THE ELDERLY ARE JUST A NUISANCE IN BRITAIN'S NHS

Best if they get a bug and die

Barbara Yeo died in March last year, and time has not yet been able to diminish for Harriet the distressing, haunting images of her mother as she lay breathless and in pain in her hospital bed. An 83-year-old former hospital matron who, in her working life, specialised in care of the elderly, Barbara had not been in the peak of health, but nor was she terminally ill. And yet her own admission to hospital for routine treatment of leg ulcers was to prove fatal. Barbara died of viral gastroenteritis - a stomach bug that she contracted from a highly infectious patient who was placed next to her on the ward. As her condition rapidly deteriorated, the acronym DNR - for Do Not Resuscitate - was placed on her notes.

'I told the doctor that that would be going against her wishes. Because she was a nurse, it was a conversation we had had many times. But they did it anyway. They treated the age, not the patient, and it cost my mother her life,' says Harriet.

The story of Barbara's demise is one that will resonate with many. We are living longer and, consequently, more likely to become frail and vulnerable through age. Two thirds of patients in hospital wards are over 65. Most of those who have had to care for an elderly and sick relative understand that resources are limited. But care, sympathy and dignity shouldn't be, and yet you do not have to canvass hard to find those who, in some way, feel let down by the system.

The problem is that, too often, frustration is swiftly overwhelmed by grief. Rather than kick up a fuss, families find themselves slinking away in bitter resignation. Harriet Yeo, however, is not a slinker. A strident woman who stands six feet tall, she is used to making her presence felt as a councillor in her home town of Ashford, Kent, as a former trades union official, and also as someone who has served on three National Health Trust bodies.

Shortly after her mother died, she was appointed a member of the Labour Party's National Executive Committee - a position that brings her into direct contact with Government ministers. And shortly after that, she found herself launching 'Forgetmenot' - a campaign that will very possibly clash with Party policy but will also, she hopes, give a strong voice to those who feel alone and powerless. 'I'm not saying that all hospital care for the elderly is bad, but a lot of it is,' she says. 'The more I talked to people about what happened to my mother, the more I realised that older people are being discriminated against, not just in my hospital, but all over the country. 'It is too big a problem for any one individual, but by creating a national force, we can be heard. And I am not going to be cowed, because speaking out is the only way I can feel some good might come of my mother's death.' ......

In November 2004, Barbara's GP arranged for her to be admitted to the William Harvey Hospital in Ashford with suspected constipation. In fact, tests revealed that there was nothing wrong with her bowels, but doctors did then advise that she undergo intensive treatment on her leg ulcers - painful sores that are usually caused by circulation problems and are common in the elderly.

Barbara was given morphine for pain relief, and from that point, according to Harriet, her condition rapidly deteriorated. She became dehydrated and delusional and remained in pain because, says Harriet 'it was the wrong sort of pain relief for the arthritic pain she had'. Following complaints from Harriet, Barbara was taken off the morphine, and within 48 hours, the delusions had stopped. But her weight appeared to have dropped drastically - although how drastically Harriet cannot be sure because Barbara was not weighed. 'With hindsight, I would have insisted she was weighed on admission, as all elderly patients should be.'

Barbara came home for Christmas, during which time she ate enough to go up two dress sizes, and was re-admitted in January to continue the leg ulcer treatment. As the weeks passed, the ulcers improved, but Harriet was less than impressed with the more general care her mother received. 'She was catheterised as soon as she was admitted, despite being fully continent. Why? Because it is easier, of course, if a nurse doesn't have to attend when she needs to go to the bathroom. But by keeping her still, they were depleting her mobility. 'During two months in hospital, she had her hair washed just once, and that was because we insisted and paid a hairdresser to do it. My mother was a woman who went to the hairdressers every week. Not enabling her to maintain her appearance was an affront to her dignity.'

Barbara died four days after contracting what staff in the hospital were referring to as the 'winter vomiting bug'. When Harriet questioned why an infected patient had been put next to her mother, she says she was told that the consultant and the infection control nurse had deemed it 'an acceptable risk'. The matter is now the subject of a police complaint, and also a complaint that Harriet has lodged with the General Medical Council. Both cases are unlikely to be resolved for many months.

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Playing politics puts mothers' and their babies' lives at risk

Comment from Miranda Devine in Sydney, Australia

The tragic case of baby Natalia Lalic, who died five days after being born at Camden Hospital in 2003, should serve as a warning of the potential consequences of political and ideological meddling in childbirth. The increasing demands by feminist ideologues for "women-centred" birth centres with midwives providing exclusive care neatly dovetail with the desire by the State Government to cut health costs while appearing to deliver new facilities in marginal seats.

Natalia was born five days after the 2003 state election in Camden Hospital's new $3.5 million maternity unit, which had been opened with great fanfare six weeks earlier. Camden was a marginal seat, and the only seat the ALP won from the Liberals. At the time, then health minister Craig Knowles, member for the neighbouring seat of Macquarie Fields, was under siege from whistleblower nurses. Though Camden was just a 20-minute drive from Campbelltown Hospital's fully staffed maternity unit, which could have done with the extra money, the Government opened the new ward against the advice of the South Western Sydney Area Health Service board, which was concerned about duplicating resources and a shortage of specialists. When no anaesthetists could be found for Camden, a bureaucrat was flown to South Africa to recruit. No expense was spared.

But, as the NSW Medical Tribunal has heard, there was no pediatrician on hand to resuscitate Natalia when she was born without a heartbeat after a difficult labour in which the umbilical cord was wrapped around her neck. Some anaesthetists on roster lived 40 minutes away and pediatricians 30 minutes away. Crucially, the hospital required 69 minutes to set up an emergency caesarean section. So even when it was clear the baby was in distress, the obstetrician on duty made the decision that it would be faster for her to be born by assisted vaginal delivery. She died five days later.

The doctor has since endured three debilitating years of blame for the judgement calls he made that terrible morning. The Health Care Complaints Commission alleged he should have organised a caesarean and called a pediatrician earlier. Last week the obstetrician, whose name has been suppressed, was cleared of any wrongdoing by the tribunal. There was no guarantee the baby would have lived if a caesarean had been ordered.

But an anaesthetist who works in northern Sydney says Natalia might have had a better chance in a bigger hospital. When an emergency caesarean is needed, the ideal time from "decision to incision" is less than 20 minutes, not 69 minutes, he says. At a hospital such as Royal North Shore a woman can be on the operating table in 10 minutes.

And yet, a recent review of maternity services in the Northern Sydney Central Coast Health service area has recommended fewer births at RNS (down 15 births a month to 200) and more at smaller, less-resourced units, such as Mona Vale and Ryde. The anaesthetist says health bureaucrats want to reduce the 2400 annual births at RNS by 600 or 700, for budgetary reasons. The amalgamation of northern Sydney with the Central Coast in January, he says, has led to a transfer of resources from northern Sydney's budget to the Central Coast, where, he cynically points out, Gosford is a marginal Liberal seat that Labor is targeting. "Politicians use obstetric services as a vote-winner," he says.

The review has not addressed specialist concerns about safety at small units and makes only politically palatable recommendations, he says. While it states that duplication of obstetric services between Manly and Mona Vale is "not sustainable", it advocates the "development of shared positions across the two sites". Specialist doctors also feel the review report was released stealthily, on January 2, "when everyone is on holidays", with comments due by January 16. The report states that "volumes of births across the seven sites are not sufficient to support seven traditional maternity units" with full services of obstetricians, anaesthetists and midwives. But it does not recommend closing Ryde and Wyong obstetric units, as many specialists think should happen.

If the safety of mother and child were paramount, common sense would dictate that you would make most use of hospitals such as Royal North Shore, instead of using every means to reduce births there. And just because there is an anaesthetist across the corridor ready for an emergency caesarean or to provide pain relief, doesn't mean a mother can't have a drug-free natural birth. It just means she has a choice.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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