Editorial: care of older people

Abstract

This edition’s content has a strong emphasis on medicolegal issues concerning older people. We are particularly grateful to Dr Rai and Dr Abdulla for their article on care of the elderly in the context of the Mental Health Act and Equalities Act, and to Dan Bennett for his article on claims concerning neglect of the elderly. By the time this edition is published, the report from the public inquiry into Mid Staffordshire NHS Foundation Trust should also have been published. AvMA was a core participant in the inquiry and we are confident that the submissions we and others made regarding the care of older people will not be lost on the Chairman, Robert Francis QC. While Stafford was unique as regards the sheer scale of neglect and breakdown of clinical governance, regulation, professionalism and compassion, elements of what went on at Stafford can be found in many of our hospitals. AvMA sees this day in day out in the casework and helpline calls we deal with. A common theme in so many of them involves what can only be called “neglect”, and all too often this is with regard to older people. The Reports by the Care Quality Commission “Dignity and Nutrition for Older People” (October 2011) found that less than half of the hospitals inspected were fully compliant with essential standards. The standard of care that some older patients receive in some of our hospitals has rightly been described as truly shocking and alarming. The question that many of us, not least Robert Francis QC, have been grappling with is “How can things get this bad in a service which, for the most part, can be proud of its excellent care?” and “How can we prevent this?” One of the pieces of evidence to the inquiry which most struck me was that of a young male student nurse. His comments found resonance with the vast majority of the great and good assembled by Robert Francis QC for a workshop on care of the elderly. He decried the way that nurses are recruited based mainly on their academic ability rather than their caring attitude; the inadequate practical experience in training; and the low esteem given to those doing the “basics” of nursing, caring for the elderly. Clearly, it is not just about these issues, but they do seem to be a credible critique of the current situation. Personally, I also think that we should not allow anyone to forget that staffing numbers has a crucial role to play. We must have clear guidelines and minimum requirements regarding staff numbers on wards. However, I am not sure all of this answers the question that perplexes me, as to how anyone who calls themselves a health professional can ignore the calls for help from a sick older person or leave an older patient lying in a soiled bed. It will be interesting to see how far the inquiry report moves us forward.