Older people

Regulator calls for better care for the elderly

Many newspapers today covered a new report on the standard of care that older people receive in hospital. The report by the Care Quality Commission (CQC), the health watchdog, found that half of all hospitals that it looked at failed in standards of care for the elderly.

The CQC said it was ‘heartened’ by the amount of good and excellent care it saw. However, it found that about half of the 100 hospitals it looked at needed to do more to ensure they were meeting people’s needs. Of these, 20 hospitals failed to meet the essential standards of care for the elderly for either dignity or nutrition. Two hospitals, Sandwell General Hospital, in West Bromwich, and Alexandra Hospital in Worcestershire, were identified as having ‘major concerns’.

Dame Jo Williams, the chair of the CQC, said, ‘The fact that over half of hospitals were falling short to some degree in the basic care they provided to older people is truly alarming, and deeply disappointing,’ Dame Williams stated that the report must result in action.

Andrew Lansley, the health secretary, said, ‘Everyone admitted to hospital deserves to be treated as an individual, with compassion and dignity. We must never lose sight of the fact that the most important people in the NHS are its patients.’

Dame Williams suggested that many trusts are already responding to the problems that were found and that inspection teams are following up to check whether improvements were being made. However, she also said that the system as a whole must change to ensure that these failings are not repeated.

What did the inspections find?

Of the 100 hospitals inspected:

  • 45 hospitals met both standards (they were ‘fully compliant’)
  • 35 met both standards, but needed to improve in one or both
  • 20 hospitals did not meet one or both standards (they were ‘non-compliant’ with improvements required)

During the initial inspections, two hospitals were identified as having 'major concerns'. These were Sandwell General Hospital in West Bromwich and Alexandra Hospital in Worcestershire. A subsequent follow-up inspection to Alexandra Hospital found that action had been taken to address these concerns and the hospital is now meeting the essential standards.

At Sandwell, one incident that inspectors observed involved a patient who had been incontinent remaining unwashed for an hour and a half despite asking staff for help. The ward on which this occurred has now been closed.

A third hospital, James Paget University Hospitals NHS Foundation Trust in Great Yarmouth, has been issued with a warning notice threatening prosecution unless swift improvements are made. This followed a second visit to the hospital, during which it was found that patients were not getting adequate help with eating and drinking and that patients in need of intravenous fluids did not have them administered.

What were the main problems identified?

The report highlighted some of the key problems in hospitals failing to meet essential standards.

Regarding patients' dignity it said that:

  • curtains were not properly closed when personal care was given to people in bed
  • call bells were often out of patients' reach or not responded to in reasonable time
  • staff spoke to patients condescendingly or dismissively
  • there were not always enough staff with the right training on duty to spend enough time giving care

Regarding patients' nutritional needs it found that:

  • people were not given the help they needed to eat
  • patients were interrupted during meals and having to leave their food unfinished
  • nutritional needs such as requirements for specialist diets, were not assessed properly
  • records of food and drink were not kept accurately so the patients' progress was not monitored
  • many patients were unable to clean their hands before meals

What did the CQC conclude?

Dame Jo Williams, chair of CQC, concluded: "The fact that over half of hospitals were falling short to some degree in the basic care they provided to older people is truly alarming, and deeply disappointing."

The report identified three underlying themes that can lead to poor care:

  • Lack of leadership: the report said that in some hospitals, unacceptable care had been allowed to become the norm.
  • Staff attitudes: "Time and again we found cases where patients were treated by staff in a way that stripped them of their dignity and respect," reported Dame Williams. She added that care has become task-focused rather than person-centred, and often "puts paperwork over people".
  • Resources: the report pointed out that having plenty of staff does not guarantee good care, but not having enough staff 'is a sure path to poor care'.

The CQC said that leaders in hospitals at all levels must create a culture in which good care can flourish, and staff should be trained and managed in a way that nurtures high-quality care. It says that staff must have the right support if they are to deliver compassionate and effective care and managers must ensure budgets are used wisely to support frontline staff.

Where can I find the list of hospitals?

The CQC assessed the following hospitals as a ‘major’ or ‘moderate’ concern.

Major concern

  • Alexandra Hospital, Worcestershire Acute Hospitals NHS Trust
  • Sandwell General Hospital, Sandwell and West Birmingham Hospitals NHS Trust

Moderate concern

  • Barnsley Hospital, Barnsley Hospital NHS Foundation Trust
  • Bedford Hospital, Bedford Hospital NHS Trust
  • Colchester General Hospital, Colchester Hospital University NHS Foundation Trust
  • Conquest Hospital, East Sussex Hospitals NHS Trust
  • Darent Valley Hospital, Dartford and Gravesham NHS Trust
  • Eastbourne General Hospital, East Sussex Hospitals NHS Trust
  • Great Western Hospital, Great Western Hospitals NHS Foundation Trust
  • Ipswich Hospital, Ipswich Hospital NHS Trust
  • James Paget Hospital, James Paget University Hospitals NHS Foundation Trust
  • John Radcliffe Hospital, Oxford Radcliffe Hospitals NHS Trust
  • Norfolk and Norwich University Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust
  • Ormskirk and District General Hospital, Southport and Ormskirk Hospital NHS Trust
  • Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust
  • Royal Free Hampstead Hospital, Royal Free Hampstead NHS Trust
  • South Tyneside District Hospital, South Tyneside NHS Foundation Trust
  • Stepping Hill Hospital, Stockport NHS Foundation Trust
  • University Hospitals Bristol site, University Hospitals Bristol NHS Foundation Trust
  • Whiston Hospital, St Helen’s and Knowsley NHS Trust

What will happen now?

All the hospitals where concerns have been identified are obliged to tell the CQC what plans they have to improve standards of care and in what time schedule. Hospitals failing to meet essential standards could face prosecution if improvements are not made.

The CQC said its inspection teams are actively following up hospitals where they had concerns to check if planned improvements have been made.

"This report must result in action," said Dame Williams. "The CQC will play its part by holding hospitals to account for poor care when we find it – our survey of trusts suggests many are already responding. But the system as a whole – those who are responsible for making sure care meets essential standards and those who commission that care – must respond if we are not to find ourselves here, yet again, a few years down the line."

What’s the difference about this report and the report published in May?

This is the second CQC report this year looking at quality of hospital care provided to older patients. Last December, the CQC was asked by the secretary of state for health to look at standards of nutrition and dignity in NHS hospitals. A series of unannounced inspections were carried out in England between March and June 2011.

The earlier report, published in May, looked at standards in 12 hospitals from around the country. The latest report gives the full set of inspection results for all 100 hospitals and an analysis of the overall findings and recommendations.

How were the inspections carried out?

Inspection teams from the CQC made spot checks at 100 hospitals. The hospitals were chosen according to whether the CQC’s own records indicated they might be at risk, as well as information from the advisory group. Information from an earlier report from the Health Service Ombudsman was also used. Some hospitals were selected randomly.

Each hospital was assessed against CQC standards in two areas; dignity (whether the patients were respected and involved) and nutrition for inpatients. The teams were made up of a CQC inspector, a practising and experienced nurse and an ‘expert by experience’. This was someone with experience of care or receiving care who had been trained and supported by Age UK.

An external advisory group of organisations representing patients, providers and professionals also supported the programme.

Generally, the CQC checks if its standards are being met by listening to what people say about care and looking at relevant data – such as patient records – to identify possible risks.

When observing the wards’ approach to respecting and involving patients, the CQC focused on the following areas:

  • Did staff behave in a way that respected patients’ dignity?
  • Were call bells within reach, audible and responded to properly?
  • Did patients have their privacy respected?
  • Were staff appropriately trained?
  • Were patients involved in decisions about their care, including being asked their views and preferences?

When observing the wards approach to nutrition, the CQC focused on areas such as:

  • Were records of food and drink intake accurate?
  • Were patients offered the chance to clean their hands?
  • Were procedures for identifying patients at risk followed and was appropriate action taken?
  • Did staff have time to support patients?
  • Were patients who needed support given it?

Each inspection covered two wards for older people in each hospital, and was carried out on a single day. Teams arrived unannounced at 9am and stayed until 4pm, making sure they observed at least one meal, usually lunchtime. They carried out interviews and recorded their observations of the quality of the care they witnessed. Patient records were also examined to look at whether care planning took account of their wishes.

What is the Care Quality Commission?

The CQC is the independent regulator of health and social care in England. Its job is to maintain and improve standards of care, whether in hospital, in care homes or at home. To this end, it regulates providers of medical and clinical treatment and providers of residential care.

The CQC licenses all providers of care services only if they meet essential standards of quality and safety. It then monitors them to ensure they continue to meet those standards.

The current Dignity and Nutrition inspection programme was launched by the CQC in response to a request by the secretary of state for health, following previous concerns raised about the care of the elderly. Its aim is to provide a snapshot of the quality of care that older people are receiving in hospitals.

What can I do if I am unhappy with my care or the care of an elderly relative?

If you are not happy with the care or treatment you or an elderly relative has received or you have been refused treatment for a condition, you have the right to complain, have your complaint properly investigated and be given a full and prompt reply.

If you are not satisfied with the way the NHS deals with your complaint you can take it to the independent Parliamentary and Health Service Ombudsman.

Under the NHS Constitution you can also make a claim for judicial review if you think you have been directly affected by an unlawful act or decision of an NHS body, and receive compensation if you have been harmed.

The NHS has its own complaints procedure, which is always the first step for any complaint. You can find detailed information about the NHS complaints procedure on NHS Choices. You can also raise your concerns by contacting regulatory bodies such as the Care Quality Commission.

NHS Attribution