Management and clinical staff at a facility in Manchester for elderly people with mental health problems have been accused of neglect by allowing the long term physical and emotional abuse of their most vulnerable patients.
Patients on Rowan ward, a mental health unit for old people run by Manchester Mental Health and Social Care Trust, endured “old fashioned” and “regimented nursing care,” says a report from the Commission for Health Improvement.
Abuse at the unit, which closed in December 2002, took several forms and included hitting, stamping on feet, intimidating language, withholding food, and playing on patients' known anxieties, says the report.
The commission was called in to investigate claims of abuse at the same time that the trust decided to close the ward because it could no longer guarantee the safety of the patients there.
The investigation in Manchester is the third into the care of vulnerable elderly people around the country, and inspectors fear that many similar situations exist elsewhere.
Acting chief executive of the commission, Jocelyn Cornwell, said, “The care received by vulnerable older people on Rowan ward was unacceptable, but we are seriously concerned that circumstances surrounding this investigation are not unique.
“The care of older people nationally is very concerning. NHS managers and commissioners should take a good look at this report and ensure recommendations are embedded in their own services. Organisations must learn to monitor closely what happens on older people's wards and open up wards to external visitors and patients' advocates.”
Rowan ward had many of the known risk factors for abuse, including a poor, institution-alised environment, low staffing levels, high use of bank and agency staff, little staff development, poor supervision, lack of incident reporting, and a closed and inward looking culture, said the report.
To improve patients' health and safety the commission recommends that trusts, strategic health authorities, and other NHS bodies should develop a reporting system for when things go wrong and ensure that staff practise modern evidence based care.
The trust at the centre of the report has pledged that its programme of internal changes, which was set up after the report was commissioned, will ensure that incidents such as those reported on Rowan ward never happen again.
The trust has recently reviewed its nursing practice and has introduced training for staff working on wards for elderly patients. It has also set up a central incident reporting system. Between February 1999 and July 2002 no records of any incident on Rowan ward were kept, and serious injuries such as scalds, bruises, and patients leaving the ward without consent went unacknowledged.
A new medicines management policy is also being employed to avoid unqualified staff handing out drugs, as allegedly happened in the past.
Sally Chisholm, head of mental health commissioning for Manchester, said on behalf of the three primary care trusts and the local authority: “There was a serious systems failure that allowed these events to happen, and all the organisations involved bear some responsibility.”
The report on Rowan ward is at www.chi.nhs.uk