'Whistleblowing in Care' conference

Care in the community is coming under particular scrutiny at the moment, and rightly. It is essential that all organisations and individuals have someone to turn to where safeguarding concerns or issues arise. Having an independent body with the experience to advise is even better. Here, the Whistleblowing in Care Conference 2011 examines how to report issues in the care sector and what organisations can do to ensure they have appropriate systems and safeguards in place.

Plans for greater scrutiny of elderly care in England

From BBC News Health 11 December

Plans to "radically drive up" standards of social care in England to protect the elderly have been unveiled by the government.

They include an online "good care guide" to allow family members to rate and review care homes and providers.

Age UK "broadly welcomed" the rating suggestion but called for more funding to improve the independent regulator.

Meanwhile, the Archbishop of York, Dr John Sentamu, has called for reforms in the way care is funded.

Care Services Minister Paul Burstow said the government's new plans would help to tackle "quality and mistreatment".

The ideas - proposed during workshops of care users and their relatives - will form plans for a new patients' rights group, Healthwatch.

They will go on to form the basis of a white paper in the spring.

As part of the plans, ratings for care and dignity standards for residential homes and home care providers would be published online, similar to the way websites used for booking holidays do.

It would include the latest information from inspections, plus any record of mistreatment or abuse by staff, as well as feedback from care users and relatives.

Under the proposals, local Healthwatch scrutiny teams would visit and speak to residents about their experiences. Committees featuring relatives of care users will also be formed to scrutinise services that do not meet standards.

However any formal inspection would still rest with the Care Quality Commission (CQC), the independent regulator of health and social care services in England.

Ministers hope it will provide a "more qualitative assessment" from the point of view of residents and their loved-ones of local care standards and would "empower people as never before" to choose the right care.

Healthwatch will, by law, be able to use duties placed on care homes which contain state-funded residents to let representatives into their premises for visits.

Ministers say they will look into options for allowing Healthwatch onto the premises of the minority of care homes with private-only residents.

"It can't be right that you can find out exactly what a hotel or restaurant is like, in just a short time searching the web, but people have so much trouble working out the standards of different care homes and home care providers - when that choice is so much more important. Mr Burstow said: "Measures like publishing social care comparison sites and opening care services up to greater scrutiny will revolutionise the way people and their loved-ones choose their social care.

He said as well as highlighting good quality care providers, "we're intent on doing absolutely all we can to shine a light on bad treatment and raise quality for everyone".

National standard

In an open letter to the prime minister, the Archbishop of York said the report by the Dilnot Commission, which recommended a £35,000 cap on individual contributions to social care costs, "had shown us the way forward".

The Dilnot Commission was a government-backed review into the long-term funding of care in the elderly.

It recommended that social care costs in England should be capped so people do not face losing large chunks of their assets but ruled out calling for care to be free.

The report also argued there should be a national standard so everyone had the same access no matter where they lived.

Dr Sentamu said: "The current adult care funding system in England is widely acknowledged to be unfit for purpose and to need urgent and lasting reform.

"What is needed is a system for funding care which enables the risk to any one individual to be pooled, through taxation or insurance or, preferably, a mix of them both," he added.

On Sunday morning Dr Sentamu tweeted: "I am calling on the Prime Minister, and taxpayers in England, to help reform funding of care for older people."

Age UK, the older people's charity, said it did not want to see the proposals detract from the work the CQC already does.

"Age UK broadly welcomes the care home rating suggestion as a potentially useful addition to the existing system of care quality commission inspections and we have been calling for elements of the proposals for a while," a spokesman said.

"But most important is radical and urgent reform to ensure a fair and sustainable care system for the future, which is why we are calling for a white paper in the spring which embraces the recommendations of the Dilnot Commission."

EHRC Report

Report highlights home care failures

by http://www.nhs.uk

Wednesday November 23 2011

Lapses in home care 'may breach human rights'

A number of elderly people are being let down by home care services, an inquiry by the Equality and Human Rights Commission has found. The commission reported that around half of the older people and relatives interviewed were highly satisfied with their standard of care. However, in a minority of cases there were significant lapses in the care some received.

Among the problems reported were older people being left unwashed, denied assistance with eating and without a say in the way they were treated. In a few isolated cases, elderly patients reported physical abuse and having money systematically stolen.

The report is one of a series of damning examinations into elderly care to be published in recent months. Investigations by the Patients’ Association and Care Quality Commission (CQC) both found major lapses in medical care for the elderly.

It is important to stress that this report, like other recent investigations, found that the overall standard of care was good and that these types of incidents are not necessarily widespread. However, the CQC has said people have a right to expect a certain standard of care and that it wants to ensure that all elderly people are being treated with dignity and respect. Earlier this week the regulator launched a major inspection programme to monitor home care services for the elderly.

Why was the inquiry performed?

The Equality and Human Rights (EHRC) says that a great deal of attention has been paid to the human rights of older people in institutional settings such as hospitals, and residential and nursing care, but that there is a significant risk that older people could have their human rights infringed while receiving care at home.

To assess the situation the EHRC examined a broad evidence base gathered from 1,254 individuals, local authorities, care providers and other organisations across England. As is the case with all surveys of this type and size, there is the potential that the results do not accurately reflect what is happening across the wider population.

 What experiences does the report highlight?

The EHRC says many older people reported being highly satisfied with their home care and that good quality home care has undoubtedly had a hugely positive impact on their lives.

The report noted though that while they may not be typical of the standard of care on offer, several people reported concerning lapses in home care, including those that may breach their human rights. Below is a selection of these comments and experiences.

Support with food and drink

In one particularly bad example a 76-year-old woman with advanced cancer had to struggle across the room to heat her own food, as her care worker said she could not use the microwave due to ‘health and safety reasons’. The EHRC contacted the Health and Safety Executive, which said that it could see no reason why workers could not heat meals in a microwave.

There were also a number of reports where older people had experienced severe weight loss and dehydration because they did not get the support needed for them to eat.

Physical abuse

A small number of people surveyed highlighted instances of intentional physical abuse, most often rough handling or unnecessary physical force.

One 78-year-old woman said: “Rather than say ‘sit in the chair’, they’d push me back into the chair, that sort of thing, and I didn’t like that… It was only on one occasion – I recognised it as a push. She wasn’t nice at all… I couldn’t do anything about it. I can’t even walk and I think they know this you see; they know you’re vulnerable.”

Neglect of personal care

In a number of instances care workers did not perform the tasks set out in people’s care plans, which often feature just the basic tasks needed to ensure physical wellbeing.

The daughter of a woman in her 80s said: "One time carers decided not to do any of her washing any more, even though [it was included] on [her] care plan, leading to my mum being left in filthy nightwear and clothes and bedding.”

Another woman described how care workers often rush their work or leave early, leaving her mother “in distress, dirty and without water and food”.

Patronising or ignoring older people

At times, the way care workers addressed people was condescending, patronising or ignorant of elderly people as individuals: “Some staff ‘talk down or shout’ at my mother thinking they will ‘get through’ to her by doing so. She is an intelligent woman and isn’t hard of hearing.”

Financial abuse and theft

Groups assisting with the report, such as Action on Elder Abuse, said they had seen a number of examples where care workers had systematically stolen from elderly people, particularly those with dementia.

However, on a positive note there were instances where care workers had protected vulnerable people from being financially exploited, such as a case where an older man was having two friends take money from his pension while pretending to assist him with banking and shopping.

Lack of control and flexibility

At times people receiving care said they felt they were treated like a task rather than as a person, or not given assistance with tasks of true priority. For example, some reported being put to bed in the afternoon due to a lack of evening care slots, and in one case, a woman was refused help getting off the toilet by a worker who had instead used her appointment time to prepare the woman a sandwich.

Lack of personal sensitivity and privacy

At times people found care workers lacked awareness of people’s cultural or personal backgrounds. For example, one older gay man with dementia said he decided to stop receiving care “because of the homophobic reaction of care staff”, and many Muslim people felt they could not be sure that the prepared meals they received were genuinely Halal.

What solutions have been recommended?

The EHRC’s extensive report looks at a range of measures that could ensure better care for the elderly. Among the suggestions made by the CQC:

The introduction of improved legal protection for older people, particularly the closure of a loophole that means that home care is not subject to the Human Rights Act in the same way residential care is.

Greater consideration of the impact services will have on people’s human rights when they are being designed and commissioned. The EHRC points out that even though budgets are shrinking, many local authorities have already redesigned the way home care is delivered to make the most of the money they have and ultimately improve the standard of care elderly patients receive.

Better guidance for older people and their families to ensure they know their rights and how these should be protected.

Having recently examined standards of hospital care for the elderly the CQC announced a major programme of inspections to assess the standard of home care for the elderly. In its role as an independent regulator of health and social care, it will start its inspections in April next year, and will scrutinise the support administered by around 250 care agencies across England.

What can I do if I am unhappy with my care?

Make sure you know your rights. The EHRC says that most older people have little or no understanding of how home care works or what their options are. If you are a carer you can find more about home care on Carers Direct or by calling Carers Direct on 0808 802 0202.

Make an informed choice. Many older people feel that they have had no choice over their home care provider, especially if it has been changed. Not only can older people make choices of who their home care is provided by, they can also choose to take local authority funding to hire their own home help (for example, through a direct payment). For more information, see Choosing your own support on Carers Direct.

Make sure you know who to complain to and how. The EHRC says that older people commonly endure distressing treatment that in some cases breaches human rights legislation. Complaints about care can be made directly to the home care provider or to the local authority. These can then be taken on to the Local Government Ombudsman. People who pay for their own care (self-funders) can complain directly to the ombudsman. You can find out more about local authority complaints on Carers Direct.

Home Care Inspections by CQC

Home care services in England are to be subject to a fresh inspection by the Care Quality Commission from April.

BBC News Health 22 November 

The CQC has announced it will report on 250 companies who help people in their own homes with tasks such as eating, washing, dressing or taking medication.

Its reports will be produced before the health watchdog publishes its verdict on the state of home care nationally.

An Equality and Human Rights Commission report due out on Wednesday is expected to be critical of home care services.

An EHRC spokesman said the care watchdog’s pledge could be an “important first step” in addressing concerns raised by its own inquiry.

CQC inspectors will carry out the reviews alongside professionals and those who have personal experience of using home care services.

‘Behind closed doors’

CQC chief executive Cynthia Bower said: “The operation of home care is not as transparent as care in hospitals and other sectors because the interactions happen behind closed doors.

“That is why we want to focus on this sector of social care in this way.”

The CQC already runs routine spot checks, but this will be an extra inspection.

An advisory group is to be set up to assist the inspection process, with members from organisations including the EHRC, Age UK and the United Kingdom Homecare Association.

Ms Bower said it would focus on areas such as dignity and respect, safeguarding of people in vulnerable circumstances, and inspections would also look at how well supported and trained staff were.

Checks will include speaking to those who receive home care, as well as to their families, and home visits, she said.

The inspections follow a pilot scheme run by the CQC in which 30 home care services were reviewed.

Protecting the Elderly from their Carers

Stephanie Rose reviews the recent Government statistics concerning risks to the elderly, and details how risks can be reduced.

Tim Ross, Political Correspondent of the Telegraph, in his spine-chilling article this week, draws our attention to the first-time-publishe


d government figures concerning abuse of the elderly.

Of 96,000 adults who had suffered alleged abuse between April 2010 and March 2011, more than 34,000 vulnerable adults were alleged to have been hit, slapped, kicked or suffered another type of physical abuse while almost 27,000 allegations of neglect were recorded. Almost one in four cases, some 23,000, involved ‘financial abuse’, including theft, fraud, exploitation, pressure related to wills, or the misappropriation of benefits or possessions. In the majority of these cases, the alleged victims were elderly. Most of the allegations were reported to social workers by health or care nurses but 42% of incidents were alleged to have taken place in the victim’s own home.

The figures make frightening and depressing reading. An occasional case of abuse is a case too many, but these figures suggest that failures in care are not occasional. Of course, they do not reveal the huge numbers of vulnerable adults who receive high levels of care and attention from their carers, nor contrast with those whose carers go beyond expectation in the way that they provide for their relatives, patients and clients.

What as a society can we do to protect the vulnerable and the elderly?

A first observation is that care should not be left as the sole responsibility of one carer. Initially, care may be excellent, but as time progresses (or a relative, patient or client becomes more challenging) care can deteriorate. Without the support and oversight of others – extended family, relatives, visiting nurses, supervisors – the risks increase. Every vulnerable person should have the support of both a carer and 'a confidant' –someone who they can confide in, and who has the capacity to take responsibility and alert other services where necessary.

Secondly, we as a society should focus greater care and support on the care providers.   There are thousands of home carers who go unassisted and unmonitored, battling daily against difficult conditions and behaviours, and no doubt succumbing to the short-cut, the drop of standards or the reaction backlash. Frequently, the sheer stress of providing care without respite may give rise to risk.

Managing risks to clients is one of ‘Stephanie’s Bespoke Care Services’ top priorities. It was for this reason that we originally introduced the relative’s video log. Clearly, over time, it has developed a plethora of uses over and above risk management, but this still remains a core purpose of the video recording. We also ensure, whilst providing continuity of care, that each client is cared for by more than one carer; and each client is seen and cared for on a regular basis by supervision. This way, the corners are identified and reinforced. Poor practices are picked up at an early stage. Carers who are not coping are supported. Most importantly, the little tell-tale signs of concern are spotted.

No system can be perfect, and any care is going to be only as good as the carer can manage; but with the right level of experienced observation and scrutiny, risks can be reduced.


The ideas here are the personal ideas of the author and may not be reproduced without permission and attribution to Stephanie's Bespoke Care Services.

Abuse of the Elderly

100,000 elderly and disabled victims of suspected abuse

Almost 100,000 elderly and disabled people were feared to have suffered abuse at the hands of their carers last year in what ministers described as “an absolute scandal”.

By Tim Ross, Political Correspondent

4:02PM GMT 03 Nov 2011

A landmark inquiry into the scale of mistreatment disclosed that a quarter of cases involved relatives or carers putting alleged victims under pressure to change their wills, stealing property, or fraud.

More than 34,000 vulnerable adults were alleged to have been hit, slapped, kicked or suffered another type of physical abuse while almost 27,000 allegations of neglect were recorded.

Ministers and elderly rights campaigners condemned the picture of care home staff and relatives who exploit society’s most vulnerable citizens.

It is the first time that comprehensive government figures have been published showing the number of cases of alleged abuse in care homes and in the private residences of vulnerable adults in England.

The figures follow warnings from the Care Quality Commission over the “alarming” failure of hospitals to care for elderly patients.

The watchdog has also severely criticised the company that owned the now closed Winterbourne View care home for disabled adults in Bristol, where alleged abuse, including slapping and taunting of residents, was uncovered in a BBC documentary earlier this year.

Details from 151 councils showed 96,000 adults had suffered alleged abuse between April 2010 and March this year.

Almost 14,000 victims were suspected of having been abused or neglected repeatedly during the year, according to the report from the NHS Information Centre.

Most of the allegations were reported to social workers by health or care nurses but 42% of incidents were alleged to have taken place in the victim’s own home.

Almost one in four cases, some 23,000, involved “financial abuse”, including theft, fraud, exploitation, pressure related to wills, or the misappropriation of benefits or possessions. In the majority of these cases, the alleged victims were elderly.

Paul Burstow, the health minister, said the figures were “an absolute scandal” and promised more snap inspections of care services to stamp out abuse.

“No-one should have to put up with abuse,” he said. “This is the first publication of mandatory data of this kind. It demonstrates our total commitment to shining a light on poor care.

“Hundreds more unannounced inspections of adult care will be taking place, and we will also be making it mandatory to have local boards, involving police and other professionals, in place to tackle abuse.”

Social or healthcare workers were the alleged perpetrators in 29% of cases while family members, including the victim’s partner, were suspected of being the abusers in 25% of cases.

There were more than 18,000 cases of alleged emotional or psychological abuse, and almost 7,000 cases of sexual abuse.

Four in 10 investigations that were completed during the year were found to have been fully or partly substantiated, while 30% were not, and more than a quarter were inconclusive.

Michelle Mitchell, Charity Director of Age UK, said: "These figures show shocking mistreatment of the most vulnerable in our society.

"It is extremely worrying to see such high levels of neglect and abuse in residential home settings. The figures also raise further concerns about the quality of domiciliary care, which is delivered in a person's home behind closed doors and so problems are likely to be under reported.

"Safeguarding measures are clearly still failing far too frequently and urgent attention needs to be paid as to why 96,000 cases of abuse were allowed to happen last year."

Adrian McAllister, chief executive of the Independent Safeguarding Authority, which is responsible for banning abusers from working with vulnerable people, said the figures were "appalling".

"Behind these statistics are stories of real pain, lives that have been damaged and trust that has been broken by those who job was to improve the lives of vulnerable adults, not abuse them," he said.

The Princess Royal Trust for Carers

Do visit the Princess Royal Trust for Carers
http://www.carers.org/


The Princess Royal Trust for Carers was created on the initiative of Her Royal Highness The Princess Royal in 1991. At that time people caring at home for family members or friends with disabilities and chronic illnesses were scarcely recognised as requiring support.

For nearly 20 years, The Princess Royal Trust for Carers has been fighting to provide carers with the support they so desperately need. The Trust understands that few of us plan to become carers, so when a caring role starts, every carer needs an expert to guide them through the maze of services, rules and entitlements. For a carer, this can make the difference between keeping and losing their job, or between staying healthy and collapsing under the stress.

At the heart of The Trust is a unique network of 144 independently-managed Carers' Centres, 89 young carers' services and interactive websites (www.carers.org and www.youngcarers.net) which deliver around the clock support to over 424,000 carers and approximately 28,500 young carers.

Our vision

Carers are recognised, valued and able to maximise their quality of life.

Our mission

To meet the diverse needs of carers through excellent local and national services.

Our strategic aims

1. To ensure that carers are able to influence decisions which affect their lives.
2. To work effectively with Carers' Centres and other partners to develop, promote and deliver high quality services for carers.
3. To raise awareness of carers and the contribution they make to society.
4. To secure the sustainability of The Trust and to effectively manage its resources.

In addition, The Trust also acts independently in the interests of carers through:

• Research, development and consultation.
• Influence on national, regional and local policy.
• Partnerships with other national organisations.
• Information through our interactive websites, providing advice and access to support groups.

Note the Getting Help page with useful links for carers
http://www.carers.org/help-directory/old-age

Elderly care in the NHS has become a national shame

By SONIA POULTON

Every now and then, a story comes along that is so stunning in it’s simplicity, yet so revealing of the machinations of our health service, that it takes a while before the full implications of the story becomes clear.

Consider, if you will, the tale of 82-year-old Shelia Smith admitted to Bradford Royal Infirmary hospital with suspected heart problems after collapsing unconscious at her nearby home.

In hospital, Mrs. Smith suffered four falls - very common for elderly patients - and became incontinent. On one occasion she was found ‘flat on her face’ on the floor, having been there for some time, and she was badly bruised.

There were further issues to contend with.

During a conversation with family members and a hospital doctor, it became apparent that the great-grandmother was suffering liver and kidney problems due to lack of food and fluid.

The doctor also, they claimed, warned that Mrs. Smith would be dead within days ‘if something wasn’t done’.

For her daughter, Annette Townend - who has the double-blow of suffering from terminal bowel cancer - this left no alternative but to take matters into her own hands.

So, at a personal cost of £1,000 she employed undercover carers - who pretended to be family and friends - to sit with her mother and ensure that she was eating, drinking and going to toilet on a regular basis.

That Mrs. Smith went on to not only survive her hospital experience but made a recovery to decent health, is surely no coincidence, is it? Of course it’s not!

Earlier this month a damning report by the Care Quality Commission found that one in five hospitals was breaking the law because the nursing care of the elderly was so appalling.

Elderly patients, the report claimed, are frequently neglected by NHS staff. They are left in pain, dehydrated and malnourished.

Is this a misguided and savage attack at our most treasured of institutions? A political assassination of a great public body?

Sadly, I can testify that there is a great deal of truth to the report and, by extension, the woeful tale of Sheila Smith.

Last year I had been pre-booked, at a Gloucestershire hospital, for extensive foot corrective surgery. Following the operation I awoke to find myself on the stroke and trauma ward.

My temperature had rocketed and my blood pressure had plummeted and, as I came around from the anaesthetic, I took stock of my surroundings through my pain and blurred vision.

It was a six-bed, single sex ward and, at 46, I was the youngest patient by decades. The closest in age was a 72-year-old who had fallen at home and suffered a stroke.

On my first night a jovial nurse in her 50s explained how to summon help as she pointed out the call bell at the side of my bed.

'I promise only to press in emergencies,' I reassured her. 'Don’t you worry,' she replied. 'You’ll have our attention anyway. Your youth means we’ll be like bees round a honey pot.'

She winked and I assumed she was kidding to distract me from the raging pain that had taken hold as the painkillers wore off.

Over the next three days I came to realise the truth of her statement. And, it has to be said, I was shocked by what I discovered.

First, to be clear, this particular nurse - as indeed several of her wonderful colleagues - are an absolute asset to the NHS.

She was attentive and sensitive to all her patients - regardless of age - and they clearly adored her. She was firm but fair and she made sure that all of us received the same level of care.

Unfortunately, there were at least three of her nursing colleagues who left a great deal to be desired. It brings me no pleasure to recall them.

During my time on the ward, I witnessed several of the day nurses behave in disturbing ways towards their patients. They delighted in ignoring, then taunting, some of the more needy women on the ward.

Myrtle, the eighty-something in the bed next to me had late-onset dementia.

Fair to say, she was a difficult neighbour. She routinely screamed, pressed the call bell repeatedly, claimed she was being kept there against her will and had angry and violent outbursts.

None of this was her fault. However, this didn’t stop the nurses in question treating her as if she was a pariah. They shot amused winks at each other, walking past her bed as she cried for attention.

Once she was left for over half an hour when she had messed herself and as the nurse cleaned her up, I heard from behind drawn curtains, Myrtle say, 'Ouch, you‘re hurting me.'

The nurse snapped back: 'Stop making a fuss, I’m trying to help you.' There was no apology.

On two mornings, I watched as the same nurses delayed in giving her a bed bath, even though they had assisted the other women who were in less urgent need.

Neither was the treatment of Myrtle in isolation.

In the corner of the ward was 80-year-old Anna. She and her husband had been involved in separate falling accidents and he had been taken to another hospital 20 miles away. Anna, scared and bewildered, was desperate for news.

During my time there, I heard her repeatedly plead with several of the nurses to let her ring the other hospital.

One nurse, in particular, kept promising Anna that this would happen and then she swiftly reneged.

She told Anna: 'It’s not convenient' and 'just concentrate on getting yourself better'.

Never mind that being left to fret about her husband’s condition added to Anna’s anxiety and delayed her healing.

The day nurse appeared to revel in the power she held. It was disconcerting to witness but in my bleary and drug-induced state I felt helpless to intervene.

It was on my second night that I realised my 'youth' gave me priority.

Concerned at my poor recovery, the ward staff decided to move a fractious Myrtle from her bay so that I could rest.

She was wheeled into the corridor where she stayed for the night. From my bed I could hear her asking over and over again, 'Why am I here? Where is everyone?'

No one answered her. It was as if she was invisible.

How profoundly sad to be on the receiving end of that. To know that your age confers you with a type of non-existence. As if you no longer count.

For Myrtle, as for everyone else observing, it was clear that my needs were considered greater than hers.

Neither is the experience of shunting elderly patients into corridors an unusual occurrence as numerous undercover investigations, reviews and the words of caring hospital staff have testified.

The reality is, hospitals are ill-equipped to deal with the elderly who require very specialist care, including help with feeding and drinking.

These issues, for example, resulted in Sheila Smith, developing further health complications because her food and drink was delivered to her but she needed assistance with her feeding and drinking. This was not available.

So is this just a result of staff being over-worked? Not entirely.

Some NHS nurses, and it pains me to admit it, have become so acclimatised to the environment of neglect that it has become, to a worrying degree, the uncaring profession.

Elder care in the NHS is scandalous and has been systematically failed by successive governments. Might it be that so many ministers are able to afford private care that they are not truly in tune with what the rest of us have to endure?

That the coalition have failed, so far, to rectify what is patently clear to the vast majority of citizens is disheartening at least, and down-right alarming at best.

We need to be realistic about appropriate care for the elderly. For the truth is, elderly people fighting illness already have the odds stacked against them. They require specialist care to compensate for their vulnerability, but they are not receiving it.

The additional stress and neglect they experience in hospital reduces their chances of recovery. How can we keep allowing this to happen? It beggars belief.

And that is quite aside from the fact that we allow them to be treated with such indignity.

NHS hospitals were once the cause of great pride for our nation. Rightfully, so. 

Today, and specifically with elderly care, they are akin to a lottery. Where the survival rates for elderly patients are a game of chance. And that, whether it directly affects us or not, is something that should shame us all.

Elderly Care: Your stories

Too many hospitals in England are falling short in the most basic care they are giving elderly patients, inspectors say.

The Care Quality Commission carried out unannounced visits at 100 hospitals to assess dignity and nutrition standards. It identified concerns in 55 cases, describing the findings as "alarming".

Here BBC News website readers share their stories.

Daryl, in London

When I visited my grandmother, I was absolutely disgusted with the lack of care she got before she died. She couldn't open her mouth to speak and her eyes looked so sad.

Continue reading the main story

I noticed that her lips were stuck closed and demanded a mouth swab to apply water from one the nurses. The nurse was so rude and shoved me a trolley with a bowl of water and swabs. Her mouth was full of gunge. It was obvious that she had not eaten or drunk any fluids for god knows how long.

“

She was a wonderful great grandmother who help and cheered up so many people. I dread being treated like this when my last few days are up in a hospital.

I'm still very angry at how the hospital left her like this on her last few days. The ward was so noisy with other elderly patients screaming for help.

Adam, in Hertfordshire

These worrying findings back up my recent experience with the death last week of my 93-year-old father. He died after five weeks in hospital. I think the inspectors probably underestimate the size of the problem.

Continue reading the main story

“

The catalogue of failings in basic care is too long to list. All of this happened in a well performing trust, which had signs up all over the place saying how well it was performing.

Apart from the failings of individuals involved in my father's care, there is a terrifying organisational disconnect whereby trusts can appear to be performing well according to national targets yet the reality of delivery of day-to-day care is appalling.

I think it is possible for hospitals to reach every government target and yet still be failing. Hospitals are dangerous places for the elderly.

I am a hospital consultant and was unable to protect my father from this dysfunctional system.

Claire, in Cambridgeshire

Until recently I worked as a health care assistant on a busy hospital ward where staff levels were usually one nurse and one health care assistant to around 15 patients.

Continue reading the main story

“

During the daily running of the ward, this worked adequately as our patients were pre-booked for investigative procedures, allowing us to prepare for their needs before they arrived.

Problems arose during the winter when the beds were 'double booked' and given to A&E patients at weekends who could not be placed elsewhere.

This meant that planned admissions who came in on Monday and during the week were forced to wait for another slot and we were left to deal with all manner of specialist conditions we had little experience with.

We were given no extra support staff and suddenly one nurse and one health care assistant had to provide care for - sometimes - 15 people needing help with personal hygiene, eating, walking and often, dementia.

Staffing levels were, in a word, unsafe, and though we did the best that we possibly could in the circumstances, feeding everyone who needed help as soon as their meal arrived was simply impossible.

Whilst I will defend over-stretched nurses to the hilt regarding feeding - simply because of logistics - there is no excuse for a lapse in patient dignity.

Pulling curtains properly takes only a quick glance over the shoulder as you enter a bed space.

Lee, in Nottinghamshire

As a nurse of 12 years experience working within a range of health care settings, mainly primary care, I'm mortified to say that I do not find the report in anyway surprising.

Continue reading the main story

The care received by many patients in the NHS or other care settings in this country currently is nothing short of scandalous. Wide ranging and urgent action is necessary to protect the vulnerable people of the UK.

“

From speaking to close colleagues and other nursing friends I think this is an endemic problem across the whole of the country.

I'd hate people to think it's just about indifferent and uncaring nurses, although in some instances that has become the case.

Unfortunately nurses are now working in a relentless environment where it is impossible for them to deal with their workloads. Most people who go into hospitals are less than impressed by some of the most basic elements of care.

I'm ashamed of the report and I find it impossible to believe that any nurse wouldn't care, but most would be like me and find it a bit difficult to do anything about it.

John, in Essex

I'm a nurse who has recently left the NHS. I left because I was no longer able to go to work to just look after people - the managers at the top had other ideas about what they thought I should be doing.

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I think the vast majority of wards need to be better staffed, have better training and a better focus on care. There is too much form filling and not enough focus on care.

Essentially, there are three things the NHS can do to solve the vast majority of these things happening. More staff on the wards, better training, and a reduction in pointless box ticking paperwork.

In my experience, managers regularly deny that under-staffing makes any impact on care. Training is usually the first thing to be cut when the books need to be balanced.

There is a culture of obsession when it comes to measuring the inane: such as are the notes written in black ink; are the forms filled in correctly; is uniform policy being complied with?

Does any of that really matter when you've got ill people to look after?

The report isn't a surprise to me. The danger is pointing the finger, as it's as much a fault of the system as the individual.