Editorial by McKenna
Are we prepared to accept inhumane hospitals? Are we prepared to condone staffing levels which we know will inevitably push staff beyond the limits of their stamina and compassion, and will cause patients to suffer?
During the Christmas period of 1997, Simon, the husband of a good friend of mine, died in hospital, 12 days after his admission and nine days after major surgery. During his hospital stay two other patients died in his bay of the ward. One was in the bed next to Simon. In the few hours before his death he was incontinent of faeces six times. The man found this distressing and repeatedly apologised. Although a nurse cleaned him up each time, his body was left on the ward for two hours after his death, during which time Simon was aware of the strong smell of his faeces. It would have been preferable for this man to have died in a single cubicle, but none was available. Witnessing his distress and loss of dignity must have been terrible and worrying for the other inpatients.
Witnessing poor care either brutalises you or outrages you
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The body of the other man was left on the ward for an hour and a half after his death. When his wife came in, no nurse was around, and she threw her arms around Simon for comfort, an experience for which he was unfit, physically or emotionally.
A man with Alzheimer’s disease was in a bed opposite Simon. He kept pulling out his catheter and he had blood all over his pyjamas. When my friend told a nurse about this, her reply indicated that it was expected that the other patients would look after him. He was very disturbed at night. Simon and another patient resorted to sleeping in the day room. Another patient was so upset by the man with Alzheimer’s that he discharged himself and drove home, 250 miles away, just 24 hours after his operation.
I helped Simon’s widow and daughter to write a letter setting out the above events and examples of other problems: lack of continuity of care; staff remarks which were erroneous, misleading, or dismissive; and conflicts between the medical and nursing staff. The aim of the letter was to try to prevent other patients and their relatives experiencing similar problems. We met the consultant in charge of Simon’s care, and subsequently the manager of patient consumer affairs and the ward sister. We learnt that the letter had caused the chief executive great consternation, and he had immediately called a meeting to arrange for the problems to be investigated.
It transpired that the nurse staffing levels during the Christmas period were higher than usual. To some extent this was offset by the large number of emergency admissions and the relatively high dependency levels of the inpatients—all the low dependency patients had been sent home. The conclusion was that the staffing levels were adequate and comparable with other times, so that no action was required or would be taken.
The ward sister and the manager of patient consumer affairs agreed that the events we described fell below acceptable standards of human decency, but were likely to be repeated time and time again. (This is borne out by the reports I hear from patients and relatives.) The only thing which could change the situation would be more staff, and this could be achieved only with an increase in funding, which seems unlikely.
I see the problems getting worse. Until recently, the NHS could rely on an endless stream of altruistic young women joining the nursing profession to replace those who were “burnt out” and disillusioned. The training now consists of less service provision and more teaching. Furthermore, recruitment and retention are becoming increasingly difficult.
Some wards provide better care than others. Additional funds—for example, from charities—and voluntary workers can make a difference. I believe, however, that we should not accept hospital environments which threaten the dignity and humanity of patients and staff. Surely we need a system for monitoring standards of care (not just of clinical competence) with in-built accountability. No one can guarantee that a traumatic experience will never be repeated, but we can identify situations which we consider to be unacceptable and take steps to reduce the risk of recurrence to a minimum. This means better staffing levels, or better management, or both.
Witnessing poor care either brutalises you or outrages you. I am outraged, and want to see acknowledgement of the problem and appropriate action.
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Rarely time to talk