NHS Care of Older People

Sarah Newton Excerpts

Thursday 27th October 2011 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in the debate when you, Mr Betts, are in the Chair.

The full title of our debate is “NHS Care of Older People”, and the fact that that distinction is made shows that there is an issue in the care of older people by the NHS that needs to be discussed. It is right, therefore, that we are debating this matter today and I congratulate the hon. Member for Stourbridge (Margot James) on securing this debate and on the way in which she opened it.

A number of reports made to Parliament this year on the failings of NHS care of older people have shocked us. The health service ombudsman, Ann Abraham, reported in February on a

“picture of NHS provision that is failing to respond to the needs of older people with care and compassion, and to provide even the most basic standards of care”.

Her report told the stories of 10 people over 65—partners, parents and grandparents: individuals who put up with difficult circumstances and did not like to make a fuss, compared with those who, as we have heard, were difficult—who wanted to be cared for properly and, at the end of their lives, to die peacefully and with dignity. Ann Abraham tells us that what the people involved have in common is their experience of unnecessary pain, indignity and distress while in the care of the NHS.

The second of the 10 stories is that of Mr D, and it particularly focuses on the last five days of his life. He was admitted four weeks earlier with a suspected heart attack but after tests was diagnosed with advanced stomach cancer. He was to be discharged from hospital on the Tuesday after the August bank holiday weekend, but it was brought forward to the Saturday. The summary of the story in the report is harrowing. The discharge of, we must remember, a man with only a few days to live was a shambles. The report goes on:

“On the day of discharge…the family arrived to find Mr D in a distressed condition behind drawn curtains in a chair. He had been waiting for several hours to go home. He was in pain, desperate to go to the toilet and unable to ask for help because he was so dehydrated he could not speak properly or swallow. His daughter told us that ‘his tongue was like a piece of dried leather’. The emergency button had been placed beyond his reach. His drip had been removed and the bag of fluid had fallen and had leaked all over the floor making his feet wet. When the family asked for help to put Mr D on the commode he had ‘squealed…’ with pain. An ambulance booked to take him home in the morning had not arrived and at 2.30 pm the family decided to take him home in their car. This was achieved with great difficulty and discomfort for Mr D.

On arriving home, his family found that Mr D had not been given enough painkillers for the bank holiday weekend. He had been given two bottles of Oramorph (morphine in an oral solution), insufficient for three days, and not suitable as by this time he was unable to swallow. Consequently, the family spent much of the weekend driving round trying to get prescription forms signed, and permission for District Nurses to administer morphine in injectable form. Mr D died, three days after he was discharged, on the following Tuesday. His daughter described her extreme distress and the stress of trying to get his medication, fearing that he might die before she returned home. She also lost time she had hoped to spend with him over those last few days.”

The summary of this case sounds terrible, but the detail was much worse. The family were my constituents and I supported the family’s complaint after meeting Mr D’s daughter. Every aspect of this case showed the NHS in a very negative light.

Let me give a summary of the detail in Mr D’s case, as reported to the ombudsman. Mr D was not helped to use a commode and fainted, soiling himself in the process. He was not properly cleaned and his clothes were not changed until the family requested that the following day. The ward was dirty, including a squashed insect on the wall throughout his stay and nail clippings under the bed. He was left without access to drinking water or a clean glass. His pain was not controlled and medication was delayed, sometimes by up to one and a half hours. Pressure sores were allowed to develop. No check was made on his nutrition. His medical condition—the fact that his illness was terminal and that he had only a few days left—was never properly explained to his family. He was told of his diagnosis on an open ward, overheard by other patients.

I spoke about this case in a debate about the NHS Redress Bill, and I agree with the comments that the hon. Member for Stourbridge made about accountability. Where was the accountability in this hospital? Where was the ward manager or matron figure who was letting these things happen?

At this point, Mr D’s daughter, a constituent, came to me for help. She desperately needed an answer and an explanation of what had happened. As her MP, I felt the hospital needed to admit its errors and take measures to ensure that what happened to that patient did not happen to anyone else. Regrettably, in the months that followed, the hospital seemed unable to do that. In fact, the dreadful failures in care and communication were made worse by the inadequate way the hospital dealt with my constituent’s complaints, as I reported to the House in that earlier debate.

After raising her complaint with the hospital, my constituent found that responses from it were not sent in keeping with agreed time scales and often took three or four weeks longer than it had promised. Copies of responses from the hospital were never sent to me, and I had to chase every single one of those responses, which were often inadequate. That was the worst thing for this bereaved family, because the delayed answers and prevarication from those investigating the complaints left the family feeling more angry and upset. Their anger was originally due to what they perceived as delays in diagnosing Mr D’s terminal condition and the poor treatment and care he received, but the whole thing became worse because of the way the case was handled.

The complaints the ombudsman’s report details are very serious, and I am talking about just one. In making their complaint, the family know that nothing can bring back their loved one—their father—or change the way he was treated, and families often tell us that. However, the family desperately want explanations and an apology, and they desperately want to ensure that no other parent is treated the same way.

[Sarah Newton (Truro and Falmouth) (Con)]

The hon. Lady is making an incredibly moving speech. I pay great homage to the work Ann Abraham has done in her role as ombudsman, and yet another fantastic report came out last week about the complaints procedure. Does the hon. Lady agree with the recommendation in that report that there should be far greater partnership working with organisations such as the Care Quality Commission? Does she agree that the Government could take steps in response to the findings of the consultation they have just held on the information revolution? Such measures would really help improve the complaints procedure, which would drive up standards of care.

[Barbara Keeley]

Yes, indeed. We discussed those issues in relation to the NHS Redress Bill. The difficulty we have with the most extreme cases, as I am describing in relation to my constituent, is that the medical establishment seems to close up when facing such complaints, and people become fearful that they will be sued and have problems in their careers. We must remove that way of handling such awful cases, because it is just not acceptable.

Like every MP, I understand that the Government cannot manage every consultant and every ward to make sure such things do not happen. However, they do happen, and there are many more cases than the 10 the ombudsman reports on. We must bring about a change of culture to allow for an acknowledgement of the fact that there must be better redress than there was in this case when a whole system of care and treatment fails a patient and his family, and when standards of professional practice and communication fall. The MP and the family should not have to battle the complaints system and eventually take their case to the ombudsman because only the ombudsman can ever make a hospital do what it should have done in the first place.

The family were looking for an acknowledgement, an explanation and an apology, and they wanted to make sure that these things did not happen again. It is very reasonable that they should expect that.

[Sarah Newton]

The hon. Lady is making an incredibly important point about how complaints are handled in the NHS. In highly effective organisations, complaints are considered to be gold dust, because they are part of how those organisations drive up standards and improve services. That benefits not only the patients, but staff. It is so demotivating if staff working on poorly managed wards, or in the NHS more generally, raise complaints, even through protected disclosures, and nothing happens. That can cause them stress and great personal harm.

[Barbara Keeley]

Indeed. I do not distance myself in any way from the excellent point the hon. Member for Stourbridge made in opening the debate: this is about leadership, management, training and accountability, all of which failed in the case I have outlined.

--- Later in debate ---

[Sarah Newton (Truro and Falmouth) (Con)]

It is a pleasure to serve under your chairmanship, Mrs Brooke. I am particularly grateful that you have allowed me to speak. I missed the beginning of the debate because my watch broke. It was immensely frustrating, so I appreciate you making an exception to the rule and allowing me to speak.

We have heard so many excellent speeches this afternoon and I agree with the contributions of all my colleagues. It is so refreshing to be part of this debate, which provides a contrast with yesterday’s debate on the NHS in the main Chamber. We are working together to highlight considerable concerns. I am sure that, considering the great passion that has been in evidence today, we can make a difference.

Other colleagues want to speak, so I will touch on only two areas that could be improved in the NHS. If they were improved, it could make a real difference in driving up the standard of care for elderly people. The first relates to improvements to the complaints process, and the second to a particular training need for people, whether they be doctors or clinicians, who come from overseas to work in the health service.

On the complaints procedure, highly effective organisations appreciate that every complaint is an opportunity to learn and improve. Such organisations have virtuous circles of continuous improvement, from complaint through to monitoring the improvements that they agree to make, to make sure that improvements result from every complaint that is investigated.

I have read with interest the recently published report of the parliamentary and health service ombudsman, Ann Abraham, “Listening and Learning”. It is a review of NHS complaints handled in England from 2010 to 2011. It is a hard-hitting and informative read. Ann says:

“In last year’s report…I concluded that the NHS needed to ‘listen harder and learn more’ from complaints. The volume and types of complaints we have received in the last twelve months reveal that progress towards achieving this across the NHS in England is patchy and slow.

This report shows how, at a local level, the NHS is still not dealing adequately with the most straightforward matters.”

We have heard that today. She goes on to say that two particular themes emerged. First, the most prevalent reason for complaints was a lack of effective communication, as every speaker today has highlighted. Poor communication can have a serious, direct impact on patients’ care and can unnecessarily exclude their families from a full awareness of the patient’s condition or prognosis. Secondly, in an increasing number of cases, a failure to resolve disagreements between patients and their GPs has led to their removal from the GP list. Her report cites a particularly harrowing example of somebody—a very vulnerable and elderly person—being excluded from the GP list in the last few days of their life.

More positively, Ann Abraham notes that there have been improvements in the attitudes of NHS senior management when tackling the issue of complaints handling and that there has been more partnership working with other parts of the NHS, such as the Care Quality Commission. However, clearly, much more effort needs to be put into showing NHS staff how complaints can drive up standards of patient care. The majority of doctors, nurses and other clinicians in the NHS in Cornwall, and I am sure around the country, get job satisfaction from delivering high-quality care to their patients. I have listened to nurses who suffer when they work in wards that are poorly led and monitored, and where bad practice is ignored. Worse still, when they try to tackle the situation by reporting their concerns and even making protected disclosures, nothing happens.

In remote and peripheral parts of the country, such as Cornwall, there is only one acute hospital, so staff are very reluctant to complain because there is nowhere else for them to go. That is stressful for staff and, obviously, far from good news for the patients on their wards and under their care. I am pleased and encouraged by the Care Quality Commission’s work in Cornwall. When all parts of the NHS and other care providers are registered, so long as they have the necessary resource, they will be highly effective in driving up standards of treatment and care. I would like the Care Quality Commission to have a far greater role in the NHS complaints process—for example, it should be given copies of all complaints, all protected disclosures and all death reviews in hospitals. That information is vital to helping the CQC to assess risks and manage improvements.

Where a complaint has led to an improvement being agreed, the CQC should have the opportunity to visit and spot-check to ensure it has been implemented. If the CQC were more involved in the complaints process, the quality of care and services, as well as job satisfaction for NHS staff, would be improved. The poor quality of care an elderly person might have experienced, either at home or in residential care, should also be dealt with by complaints processes that involve the CQC.

A more public communication of complaints data will also help to drive up standards of care and will give patients more important data upon which to make a choice. I am pleased that, from this month, the Department of Health has committed to publish complaints data by hospital, and that foundation trusts will also shortly be required to provide information on complaints. Like Ann Abraham, I hope that, following the Government’s consultation “An Information Revolution”, a framework for making that information available will be published. It is important to have standardised indicators and measures for both complaints and lessons learned, so that patients and staff can compare like with like. I hope that the Minister might be able to comment on that today.

The second point is about staff who come into the NHS from overseas and who have been trained overseas. Much has been reported in the media recently about the poor language skills of some of the doctors, nurses, clinicians and care workers who come into the NHS, and the problems that that causes. That is an important issue but the attitude of such staff, especially towards older people, is as significant.

Although I appreciate that the training of doctors is not the responsibility of the Department of Health, it could be part of the commissioning of services. Guidelines could be given to commissioners not only on training, but on ensuring that people coming from overseas had effective training on how to treat people with respect and dignity. The value assigned to elderly people is different in different cultures around the world, and that needs to be addressed when employing people in the NHS. I am aware that many colleagues want to contribute, so I shall conclude my comments there.