Tuesday, 15 February 2011

Our Elderly Generate Losses Not Profits

A damning report issued this week by the Health Service Ombudsman, criticised the care of the elderly in English hospitals. It is no surprise to a retired nursing friend who lives in England.  She has been concerned for some time about reaching 65 (which is this year) because she knows her health trust treats the over 65s quite differently from younger generations. More than once she's said when we reach the magic 65 we will become second-class citizens in the eyes of the NHS.

I have told her I've seen no evidence of this here but that it's very obviously today's nurses are a different breed from the nurses of yesteryear.  No longer is the overall wellbeing of patients paramount - their sole interest is the medical care of the patient.  Nutrition, personal hygiene and emotional needs are not important.  Part of this is because nurses now need to have university degrees which cannot assess their natural caring skills, but that's not the only reason.

Money is the main reason our elderly's wellbeing is way down the list.  There's no money generated from nursing the elderly.  Dr Grumble and a GP explain their findings.

I'm more than grateful I live in an area where the elderly are treated with as much respect as others.  Also I'm more than grateful that the Scottish government refuse to go down the privatisation road, but maybe they will be forced to do so before long. Why should I feel so grateful when, looked at objectively, I have paid my health insurance all my adult life.  It's a scary time to be reaching the magic age of 65 - particularly for those who live in England.


Mark Wadsworth said...

"Losses" not "loses".

tris said...

I hope that if there is a change of government in Scotland, the new government won't go down the road of privatization, but I have no confidence in them.

If we go down the same road as England, I hope I die before I get old....

....Or that I win the lottery.

The super rich don't have these problems, which is why the English government doesn't actually understand or care.

hector said...
This comment has been removed by the author.
hector said...

i have heard the issue of nurses now 'having degrees'as though it was detrimental to the care they give.this is not the case. can someone know to much about their profession?is a doctor any less caring because he/she has a degree?nursing is now more skilled and knowledge based.as well as more responsibility.the basic care is still there and given.however with increased pressures of cash restrictions in the nhs and staff shortages it is not always easy for nurses to give the they care know is best.

subrosa said...

Thanks Mark. Just noticed the typo and amended.

subrosa said...

It's a bit of a lottery in Scotland too though Tris. But not only for the over 65s. I'd say for anyone over 50.

subrosa said...

Hector, I have quite a few friends who are retired from the nursing profession. None would say today's nurses understand the true meaning of caring or hygiene. None is a grumpy old woman either. They belong to the days when hygiene and care was uppermost in a nurse's daily work.

The basic care is not still there because nurses are no longer employed for their natural caring skills but their ability to struggle through a degree course. I know two young women who would have made very good nurses but neither could attain a good enough English higher to gain entry to a university course. Both decided they couldn't afford another year at college to achieve it as neither was well enough off.

I do wish you could talk to my friends. They would tell you their own experience of modern nursing. Mine is just from being a patient.

Joe Public said...

And the other side of the coin is that I bet some of those nurses & carers could tell a few tales about some of the grumpy old twats (no offence intended to that self-confessed, recently-departed blogger), they've had to deal with.

And if they did, it'd be curtains for their career, along the lines of 'unprofessional conduct'.

subrosa said...

My friends say during their careers the elderly were usually the least demanding and the most were those with medical qualifications. Of course there are all sorts in all age groups and they admit they're dreadful patients themselves.

JRB said...

This scenario may be nearer to happening in Scotland than you might think.

In a worrying report published in October 2010 the Royal College of Nursing (Scotland) warned that nurses in Scotland were being overloaded with paperwork which was stopping them from caring for their patients.
The RCN is called for an urgent review of paperwork so that nurses could spend more time with patients.

In addition, the RCN reported that nurses in Scotland are not able to care for patients with dignity because of a lack of staff. Research by the RCN found that more than half of nurses said they were prevented from providing dignified care to patients to a standard they were happy with.
Theresa Fyffe, director of RCN Scotland, said dignity was about the core essentials that matter to people. This included having the time to help people eat, talking to patients and helping them with simple tasks such as getting to the toilet.

In a recent development, which I find totally mystifying and a little horrifying, NHS Lothian is to initiate a new scheme whereby nurses will be able to spend more time with patients. The “Releasing Time to Care” programme will allow staff on wards to factor in spending time with people as part of their working day.

I am perhaps being naïve but I had always thought that patient care was, or should be, the prime directive for all nurses.

In its furtherance of implementing all the latest Policies, Procedures and Protocols; the NHS is at severe risk of leaving one essential ‘P’ behind – the Patient.

English Pensioner said...

Nursing is one of quite a few occupations which have become degree based, rather than being trained on-the-job and then taking exams. In most such jobs, you used to start by doing the menial jobs, and if you don't like it, you left and went in for something else. Now, newcomers take a degree, then take some specific job training, probably taking more than 4 years overall, so by then they are committed, however much they find they dislike the job. And of course, having got a degree, they expect a nice comfortable clean job like their friends who took up something like accountancy. Nursing has also lost the route whereby the less academically minded but caring could become State Enrolled Nurses and look after patients who require care and attention.
It was exactly the same with engineering; Suggest to one of the bright young things straight from university that they go to stores and draw a pair of gum boots and some wet weather gear and get down to site and see how the trenching and cable laying is going, and a look of horror appears on their faces - they envisaged sitting in a warm office issuing orders, not getting out in the rain and mud and seeing that they are carried out.
Degrees have their place, but not in most of the places where they are now required.

subrosa said...

John, I was hoping you would respond to this.

What you write is worrying. I know, from my own limited experience, that nurses don't nurse these days. People are left waiting for hours for help - even folk younger than me. I never saw anyone receive any help with accessing the toilet.

As I've said my retired nursing friends are of the same opinion as yourself but what can we do? A new scheme is an insult to those nurses who dedicated their working lives to caring.

If setting up a petition would be the way forward then I'd be happy to do that with your help. Just let me know and thank you for the information. Invaluable it is.

subrosa said...

Yes EP, it's such a shame many people, who would be very suited to the nursing profession, are excluded because of this necessity to take a degree. Such a waste of talent in an profession which has lost its way.

Doug Daniel said...

English Pensioner is quite right, in my opinion. Far too many jobs now state a degree as a minimum requirement, where in reality they do not require it. There are some jobs that require a great deal of detailed knowledge of the subject before you can even begin to start practising the job for real, such as medicine, law and nuclear physics; but for the vast majority of jobs, all the knowledge you really need will be garnered through your early years in the job, and this is in fact the best way of gathering that knowledge. Far too many graduates leave university saying that they use about 5% of what they learned in their actual job, and that's just those who get jobs in the same discipline in which they studied.

Degrees are being used as excuses to offer lower pay to those without degrees, and to replace the need for employers to provide training to new recruits, as this is now provided by the tax payer. In making degrees become an essential stepping stone to many jobs, they have gone from being a trump card to being a hindrance. I have a degree in Computing Science, but in truth there are a vast number of jobs I would be quite capable of doing if I was given the right training, but the simple fact that these jobs now require degrees in their field prevents me from even applying to half of them. In truth, it's extremely dubious as to how worthwhile a Computing Science degree even is, as most of what you use is picked up on the job, and all top-notch software developers - without exception - are the kind of people who play about with computers in their spare time, rather than the ones who just chose to study computing for 4 years. I'm digressing now...

Put it this way: would you rather be treated by a nurse who had just left university and gotten a first-class honours in Nursing; or one who had spent those four years on the job, learning what it's really like to work on a ward?

Degrees should be for those who enjoy learning, those who have an intense interest in a subject, and those who intend to embark on a career that requires a very detailed background knowledge before they even begin to practice for real (doctors, lawyers, nuclear physicists...) Everyone else should just get started at the bottom and work their way up. There really needs to be a big debate in this country about what university is for, and how we can stop it being so commercialised.

wisnaeme said...

Anyone seen the latest offering in the Dail Maul.
... on the use of tresspass laws to evict elderly patients from their hospital beds.

Aye, ah'm sure the elderly appreciate living in today's "Big Society".

Utterly shocking that story is, even allowing for the Daily Maul's tendency to use journalist expresion to titilate it's somewhat right of center readership.

Edward Spalton said...

The trouble is that degrees these days are, like everything else, awarded on a tick box basis. I know of a young man who is going to New Zealand to qualify as a doctor because he reckons he cannot put in the necessary hours to get the experience here - because of the EU working time directive.

It is a lack of humanity that causes the atrocities in hospitals. In Staffordshire near us it was reckoned that 1200 people died for lack of proper care. Patients were so thirsty that they were drinking water out of flower vases. Several years later, some of the nursing staff may be disciplined. They say they were frightened to speak out because of fear for their jobs. I cannot imagine any of the older generation of nurses whom I have known being shut up like that.

Yet by this time the managers responsible will have moved on to promoted posts. If this had been an ordinary business like a restaurant chain there would have been criminal charges - probably for manslaughter.

It is certainly not a question of "resources" but of attitude. As with schools, money has been poured into hospitals as if it were going out of fashion - as anybody who has had to make an appointment on the "chose and book" system will know.

JRB said...

post script: Your piece has proven to be very timely indeed, Subrosa.

I note from today’s ‘Scotsman’ ( Wednesday 16th February) that –
THE amount of time patients spend in hospital is to be cut as part of a plan to find savings of £300 million in Scotland's NHS budget over the next year.
Health secretary Nicola Sturgeon launched the drive at Stirling Royal Infirmary yesterday.

It is inevitable that patients, especially the elderly, will suffer in order for the NHS to achieve such savings.

subrosa said...

Doug, any older nurse will tell you their education happened in wards not classrooms, so you're quite right about degrees not being absolutely necessary in this profession.

Of course for those nurses who want to branch into management there should be courses available, but we do not need every nurse with a degree.

subrosa said...

Yes wisnaeme, I've read it now. There's possibly more than a grain of truth in it too.

subrosa said...

Edward, one of my readers has a son who has gone to Australia for exactly the same reason.

As I said earlier, the majority of the older patients who do speak out are themselves retired from the profession. Others, who have no family to speak for them, are left.

As we know, hands on experience is far superior to classroom. A mix of both are far better but the balance at present in the course weights much towards the classroom.

I can't understand why the RCN permitted this degree only system in the first place. Some years ago I remember talking with one of their senior representatives who said it would cause distress to many potential nurses as less than half the population are academically inclined.

subrosa said...

There's no doubt about it John. Once you reach 65 you have to fight. Problem is, by the time many of us reach hospital, we're too ill to be bothered.

Where are these poor souls going to go if they're unable to fend for themselves and councils hold back finance for any kind of half-way house for them?

hector said...

subrosa,nursing like some other professions change training from time to time.i see this as a plus as demands change.in nursing this seems to be about every 10 years.the training that an individual done themselves is often precious to them,to what went before or after.i am sure your retired friends were criticized by those who went before them.nurse training is not just for one particular area e.g. care of the elderly.the training has to include many areas.community nursing,addictions,coronary care i.t.u.,i could go on.i am sure if you asked florence nightingale about methadone prescribing or heart monitors she would possibly have had to ask someone. .i take english pensioners point re state enrolled nurses.there may be a place for them in certain areas.

Elby the Beserk said...

It's a horror show down here. My mother, having had a serious stroke, was admitted to the local hospital on a Friday evening.

She received no specialist care until the Monday; this despite the fact that she was also having regular convulsions. On Monday a consultant came in, and prescribed anti-convulsants.

We were later to find that she had been having regular small attacks of epilepsy since her first stroke a couple of years earlier. As she was an alcoholic, it was assumed that all the falls she had been having were down to the booze.

In neither case did her GP visit her after discharge. Nor did he after her numerous admissions for fractures from said falls.

There was a lady of some 80 years or so on Today yesterday morning. My wife thought it might have been Eva Figes, but I didn't catch her name. Wo'eva.

She'd gone in for a hip op or such like, and said that the care in the Orthopaedics ward was fantastic (I can confirm that, having had two hip ops in the past two years - I have nothing but praise for all involved, although the nurses seemed now to be totally desk bound.

Said lady then got blood clots in her lungs, and was admitted to Geriatrics, where she became a non-person. So much so that she - articulate and well able to defend her own corner - had a couple of full on rows with nurses there about the appalling care meted out.

My late mother-in-law, a fine woman, had a stroke at the age of 89. Mild, but she needed rehab as she lost the swallowing reflex. Rehab turned out to be 20 minutes of therapy a day, and the rest of the time being utterly ignored except at meal times. She was a bright and sociable woman, with all her marbles intact, and she might as well not have been there.

Tell them your partner is a lawyer, if you are elderly and admitted to hospital. Make sure they hear you.

Hector. You present a number of opinions but fail to back them up in any way with hard evidence. Care to sort that for me?

I had a long chat with the Staff Nurse who discharged me last month. She had been in the NHS 30 years, and said there were two major problems which had to be addressed - endemic waste, a culture of waste almost, and the layers of layers of middle management who seem to do nothing, except make it harder to get a decision about anything, as the buck was always passed on.

Her opinion was that you could lose 25,000 staff from the NHS overnight and not notice.

Ironic fact about my Mum - she taught girls how to drive ambulances during the war.

I shall be making sure that I have something painless and sleeeepppppyyy tucked away for when the time comes. And a fine bottle of Islay malt. I think I would trust them better than nursing care in hospital.

Ah yes - patient of my wife's (comp therapist), stroke at 91, found by her when visiting "folded over" in bed, as he couldn't move himself, and clearly dehydrated.

Other patients recount parents found in faeces and urine, one in a chair by her bed.

It would seem no-one gets punished. Indeed, in the case of the Mid-Staffs Morgue, the perpetrators got away scot free with 7 figure pay-offs.

subrosa said...

Hector, I agree. Natural progress in professions are to be welcomed, but a degree for all isn't natural progress. One of my friends was a very senior nurse and still advises about procedures. She's unavailable at the moment but promises to write a post I will publish in a week or so.

I doubt if you will be able to fault her assessment of the present situation. The care part - the most important in my view - has gone today.

subrosa said...

I've never heard such horror stories up here Elby. My own mother had a series of TIAs and after the most serious rehab was immediately instigated with the stroke department taking over. She spent a day a week there for a couple of years. I couldn't fault them.

Thanks for the advice about the lawyer angle.

A few years ago my own experience was of nurses sitting round the station. One night I was feeling bad and got up to avoid anyone coming into the ward. The three nurses were sitting in their station having rather a pleasant supper. I was told I would get some pain relief when they were finished so I just walked up and down past them for about half an hour. None of them paid the slightest attention.

My plans are along the lines of yours Elby.

One of my nursing friends always pulls back the sheets when visiting anyone in hospital. When I asked her why she said she was checking if the bed was dry. Older folk seldom want to complain if they've wet the bed because they couldn't get help.

No no one does get punished. There's no proper hierarchy these days, except managers who wouldn't be capable of giving a bedpan.

Foxy Brown said...

There have been a lot of excellent comments on this thread, and I concur with much that has been said. It'll be a fair few years before I reach the age of 65, and hopefully the NHS will be dead and buried by then. I've experienced modern nursing in one London hospital, which was supposedly a flagship institution, and the whole episode was truly terrifying.

I had an operation which didn't go to plan, and I could have popped my clogs. I never felt so vulnerable in my life as then. Apart from a few exceptions (all of whom were nearing the age of retirement) the members of the nursing staff on my ward were appalling. One my sisters came in to attend to my hygiene needs, as no one else would do it, not even when asked. My catheter frequently went unemptied. A very visible sanguinous dressing lay at the side of my bed for half a day - it was repeatedly stepped over. But there were lots of nurses running around with clipboards.

In order to raise the status of nursing, which has largely been an area of female expertise, it became necessary to make degrees mandatory so as to achieve parity with medicine, which up until quite recently was heavily populated by males. Nurses are now part of a profession, and the consequence of this is that assisting the infirm and incapable with feeding and toileting is somewhat beneath them.

And it's no use lodging complaints.

subrosa said...

Foxy, what an experience. Just think, if you hadn't had your sister to help. Many elderly don't have their families near at hand to help and they just wouldn't ask friends. That's why they rely on nurses.

Their interest in now the medical care patients and nothing else.

You're bang on about complaints. No matter how objective and calm you are, the response will be pages of jargon which say nothing.

Take a tip out of Elby's comment and in future say a close family member is a top lawyer. I'll do that in future.

Weekend Yachtsman said...

"I have paid my health insurance all my adult life"

Ah, but it's not insurance, is it - it's actually a great big Ponzi scheme, and now it's running out of money, as they always do. Bernie Madoff had nothing on the Welfare State, as we're about to find out.

As Bevin famously said, the great secret about the National Insurance Fund is that there ain't no fund.

subrosa said...

But that's the shame and the fault is totally that of politicians WY. I'm sick of taking the hits when they fail.

Disgraceful that, with Westminster insisting on making the NHS the biggest health business in the world, the bookkeepers involved don't have a clue.

Is it any wonder so much money is wasted?

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