NHS Care of Older People

Peter Aldous Excerpts

Thursday 27th October 2011 Westminster Hall

[Peter Aldous (Waveney) (Con)]

It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate my hon. Friend the Member for Stourbridge (Margot James) on securing this worthwhile and important debate.

The subject is of particular interest to me because the James Paget hospital in Gorleston serves my constituency as well as those of my hon. Friends the Members for Great Yarmouth (Brandon Lewis) and for Suffolk Coastal (Dr Coffey). As we have heard, the hospital has received two unfavourable Care Quality Commission reports and a red Monitor warning, and a third report is awaited. Although improvements have been made since the previous visits, there are still areas to address because elderly patients are not being given appropriate support with eating and drinking, and people in need of intravenous fluids are not getting infusions. I do not propose to go through the reports in detail, but I will highlight a few concerns that we need to address, not only in the James Paget but across the country.

My first point specifically regards the James Paget. The hospital’s main asset is its loyal and hard-working staff, including doctors, nurses, care assistants and the volunteers provided by the very good league of friends. There is a very strong team spirit, and it is vital that the staff, who want to provide the best quality care, are given the resources, training, support and leadership they need.

[Annette Brooke in the Chair]

My second point is about funding. A particular issue in an area such as ours—we have heard from my hon. Friend the Member for Suffolk Coastal—is that Suffolk and Norfolk is a popular area to retire to, and that puts pressure on the hospital. In Yarmouth and Lowestoft, there are pockets of deprivation, and the area is a popular holiday destination. Four or five years ago, when my late father was in the James Paget, he was probably one of only two local people on a ward of eight. That is an indication of the challenges that the hospital faces, and I hope that its funding generally takes that into account.

Hospitals need not only to tackle excessive bureaucracy but to look at areas of staff shortages. If the NHS is to survive, it must tackle social care, because otherwise we will face the prospect of more and more older people in hospital beds, creating a logjam and bringing the system to a grinding halt. It may well be that we should divert funds from the acute hospital sector and into adult social care to cope with the rising costs of health care and an ageing population; it is important to make savings wherever possible.

I do not like saying this, but there is a sense of déjà vu here. This debate is very welcome and we are all approaching the matter in the right way, but I sense that we have been here before. The CQC findings are similar in many respects to those in the Secretary of State’s 1998 report, “Not because they are old”, and there are parallels with the Patients Association study of two years ago. It is as if each new revelation creates a sense of outrage, and then nothing happens. We all have an obligation to ensure that this time is different.

There is perhaps an institutional ageism in our society to the extent that at times we do not understand the needs of the elderly, and are too condescending and dismissive. That needs to be replaced with a sense of kindness and compassion, with patients’ dignity respected. We should treat patients as people, not processes; perhaps in the past, in a drive to meet targets, patients were seen as procedures to be processed. There is perhaps a problem of patient care getting sidelined by targets, by finances and bureaucracy. The delivery of care has perhaps been regarded as a task to be completed, but it is a vocation, not a unit of work. More training and staff development is needed, with patient care at the centre of things.

On leadership and support, we must create a different culture in which good care flourishes. Leaders and managers in hospitals should work closely with staff in proper liaison. It should be a two-way relationship. Staff must receive the right support, and management must ensure that budgets are spent wisely.

Over the years, a poor understanding of malnutrition has crept up. There is a lack of awareness of the importance of good nutrition. Malnutrition costs the NHS £13 billion per annum. Inadequate food is a problem, as are inflexible regimes and a failure to meet basic physical care needs, which causes patients to become lonely and bored. Similar problems exist in some care homes; lack of attention to detail is a problem. Hospital food can at times be unappetising and unpalatable. We must examine food budgets closely. Are they too low? Should they be higher?

We need a fundamental look at the issue. The CQC does valuable work, but it cannot go back all the time, so we must consider giving patients an advocate who can fight their corner. Local HealthWatch organisations that carry out unannounced inspections have a role to play. Publication of malnutrition rates should also be mandatory, so that people can discover problems earlier and notify where they might be occurring.

Finally, I will mention an issue that is not the topic of this debate but is an elephant in the room: social care for our elderly in their last days. We need to integrate the health service and social care. The Dilnot report presents an opportunity to address a time bomb that has been ticking for a long time and that successive Governments have not grappled with. I hope that, in the spring, the Government will face up to reality and publish a positive response to what Andrew Dilnot said.