No compasssion or concern even for a man aged 101! Decent people would have treated him with honour, not contempt
John Platt was used to facing life-threatening situations with courage. In World War II he won the Distinguished Service Order for his leadership in one of the fiercest battles of the Italian campaign. But nothing, even in his wartime experience, prepared him for the treatment he received from the NHS.
Aged 101, he was sent away in a taxi to die by Salisbury District Hospital, wearing only a nappy and a set of ill-fitting pyjamas. He was discharged unable to feed himself and clutching a bag of soiled clothing. He was confused and incontinent after a spell in hospital that had left him, according to his family, 'degraded and humiliated'.
During his five days at the hospital, someone stepped on his hearing aid, his false teeth went missing and soiled pyjamas piled up unwashed in a locker. His daughter-in-law said: 'All that he had at the end of his 101 years was his dignity and they took that away from him.'
What kind of institution does that to an old man? What kind of people are forcing a dying patient to undergo an hour's taxi ride in someone else's pyjamas and a nappy tied so tight around his waist it left red marks? Did they think they'd done a good day's work when they went home that night? If criticised will they, like the social workers of Baby P, complacently point to targets reached, meetings attended and boxes ticked? Why has compassion, which after all costs nothing, suddenly become the scarcest commodity in the NHS?
Niall Dickson, chief executive of the King's Fund, an independent health Think Tank, believes the NHS is fast losing its caring attitude towards patients. He said: 'I have very little doubt that we've seen deterioration in the level of compassion that is shown by staff to patients. 'If we can't get compassion into our healthcare, the system is failing.' Sadly, there is plenty of anecdotal evidence to suggest that the system is indeed failing, at all levels. Take, as another example, the case reported by one nurse at a packed meeting at the Royal College of Nursing last summer.
When one of her patients had died, managers rang the staff nurse in charge four times within two hours to see if the bed was free. 'On the final call, one of them said: "Haven't you got rid of that body yet?" ' the nurse recalled. 'It was disgraceful. When a patient dies, they are entitled to respect and dignity.' Indeed they are. But often they get neither. So what is going wrong? Dickson points to shorter stays and sicker patients putting pressure on staff and turning hospitals into 'medical factories'. He blames 'very difficult situations' rather than staff suddenly 'turning into nasty people'.
But it is not just the sheer numbers of patients that is creating this situation. It is the culture of the NHS itself. During a year-long investigation of the NHS that I undertook a little while ago, I met many medical staff who gave their patients outstanding care. But, sadly, they proved to be the exception. I saw far more examples of indifference and disorganisation. As in any institution, from the NHS to your local restaurant, not everyone gives good service all of the time. What sets the NHS apart is its refusal to give anyone the authority to put that right. It is shocking to discover that no one person has the power to oversee all elements of a patient's care, pull them together and take responsibility for that person's wellbeing.
So, for example, there is little incentive for a nurse to check an old lady for bedsores except her own humanity and professionalism. Nor is there any punishment if she forgets or does not bother. As one nurse at the meeting on dignity observed: 'I have seen staff doing full sets of observations on patients without saying anything to them. It is really hard to imagine how you could do that, but it happens.' Over and over again, matrons and sisters complained it was impossible to discipline a nurse for incompetence, let alone for unkindness. In the no-blame culture of the NHS, the emphasis is on making sure it is no one's fault.
Modern management is meant to 'nurture' its employees - even if they have proven woefully inadequate. The errant nurse is offered training, supervision and given chance after chance. This can go on for a year. 'In the meantime,' complained a former matron, 'patients are going through her hands and suffering.' Or as one consultant said: 'We are meant to be the caring profession. But sometimes we put caring for each other above caring for our patients.'
A nurse's training is another bar to compassion, as it has become more theoretical and less about the practicalities of patient care. Twenty years ago nursing turned itself into an academic profession. Nurses became embedded in a power struggle against doctors, the NHS and even patients. Woe betide anyone who asked them to perform any duty that undermined their status. An Irish sister complained that her recently qualified nurses were horrified to discover that 90 per cent of their time 'is doing things for the patient' rather than 'sitting in front of a computer'. She went on: 'I see nurses walk past a patient ignoring his distress-This lack of consistency and authority can have dire consequences for the most vulnerable patients. I saw this for myself staying overnight in hospital to be with a dying friend.
He had slipped into unconsciousness, but at about 6am began to moan with pain. No one came near. The moans turned into screams. The nurses at the nurses' station did not glance his way. Finally, I approached and asked for pain relief. One looked briefly at my friend. 'He's not my patient,' she said. Where was his nurse, I persisted. 'She's giving a bath and cannot be disturbed,' she reproved. It was only by becoming angry that I forced her to fetch something to ease what turned out to be his last few hours. I wondered if she would have treated a howling dog better. It is bad enough being ill and in pain. To be abandoned or treated unkindly is almost insupportable.
In fairness, the Government has responded to public concern by listing compassion as one of six core values in its recent draft constitution of the NHS. It is developing ways of measuring compassion and has even appointed a dignity ambassador, Sir Michael Parkinson. But like the 'Superbug Tsar', another NHS government initiative, will it actually achieve anything or is it a PR sop? Lizzie McLennan of Help The Aged pointed out that health and care providers 'are assessed on lots of things, but dignity and compassion are shamefully not included'. Until the caring professions really start to care again, we have no right to call ourselves a civilised nation.
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Australia: NSW public hospitals not coping with emergencies
Almost one in three people are waiting more than eight hours in emergency departments for a bed, the highest in 18 months, but doctors say the true figures are much worse as hospitals struggle with a surge in the number of patients and a lack of staff, beds and funding. NSW Health figures, released yesterday after the Opposition health spokeswoman, Jillian Skinner, submitted a freedom of information request, show that 29 per cent of people are waiting more than eight hours for a bed, known as access block, up from 19 per cent six months ago, but the figures failed to reveal that some patients could wait up to five days, the president of the Australasian College of Emergency Medicine, Sally McCarthy, said yesterday.
"A patient is only counted when they have been waiting for eight hours or more for a bed, but you can have people waiting for days and days in the emergency department," she said. "There are plenty of cases where management will move a person out of the department when they have been waiting for 7« hours to avoid them being counted as an access block statistic, while someone who has been waiting more than eight hours could be overlooked and left for days because they have already been counted anyway."
About 17 per cent of people who present with imminently life-threatening conditions (triage 2 category) are not being seen within the required 10 minutes and 32 per cent of those with potentially life-threatening conditions (category 3) are not being seen within the necessary 30 minutes, up from 15 per cent and 30 per cent 18 months ago. The number of patients not being seen on time in categories four and five remain the same. There were 153,897 people seen in emergency departments between June and September, up from 137,117 in June 2007, with most of the increase in the middle and lower triage categories.
"Bed numbers have not changed in 10 years but we are seeing about 40 per cent more patients through our emergency departments," Dr McCarthy said. "It is very bad for the proper functioning of any emergency department because once we have 10 per cent of patients not being moved out to a bed, it starts to create problems. We have no space to see new cases, ambulances are delayed, patients get poor treatment and it has been well documented that mortality rates go up."
Mrs Skinner said: "They are the worst emergency department figures I have seen in my 13 years in the job. No wonder the Government tried to hide them. The Garling inquiry was told that stressed ED staff need more doctors, experienced nurses and beds in wards but nothing has been done."
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