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20 May 2008 : Column 34WH—continued
11.43 am
Mr. Andrew Smith (Oxford, East) (Lab): Thank you, Mr. Atkinson. I was taking account of the time available. I thought that I would take the opportunity to make a few points, and I am sorry that the hon. Member for Leeds, North-West (Greg Mulholland) has already given his winding-up speech.
I congratulate the hon. Member for Newbury (Mr. Benyon) on raising this vital subject. It is crucial that elderly people receive the best treatment, whether in hospital or elsewhere in society, and none of us can be anything but very unhappy when that treatment is not provided.
I want to set my remarks in a wider context. Across the NHS, I believe that a fantastic job is being done by staff, including nurses and doctors. Indeed, I receive many more positive messages and letters, including from elderly people, about the treatment that they are receiving in the NHS than I do complaints. However, that in no way diminishes the importance of the points that the hon. Gentleman and other hon. Members have made in the debate.
Although incidents of poor treatment of the elderly are in the minority, when there are instances of people’s dignity not being respected they are enormously concerning to us all. For example, I received a complaint from the daughter of one patient, who, on visiting her mother, saw that she had not been eating properly, her bed gown was dirty and she did not seem to be receiving proper care.
I feel sure that there would be common ground for the view that, although professional development, training, inspection and all those types of work are, of course, really important, what is also important is the daily entrenchment of a culture of sensitive caring on the part of everybody who is managing the treatment and care of elderly people. It is shocking when such good treatment is not provided and when there are these cases of neglect, including people being left in their own
faeces or not being fed. We think, “Well, somebody is seeing them and somebody is responsible for that ward, so why is the treatment not being provided?” The Department of Health—together with trusts, matrons and managers, and working with the nursing professionals, who will be fully signed up to the highest aspirations for standards of care—must make a concerted effort to root out totally unacceptable practices.
I take the points that were made about the importance of the national dementia strategy. There is a particularly poignant dimension to the position of people suffering from dementia. Often, they are not in a position to signal their needs and feelings, other than sometimes through what is seen as aggressive and inappropriate behaviour.
Furthermore, the idea that such aggressive or inappropriate behaviour should be controlled inappropriately by anti-psychotic drugs is utterly abhorrent. The Alzheimer’s Society has estimated that more than 100,000 elderly people with dementia are being prescribed anti-psychotic drugs and that, in two thirds of cases, those drugs are unnecessary.
There clearly must be a thoroughgoing revision of the prescription policy on the use of those drugs. As was mentioned earlier, alternative therapies and ways of managing people’s conditions should be used instead. No one pretends that the situation is easy, but this is a critical challenge that we all must face up to, in partnership with those in the NHS.
On nutrition, I do not think that it is just a question of monitoring, measuring and inspecting, although all that work has a role to play. I believe that there is also a common-sense issue of putting wholesome food, which people want to eat, in front of patients. I know that there have been pilot schemes in the west country—I dare say that the Minister will refer to them—using locally sourced produce, rather than the prepared meals that travel a long distance, are reheated and sometimes stuck on a tray that is out of reach of patients. Getting food that is nutritious and good to eat must be a common-sense part of the solution to those problems. Furthermore, the amount of food that is thrown away in the NHS is, in itself, an indictment of the inadequacy of the food supply system.
Mr. Benyon: I hope that the right hon. Gentleman may move on and take the opportunity to bend the Minister’s ear on the question of specialist orthopaedic hospitals. I mentioned hospital-borne infections. It is worth noting that the level of infections is far lower in those specialist hospitals, yet they are suffering the difficulty of financing themselves, due to the question of the tariff.
I hope that the right hon. Gentleman, who is a very able chairman of the all-party group on specialist orthopaedic services and hospitals, will raise that point with the Minister.
Mr. Smith: The hon. Gentleman has done it for me. I can also assure him that barely a week goes by without my bending the Minister’s ear on the position of orthopaedic hospitals in general and Nuffield Orthopaedic Centre in particular.
The hon. Gentleman is quite right: there are very low infection and cross-infection rates in the orthopaedic sector. Indeed, I hear enormous praise for the treatment that people receive at the Nuffield. That reinforces the powerful case for resolving the tariff problems that affect that sector, and in a meeting with the Minister a couple of weeks ago, I urged him to do that. This debate gives him the opportunity to discuss that important issue as well.
The point that I was making about food is that the predominant existing sourcing of food for the NHS clearly is not working that well in many instances, as judged by the colossal amounts that are thrown away. That is a dreadful waste. I presume that the amount ordered is thought to be the amount that patients might need to eat, but the fact that so much is thrown away is in itself an indicator of nutrition not being what it should be.
I look forward to the Minister telling us about the experience gained from efforts that have been made to give people wholesome and attractive food. The fact is not only that the general hospital experience benefits, but that there are direct health benefits, which aid recovery. Again, that is common sense and not at all surprising.
The hon. Member for Newbury mentioned the important matters of care after leaving hospital and social care. I certainly urge a continuing drive to maintain and enhance standards of care in social care homes. There are many examples of good practice as well as bad. I visited a St. John Care Trust home in my constituency a couple of weeks ago, and I was very impressed with the ambience of the place, the caring attitude of the staff, the positive feedback that I had from residents and the extra efforts being made. The aromatherapist who comes in happens to be blind, and she brings her dog so that the elderly people have something to pet. There was a warm and caring atmosphere.
The social care sector is often spoken about as a sort of Cinderella, but it is important to signal that very good work is done in it. There are issues around the training of social care staff, but I believe that many of them, through their caring attitude and day-to-day supportive work, bring an enormous amount that perhaps compensates for the lack of formal professional qualifications. It is important to enhance people’s wish to care for elderly people and to attract and retain such people in the service, including the many migrants who have come to this country and done a good job. That should be praised, but it is clear that we need to learn from best practice and apply it more generally.
I close with a bit of lateral thinking, which was drawn to my attention just last week. The Ridgeway Partnership, which is the learning disability trust in Oxfordshire, is an excellent provider. The hon. Member for Newbury said that the treatment and care of learning disabled people are relevant to this debate. The partnership does a wonderful job with homes in the community and support for learning disabled people. It is one of the best performing trusts in the country. At a reception, it voiced to me the potential that there might be for applying the expertise that it has developed in domiciliary care precisely to the needs of elderly people, including the vulnerable elderly. In other words, it would support the third option. Many people would like to be not in hospital or a social care home, but in their own home.
I look forward to the Minister’s response as to whether we might look at that example of best practice and run pilots whereby we could explore whether the service of such a trust, which has a track record of excellent service to the learning disabled, might be diversified to elderly people who may have higher-level needs and would like to stay in their own home.
This is a vital area. It is important that our criticisms are couched in an overall context of recognition of the terrific amount of valuable and successful work that is done through the NHS. However, there is no doubt that there is a formidable challenge in ensuring that the dignity of elderly people is properly respected, that they get the standards of care that we would all want for our own loved ones, and that unacceptable practice is driven out and, equally importantly, good practice is learned from and applied more generally.
11.55 am
Anne Milton (Guildford) (Con): I begin by congratulating my hon. Friend the Member for Newbury (Mr. Benyon) on introducing this debate and highlighting the very real problems of caring for the elderly in the national health service. In my speech, I shall pick up on some of the points made by the right hon. Member for Oxford, East (Mr. Smith). It is important to have balance in a debate such as this one. We realise that some very good practice is being followed, and it is important to pay tribute not only to the nurses and doctors but to all the care staff involved in looking after elderly people who are doing an excellent job; on the other side, however, there is no doubt that there are problems and areas of concern.
I gather that my hon. Friend was inspired to introduce this debate because of the experiences of Jenny Pitman, who felt that standards in the NHS had fallen well short of that which she expected. He highlighted cleanliness and dignity, and in all the issues that he raised he stressed the importance of the detail. The hon. Member for Leeds, North-West (Greg Mulholland) spoke about the basics. This debate is about the basics and the detail. It is about getting things right and setting the bar high for standards in the care of elderly people.
[Mr. Eric Martlew in the Chair]
When discussing cleanliness, my hon. Friend obviously had to raise the matter of some 6,500 people dying every year from C. difficile. Many agencies say that the problems with C. difficile and MRSA are down to standards and about nurses having the time to carry out procedures properly. I shall return to that later.
My hon. Friend also raised an interesting idea of having photos of people above their bed. I will refer to that when I close, but it is terribly important to remember that elderly people were young once and that some had terribly important jobs—perhaps more important than those of us in this House feel we have. We sometimes lose sight of that when we see in front of us someone who is, perhaps, incontinent, or who cannot feed themselves. People who have had a stroke at a young age tell us that the problem is particularly acute for them because they are treated as though they are elderly, when, in fact, they might be 45, and only the day before had responsibility for a full-time job and a family at home.
My hon. Friend discussed the care of people with dementia or mental health problems. There is no doubt that our concern about older people and the care that
they receive should increase 100 per cent. when we consider the care of older people who have dementia or mental health problems. It is not easy to care for people who have dementia, who are confused, or who are older. It is triply difficult to care for people who have all those problems. The dignity with which we treat them is extremely important.
Speaking of dignity, I make no apology for the fact that much of what I say today relates to my experiences as a nurse in general hospitals and as a district nurse in the community. I am sure that the hon. Member for Crawley (Laura Moffatt), who is now not in her place, would agree with my comments, as she was a nurse. I remember somebody once saying to me that when a person goes into hospital they hang up their dignity as they go into the ward and pick it up when they leave. That was said to me many years ago, but it probably remains true today.
There is much talk about human rights and the human rights of patients. I always feel slightly despondent when I hear people talking in such terms, because things really should not get to that point. We should not need to demand that people’s human rights be respected. This is a matter of courtesy, respect and being civil to people. It is not about patients, but about treating people. Somehow, it seems, people hang up their dignity and become a patient and a different being, and we are entitled to treat them differently and not with the same respect. We need to remember that we are treating people. People are being cared for by the state, so we have a duty of care to them that we should feel acutely. It is a long time since a radio programme called “Does he take sugar?” was broadcast, but a lot of what has been said today echoes what we heard in that programme. We often forget the person sitting in front of us.
Mixed-sex wards have been mentioned. I understand that the most recent Healthcare Commission survey reported that 30 per cent. of people are still sharing bathroom areas. The Government are trying to deal with this, but that is not good enough. Male and female patients having separate facilities is fundamental to respect and dignity. Generally, in all wards, there are curtains around a bed, but even if people are sharing a same-sex ward, that is not enough to afford them privacy when intimate procedures are being carried out. Everybody can hear what is going on and what is said behind the curtains, and often the curtains do not meet. Mixed-sex wards in any form are not acceptable. I should like the Minister to tell us what progress the Government feel they are making on this problem, which has been hanging around for much too long.
The British Medical Association recently reported that 20 per cent. of people in hospital are malnourished, thin or losing weight and that 80 per cent. enter and leave hospital without any action being taken to address their nutritional needs. Some studies have found that the number of malnourished people leaving NHS hospitals in England has risen by 85 per cent. in the past 10 years. During the Committee stage of the Health and Social Care Bill, the Minister and I discussed weighing and measuring children. If my memory serves me correctly, I mentioned that we are keen to do something about childhood obesity, but said that, at the other end of the scale, we should also be keen to do something about older people’s nutrition. Poor nutrition can lead to older people getting thin and frail and can lead to
confusion, mental health problems, dementia and depression. I should like the Minister to reassure us that the Government are taking malnutrition in elderly people seriously. It is not only what happens to elderly people when they go into hospital that matters: often, they are malnourished before they enter.
The right hon. Member for Oxford, East mentioned wholesome, locally sourced food. All hon. Members would go along with that. However, I think he missed the point. The problem in respect of much malnutrition in hospital is not that the food is not getting to the person’s bedside, but that it is not getting into their mouths. A lot of people cannot feed themselves.
Mr. Andrew Smith: I mentioned trays being put out of reach. People need both wholesome food and the means to eat it.
Anne Milton: I do not think for one minute that the right hon. Gentleman does not consider that to be a problem, but it needs emphasis. How many times have hon. Members been on a ward or in any sort of care setting and heard a patient say, “Can you hand me my drink?” or, “Can you pass me the tray of food?” What is important is individual care, paying attention to people’s nutritional needs and what food they like to eat and providing them with the ability to eat the food that is put in front of them. Although I am not one to rush into monitoring, staff need to be given clearer guidelines and we need to raise this matter as a priority. The danger is always that nutrition slips down the list of priorities and other things get attention first. I said to somebody the other day that the danger with oppressive targets in health care settings is that they become the priority. If nurses in hospitals that are short of staff are rushing around washing their hands, which we commend, they simply may not have the time to feed people. I would not like to see any issue gain importance above another.
My hon. Friend the Member for Newbury mentioned resourcing, which is an issue, along with training, support and nurses having the time to nurse and care. One of the most common problems that nurses contact me about is their feeling that they do not have the time to care for people in the manner in which they were trained and hoped to be able to practise, or in a way that maintains people’s dignity and privacy and gives them the care that the nurses themselves would expect to receive.
I have to return to how managers treat their staff. To some extent, if we want people to care for others, they have to be shown the same amount of dignity, respect and courtesy and have to be treated with the professionalism with which they are expected to treat their patients. I am concerned that sometimes the management styles in the NHS do not necessarily engender that. The hon. Member for Leeds, North-West mentioned some of the problems experienced in Maidstone and Tunbridge Wells NHS Trust. Whether or not it is in the Health Commission report, there is a lot of anecdotal evidence suggesting that the management styles in that trust were poor, staff were not treated well or with respect, and staff had no way to complain to their line managers about what was going on in the wards. That is important. Although such feelings are subtle and hard to put one’s finger on and cannot be measured, a lot of NHS staff feel that
they are oppressed by targets and the need to produce figures and numbers, and that not enough time and attention are given to their concerns about the quality of care that they need to give. Quality takes time, and it means that people need more resources.
Hon. Members mentioned discharge from care—not only from care in hospitals, but from nursing homes and other settings. At every step, people’s dignity must be maintained. We sometimes forget the fear following, for example, a fractured neck or femur or a stroke and the imminent prospect of discharge. I heard recently about an elderly gentleman who is frail and has been admitted to hospital with a stroke. He is in a fantastic stroke unit that is an example of the best practice that we have talked about. His discharge home is being planned: the man’s wife is having a stair lift installed and is employing a carer to look after him. However, she and her husband have considerable fears. At the moment staff are on hand to help him to the lavatory, but he is concerned that, when he gets home, he will not make it to the lavatory. Those are the sorts of things that people are concerned about. Many people would prefer to be looked after in their own home, but there are some big buts for those people and their families. They want to be looked after at home, but only if they have help to get to the lavatory, only if their wife has somebody to help with the shopping and only if their wife has the time to feed them.
There are also complicated issues to do with people’s feeling that they are a burden on others. The language used in respect of discharging people from hospital has been most unfortunate at times. People are referred to as bed-blocking, as though they were staying in hospital on purpose or as if it were their fault. It is not their fault; there is no doubt about that. I make no party political points about this matter. I hope that we will have a joint approach to the concerns about the huge number of elderly people for whom we will have to care and offer support in the years ahead. When I was training to be a district nurse a very long time ago—probably well over 20 years ago—I did a project on discharge home from hospital, and I read some research that pointed out that being in hospital is very brief interlude in someone’s life. It is a brief spell out of their home, and at every step we must consider what people’s needs would be in their own home.
The hon. Member for Crawley was not in her place when I mentioned her earlier, but I am sure that she shares my feelings about the care of the elderly in the NHS, because I know that she trained as a nurse. I am also sure that, like me, she was taught to provide the highest standards of care for the people she looked after. I continue to be proud of the fact that I trained at St. Bartholomew’s hospital and of the training that I received there. All that I learned at that time stands me in good stead: it guides me as a politician. It is extraordinary how useful such training is for a politician—to some extent, that training and experience on the front line took me into politics.
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