Argus title : The painful truth about NHS care
It’s difficult to know how and where to start this column. I find it so painful to write.
I wept as I watched the Panorama programme about care on Stewart and Peel ward in the Royal Sussex County Hospital (RSCH). My father was a patient there for a few days, shortly before his death in November last year. It is possible he was there during the time the documentary was being researched.
Though I was deeply upset by the suffering of elderly patients revealed in that documentary, and tormented by the thought that my father may have been ill-used in my absence, I was distressed most of all by the response of the Chief Executive.
In such circumstances, I would have hoped to see genuine shock, compassion and remorse. Peter Coles might have pledged to ensure that nothing like this would happen again or issued an invitation to concerned families to contact him. He could have made a commitment to personally undertake random checks on wards.
He did none of these things, but responded with a mechanical apology and defensive assurances that problems in this particular ward had already been identified and addressed.
Mr Coles’ assertion that the programme was “unnecessary” and his subsequent comments about the ‘disloyalty’ of the nurse who blew the whistle, give grounds for despair rather than optimism.
What he must know – and if he does not he is not competent to be in his post – is that the problems are not confined to one ward, but are endemic within the Trust. The Zero ratings received by the Trust are symptomatic of this.
In years of ill health, my father experienced the best and worst of care in Brighton’s hospitals. Stewart and Peel ward was by no means the worst – though it was seriously understaffed.
In February 2004, following fruitless complaint to managers about my father’s care in another ward, I was sufficiently angry to write in this column about hospital care for elderly people with dementia.
Margaret Thatcher and my father were then of a similar age. I contrasted the NHS care he experienced with the private care standards someone of her wealth could expect.
I wrote: “She will not lie in her own urine, as my father did in an NHS hospital ward, because there are not enough staff to ensure that pads are changed and therefore it is ward policy not to use them. She will not be dressed in someone else’s glasses, underwear or slippers. Her relations will never have to retrieve her clothes from another patient, and take them home to be washed, reeking of someone else’s sweat and excrement.
“The drainage bowl from somebody else’s catheter bag will not be abandoned under her bed. She will never have to plead for a bedpan. Her visiting grandchildren will not gag at the stench of faeces, or have to watch naked, humiliated old men, in an open ward, struggling with catheters.”
This was strong stuff, designed to elicit a response. But there was none. It seemed local managers simply didn’t care.
In the original article I did not name the ward and hospital, but I will do so now. It was Chichester Ward at the RSCH.
I received no response in April 2005, when I wrote of the painful death of an elderly Brighton man with Alzheimer’s disease called Len Jordan. His daughter told me that even though he had an infected open wound in his leg and was suffering from MRSA, he was considered a ‘bed blocker’.
She found that the only way she and her mother could ensure he was hydrated and fed was to visit at meal times and do it themselves. On the day he died he lay for at least three hours in pain, drenched in foul-smelling effluent from his wound. Though they requested morphine, he died before it was provided.
My father received good nursing care in A&E and wards for acute health problems. His difficulties arose when he was transferred to wards providing ‘elderly care’.
Despite the best efforts of some dedicated staff, all too often these are ‘sink’ wards, poorly funded and grossly understaffed. In such settings poor practice and bullying can flourish.
Chichester ward was definitely one such ward. There was a culture of disrespect and apparent indifference to patients’ distress. It was difficult to find a nurse to attend patients and I often saw people begging for help with catheters.
The stench of urine was often overwhelming. It was commonplace to see nurses hand a bottle to a patient and expect him to use it without drawing the curtains. I had to prevent my daughter visiting her grandfather because of this.
More than once, I witnessed ward staff and at least one junior doctor laughing and chatting while patients waited for care. On one occasion, the doctor had his feet up, resting against the nursing station.
Bad as Chichester Ward was, Dyke 3 at Brighton General Hospital, was far worse.
While most hospital wards allowed morning and afternoon or evening visits, staff on Dyke 3 refused to allow visitors before 3.00pm. Despite the fact that this made it difficult for elderly people and those with children to visit, time limits were rigidly observed.
Visiting times effectively prevented families meeting with doctors and other professionals involved in the care of patients and made it well nigh impossible to check whether elderly confused relatives had had sufficient food and fluids.
Of course, patients’ relations should be able to trust that nursing staff have provided such basic care. But, this is not a hospital system which can be relied upon.
After my father’s first admission on D3, a couple of years ago, I noticed a marked deterioration in his health. He was not encouraged to walk and was often dehydrated. I brought him home as soon as I could.
My father was rushed to A&E many times after that. I used regularly to plead with doctors not to send him to D3. Unfortunately, during his last illness that is exactly what they did.
My father had been admitted primarily for ‘social’ reasons because we needed to ensure his safety and arrange 24 hour professional care at home. Unfortunately, after admission, his health deteriorated to such an extent that additional medical treatment was required.
The first time I visited him on the ward he was bleeding from his catheter. I asked for it to be removed, but the staff nurse refused saying that it was ward policy that everyone should be catheterised. He was impatient and aggressive in his manner.
As time passed we regularly found my father dehydrated. He developed a severe urinary infection.
On one occasion he seemed particularly unwell. After repeated unsuccessful requests for help, a nurse examined my father and discovered that the catheter bag strapped under his pajama trouser leg, was empty. It had not been checked all day and consequently a blockage of his urinary passage had not been discovered. My father had been in pain for hours.
Thereafter my father’s health deteriorated rapidly. He was sedated at night and kept immobile during the day. Despite my protests that before admission he had been able to walk very slowly with a zimmer, he was not assisted to leave his bed or helped to practice his walking. As a consequence, within 2 weeks he lost the capacity to walk.
When I subsequently protested to a consultant, I was assured that “Mr Griffith’s” mobility had been assessed. When I reminded her that my father was “Mr Calder”, the consultant realised that another patients’ records had been inserted into my father’s medical file.
He was discharged with no immediate prospect of coming home – because he now needed not just 24 hour care, but hoists, a new bed and district nurse input as well.
We arranged for admission to a nursing home, and for the 2 weeks he was there, worked frantically with community health services to get the equipment we needed to bring him home. It was evident he was close to death.
In the event, the urinary infection with which he had left the hospital worsened. He collapsed, was readmitted to the RSCH and the next day experienced the massive stroke that eventually killed him.
My father’s death was never likely to be easy and I do believe that in his last days medical and nursing staff did all they could to assist his pain. However, I also believe that if he had had better care in the weeks preceding his stroke, he would have had a fighting chance of dying with dignity at home.
I support the call for a public inquiry.