of which were released earlier this month, believe that health care services for elderly people are simply not good enough. For example, 68 per cent. of doctors believe that staffing levels are inadequate, and three in five believe that the necessary continuity in health and social services does not exist.
Not surprisingly, older people account for the highest use of acute hospital services. The NHS spends 45 per cent. of its expenditure on them, but that is not necessarily reflected in the priorities given by health trusts. I say to the Minister that that can be addressed at the grass-roots, organisational level of the NHS. That needs to be the focus. There have been positive developments such as the national dementia strategy, but I hope that the Minister will acknowledge that there still appears to be a disconnect between the positive policy initiatives that we all support and what is happening on the ground.
Older people’s organisations, older people themselves and their relatives, families and carers highlight dignity in particular. As we know, older people are particularly vulnerable because they are often in positions of reduced control over their health and well-being. Help the Aged states:
“Stories of older people left in pain, ignored, or distressed by a lack of privacy in health and social care settings emerge at such a frequency that they cannot be dismissed as isolated cases.”
It also states that that is in spite of policy guidance. Again, things are not happening on the ground. The Healthcare Commission reports that the three most common causes of complaint in relation to dignity are patients being addressed in an inappropriate manner, being spoken about as though they were not there and not being given proper information.
The hon. Member for Newbury highlighted the problem of mixed sex wards and mentioned the figure in “Caring for dignity” showing that almost a quarter of elderly patients have had to share a room or bay with someone of the opposite sex at some time during their treatment. That is simply not acceptable. I echo his comments and ask the Minister when that figure will come down and when people will be put in mixed sex wards only in situations of emergency or absolute necessity. That is one of the major concerns for older people and their families.
The hon. Member for Newbury mentioned some particularly terrible cases of people not being taken to the toilet when they asked. In some of the worst cases, people have been allowed, or even told, to go to the toilet in their bed. He was right to highlight the knock-on effect of that on hygiene and health care associated infections. I chaired a Westminster health forum conference on that subject this morning.
We are not making the connection as we should, as is clear from the Healthcare Commission report on the appalling incident at Maidstone and Tunbridge Wells, which says that the families of patients
“told us that when patients rang the call bell because they were in pain or needed to go to the toilet, their call often wasn’t answered, or not in time. Particularly distressing, nurses had told patients 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.”
I accept that that was a particularly awful and, I hope, isolated situation, but if we do not address the key issues of people’s dignity, we will open a can of worms in relation to health care acquired infections.
I wish to highlight a couple more areas of concern. The hon. Member for North-West Leicestershire (David Taylor) rightly mentioned dementia. The wider issue of older people’s mental health is of particular concern. Age discrimination is explicit in the health service in the case of people with mental health conditions. Someone over 65 is subject to a different service regime from someone under 65.
The difference between the services can be seen most starkly among those who experience a transition from adult mental health services to older adult mental health services when they turn 65. Many of them find that vital services on which they rely are no longer available to them. That is simply wrong, and I ask the Minister to look into it. I have said that the national dementia strategy is a good thing and that the focus on that distressing condition is welcome, yet age discrimination is inherent in the system. That is not acceptable.
The hon. Member for Newbury mentioned the need for training and I reiterate that there must be far more training for staff in the area of mental health. I also agree with him that the provision in this area within nursing training is not acceptable.
The final point that I want to make is about the worst problem in this whole area, which is elder abuse. In this country, elder abuse still goes on far more often than it should. It is often undetected and it still does not seem to be taken as seriously as it needs to be by the authorities. Help the Aged has estimated that at any one time about 500,000 older people are being abused in the United Kingdom. The Community and District Nursing Association told the Health Committee that 88 per cent. of district nurses report having seen cases of elder abuse. We know that the majority of elder abuse happens within the family, which makes it a difficult and distressing problem to deal with. Nevertheless, a considerable proportion of elder abuse is down to care workers and that must be clamped down on.
I ask the Minister this question: when will we start looking at providing more training in prevention and recognition of elder abuse? Surely, such training should be a mandatory element of all staff training for all front-line staff in the health and social care sector. Furthermore, to widen the debate, when will we see adult protection becoming a compulsory part of police training and would it not be a good thing for such training to be placed on a statutory footing?
I ask those questions because I am very focused on the human rights agenda and I know that the Government are also committed to that agenda. However, it still appears that the human rights of older people are simply not recognised in the same way as those of younger people. That is a situation we simply cannot accept.
In conclusion, I echo the point made by the hon. Member for Newbury, who said that in many years’ time we will have considerably more older people in our society, so this issue will come into even greater focus.
In 20 years, a quarter of the UK’s population will be over 65 and the number of people over 85—that is the particular age group where a lot of these problems occur—will have doubled. So, this is something that we must tackle and an issue that we must address now, as a society; it is not just about Government.
As I said at the start of my speech, there are some positive policy initiatives, but we now must ensure that they are carried through on the ground and that we have a change of culture in the NHS, so that the dignity and care of older people are paramount. I hope that the Minister shares those sentiments, and I look forward to him addressing some of the points that have been raised by the hon. Member for Newbury and by me.
Mr. Peter Atkinson (in the Chair): I appreciate that the right hon. Member for Oxford, East (Mr. Smith) has changed his mind about speaking. I also appreciate that it is somewhat unusual for a Back-Bench contribution to come after the winding-up speeches have started—the hon. Member for Leeds, North-West (Greg Mulholland) will not have the opportunity to comment on the right hon. Gentleman’s speech—but I gather that there is no objection to that and, as we have plenty of time, I call Mr. Andrew Smith.
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