Why have some nurses stopped caring? An investigation into crisis-hit NHS
My 89-year-old mother has suffered with dementia for the past seven years. Over that time she has been in and out of hospital. Some of her care has been excellent, but some has been shocking.
Once, when she collapsed, she was taken to Kingston Hospital, in South-West London. After a long and stressful evening in A and E, a bed was eventually found for her at midnight.
What a relief, I thought she was safe and I could go home. As I stooped to whisper goodbye, a nurse shoved something in my face. ‘Sign this,’ she said bluntly. It was a form to absolve the hospital for any loss of my mother’s valuables.
Instead of relief, I now had to worry that someone might wrench her wedding ring off her finger, so much for a place of safety.
If her admission was worrying, it was the manner of her discharge which was particularly shocking. Although I had told the ward I would collect her when I finished work, the nurses dressed her and allowed her to leave alone.
When I arrived at the hospital a nurse told me that my mother had said she would go home by bus and they had let her go. I rushed off to see if I could find her but without success. The hospital then alerted the police. She eventually turned up at her home, four hours after she had left the hospital.
I never witnessed any deliberate cruelty towards my mother during her many spells in hospital. Yet aspects of her care were still horrifying. Some of the staff were ignorant, apathetic or both. Nor was there proper continuity between the different people who saw her, or clarity about who had overall responsibility for her case.
It’s a telling reflection on our hospitals today that whenever my mother seems ill now, I try to avoid any actions that might lead to a hospital admission.
Evidence has been piling up recently to suggest that something is seriously, and systemically, amiss in our hospitals. This week, the scathing report on the Stafford Hospital Scandal, after abuse and neglect led to the unnecessary deaths of hundreds of patients said ‘fundamental change’ was needed in the NHS.
It condemned ‘failings at every level’ and contained 290 recommendations for reform. However, Robert Francis QC’s report was merely the latest damning indictment of the health service.
In November 2012 the Care Quality Commission found that ten per cent of hospitals and 15 per cent of care homes weren’t treating their patients with respect. Health Secretary, Jeremy Hunt, warned that cruelty and neglect had become normal in some hospitals and care homes.
So endemic is the problem that the country’s chief nursing officer, Jane Cummings, has been forced to tell nurses that they must put patients first, releasing guidelines which remind them that compassion and care are part of the job. As shocking and ineffectual as this may seem, the comments are long overdue.
Reports in 2011 from Age UK and The Patients’ Association exposed some horrendous instances of abuse and neglect not only enforced incontinence and unanswered buzzers, but patients left hungry and thirsty or in soiled bed-linen.
In one dreadful case, a desperate patient had drunk the water in a flower vase. The Care Quality Commission’s subsequent investigation made it clear that these failings were widespread.
How have we reached this situation where our hospitals, which ought to be places of refuge and care, seem frightening and potentially dangerous? What’s happened to nurses who were once the embodiment of compassion? How could people employed to care, leave elderly patients confused, frightened and hungry?
Liz Pryor witnessed the appalling treatment of her 79-year-old mother, Anne Robson, in West Suffolk Hospital after a minor fall. She believes her mother died because of the neglect she experienced in hospital, and thinks that the failings there come from a failure at a deep social level from a failure of kindness.
Liz’s mother was admitted to a ward where the norovirus infection was present. As a result, Liz was barred from the ward, where her mother became increasingly confused as she waited for decisions about her treatment.
Nurses told Liz that her mother was ‘unfit for theatre’ and needed to be kept in hospital until she was fit. But after a few days, it emerged that they’d misread the doctor’s notes which actually said ‘not for theatre’ (the doctor established that no bones had been broken).
By then, Anne had developed a stomach upset and was moved to an isolation room. Desperate to see her, but forbidden to enter the room, Liz wrote her mother a card, expressing her love and trying to explain the situation. She handed it to a nurse who promised to read it to her and to make sure her mother had water.
Until this point they had been able to speak by phone, but a problem with the transfer of telephone credit meant her mother was initially unreachable in her isolation room. The family desperately tried to find out what was happening and were given contradictory information about Anne’s condition.
Since no operation was actually needed, Liz is convinced that her mother’s stay in hospital was unnecessary. She also believes it was fatal.
When the family finally reached her by phone, they were horrified to find their’coherent, stoical and uncomplaining’ mother had become confused and distressed. Weeping, she told them she had been left in a wet nightie, handled roughly, not had anything to drink and had no idea what was happening to her.
A few days later, Anne was suddenly released onto the ward even though Liz had been told that her mother would have to have been free of the virus for 72 hours before she would be allowed out of isolation. More surprisingly, Liz was suddenly told that Anne was well and fit for discharge.
In fact she was parched, horrifyingly thin and incoherent. The family hired a private ambulance to get their mother back to what they now saw as the safety of her care home but sadly, Anne Robson died just hours later.
Liz was broken-hearted that what had been a hospital admission for a minor fall ended in the death of her mother isolated, confused and seemingly deprived of human compassion. The final straw was discovering her unopened card among her mother’s belongings. The nurse had never read it to her.
So, do these distressing stories reflect a society which has lost its moral compass? Where kindness and compassion are no longer even part of a caring profession? Or is the reason more structural? Is it poor training or poor management? Or is it new pressures on nurses?
On occasions with my own mother, I witnessed wonderful nurses acting with the generosity of spirit always associated with their profession.
Television series show nurses dealing with demanding situations, often responding with touching devotion. In a way, that makes these accounts of cruelties all the more puzzling.
It is deeply worrying that bad practice crops up so often when many nurses still have the right values. Deeply worrying, too, that some nurses, including one I spoke to for this article, say they don’t feel it’s safe to blow the whistle on incompetent colleagues.
Talking with a cross-section of hospital staff, older nurses told me where they feel the problems lie. They say it is not so much a question of cruelty and neglect, although they acknowledge that this can exist but more that ward culture has changed.