Here is a letter I wrote about a patient who was discharged from hospital last year. I was quite upset, as you can tell. Names have been changed to protect confidentiality, but it’s otherwise exactly what I wrote:
Dear Consultant/ ward sister/ Hospital Chief Exec.
I visited Mr Bloggs at home today just a few hours after he was discharged from 2 weeks on Ward 3 under your care. When he arrived home he looked as if he had spent 2 weeks sleeping on the floor of a hostel for alcoholic sailors rather than on the acute ward of an NHS hospital. He had an enormous beard, he was absolutely filthy and he was disorientated. If I had taken photographs of him and sent them to the national newspapers there would be no doubt that he would be on the front cover of all of the grubby tabloids and probably some of the more serious newspapers. I simply cannot believe that this is happening on your watch to one of my patients. His carer spent over 2 hours cleaning and shaving him when he got home and I went round to visit as soon as I could so I could help to make sense of the mess of his medications.
I would be grateful if you could give me your considered response and assurance that this won’t be happening again.
Mr Bloggs, has metastatic cancer and is quite easily disoriented. He is quiet, gentle and uncomplaining, like many elderly people.
I’ll quote from the letter of response:
Mr Bloggs medical and nursing notes are comprehensive and note that he was assisted with personal needs. … a heavy beard is not recalled … he was regularly monitored and well attended to … he did not voice any concerns … he engaged well with staff and there were no reports via staff of dissatisfaction. I appreciate patients do not always feel comfortable raising concerns but usually there are indicators that staff will pick up on.
Mr Bloggs social worker … has also confirmed that Mr Bloggs did not raise any concerns about his care on the ward.
I am sorry that there is such concern about Mr Bloggs care. I appreciate that this may be an unsatisfactory response from me and I certainly do not wish to be, or appear, defensive.
There are a few important points I think come from this.
1. Many elderly patients, like Mr Bloggs, do not complain, or ask for things they need. The have to be looked after, they need doctors and nurses to advocate for them and to be pro-active about their care rather than waiting to be asked for help. The political project to convert patients who need looking after into consumers who can advocate for themselves needs greater criticism.
2. Shocking as this may seem, it is possible for people to be neglected while everybody is following procedures and for nobody to notice. Box-ticking medicine and nursing cannot ensure personal care.
3. Patient choice (part of the project to convert patients into consumers) is not likely to improve the situation, Mr Bloggs and others like him, will keep going back to the same hospital and being neglected. There are no shortages of patients like Mr Bloggs. As a local GP I want my local hospitals to improve the quality of care, it simply isn’t practical for many of my patients to go to another hospital next time they are critically ill. See this post for an example of patient choice worsening inequalities.
4. In my practice, every complaint is subject to a ‘critical and untoward incident analysis’ with a plan drawn up to try avoid something similar happening in future. Hospitals need to respond to complaints in a way that demonstrates action is being taken to prevent the same problem happening again and they need to be assessed, as we are, to ensure that action is taken.
5, Hospitals must, urgently improve the personal care of patients. The neglect of the elderly quite rightly horrifies us. It is inexcusable. But if we want better personal care, we need more nurses (or more care assistants) and we have to pay for them. This is impossible whilst the government are trying to achieve the cheapest universal healthcare in Europe by making £20bn cuts and spending £3bn on a massive re-disorganisation.
6. My patients complain about hospital care quite a bit. Only rarely is it necessary for me to complain on their behalf.
BMJ blog by Allison Spurier. Caring for Older People