Splashed on the front pages of two national British newspapers this morning is a truly alarming report by about the care people with dementia receive in care homes and hospitals, by the Care Quality Commission. The Commission said it found widespread neglect, lack of care and training.
My eyes opened wide. Is this the same Commission that was accused of bowing to political pressure and orchestrating a cover up a few years ago? That concealed the fact that a quarter of NHS Trusts were failing to meet basic hygiene standards, and that destroyed evidence of its failure to prevent the death of 16 babies at a hospital maternity unit in Cumbria?
Times are changing and this government quango has reformed, I thought. Then I read the article more carefully and thought further.
It says that: ‘It is likely that someone living with dementia will experience poor care at some point while living in a care home or being treated in hospital.’ That could be true of anybody who has to go into hospital, though it needs to be said that most of the time our doctors and nurses give excellent care and treatment. But people with dementia aren’t able to speak for themselves, which is what makes the report so poignant.
The report said that 42 per cent of hospitals and 34 per cent of care homes are failing to deliver consistent care. CQC inspectors visited 129 care homes and 20 hospitals across England.
There are 20,026 care homes in England, and 168 NHS ‘acute Trusts’ – main hospitals. http://www.nhs.uk/servicedirectories/pages/acutetrustlisting.aspx
42 per cent of hospitals and 34 per cent of care homes were failing to deliver consistent care, so the percentage in hospitals was higher than those in care homes, even considering the relatively small sample of care homes inspected.
It’s long been known that when people with dementia have a hospital stay their condition deteriorates. How could it be otherwise, when they find themselves in a strange place with strangers in beds alongside them, with noise and bustle and all the things that are known to be stressful for people with dementia? Even people without dementia find hospitals a strain.
When one of our housing residents was in hospital the care manager became so concerned about her deterioration that, once the tests had been done and nothing had been found, she arranged to meet the lead doctor to discuss bringing her back home.
She was only just in time. The consultant was considering transferring the resident to an EMI (elderly mental infirm) ward. Once back in her familiar own home, with the domiciliary care she needed, the fellowship of others at the daily devotions (this lady loves company) she improved by leaps and bounds.
What the report doesn’t say is that acute hospitals don’t have enough staff to give the intensive care and attention that dementia patients need. This was highlighted four years ago, with the campaign to ban anti-psychotic drugs. Writing in the Telegraph, hospital doctor Max Pemberton pointed out that It’s right that doctors should use less anti-psychotic drugs on dementia patients, but that ‘our hospitals are woefully unprepared for the extra care this move entails.’
He describes a man who had been brought in after being found wandering and had to be admitted to an acute medical ward and be sedated while we waited.’ I’d like to tell you that this is unusual, but it is not. The reason for this situation is that in recent years trusts have dramatically reduced specialist old age mental health provision,’ he added. ( http://www.telegraph.co.uk/health/8093523/The-dangers-of-cutting-the-chemical-cosh.html)
It’s hardly surprising then, that patients’ mental, social and emotional health is being neglected. It hasn’t got any better since then. NHS Trusts have been closing Old Age Mental Clinics and merging them with all-age units, a move condemned by the specialist consultants involved. You’d need to be living on a desert island not to have noticed how stretched NHS hospitals’ resources have become.
The report doesn’t mention anything like this. Its survey on care homes is an extrapolation of just 129 visited, out of 20,026. And as a letter in last month’s Caring Times pointed out, most are doing a first rate job.
It looks to me that CQC has just swiped the top off the challenge and presented a report that shows they are now doing something. But at best it’s something we already know, and at worst, castigates health care professionals and care homes who are doing a great job while struggling with the twin pressures of gross underfunding and increasing demand.
Let me leave you with an encouraging and uplifting little clip on just one of our care homes. This is a standard day in one of our ‘standard’ homes.