Hospital care for elderly scrutinised

The Care Quality Commission has today published a series of reports on the quality of hospital care for the elderly in England. These reports, covering 12 hospitals from around the country, are the first  in a series of 100 that will look at standards of nutrition and dignity for older patients  These reports have been widely covered in the press, although a full set of inspection results and overall analysis will not be available until the autumn.

Among the first 12 hospitals inspected, three were considered to be failing to meet the essential standards required by law, with less serious concerns identified in a further three.

What are the reports looking at?

The 12 reports are the first to be published by the Care Quality Commission (CQC), England’s care regulator, as part of its inspection of standards of care for elderly people in 100 hospitals.

The reports focus on whether older patients are treated with dignity and respect and whether they get food and drink that meets their needs. Inspection teams from the CQC made spot checks on each hospital, assessing two wards in each against CQC standards for dignity and nutrition for inpatients.

The 12 hospitals inspected were:

• Imperial College Healthcare NHS Trust
• Clatterbridge Centre for Oncology NHS Foundation Trust
• Wirral University Teaching Hospital NHS Foundation Trust
• Countess of Chester Hospital NHS Foundation Trust
• Mid Staffordshire NHS Foundation Trust
• Plymouth Hospitals NHS Trust
• Sheffield Teaching Hospitals NHS Foundation Trust
• Wye Valley NHS Trust
• Homerton University Hospitals NHS Foundation Trust
• The Ipswich Hospital NHS Trust
• Royal Free Hampstead NHS Trust
• Worcestershire Acute Hospitals NHS Trust

What did inspections at these hospitals find?

The reports identified three hospitals as failing to meet the essential standards of care in these areas, which are required by law. The hospitals are Worcestershire Acute Hospitals NHS Trust, The Ipswich Hospital NHS Trust and Royal Free Hampstead NHS Trust.

Less serious concerns about standards relating to dignity and nutrition were identified in a further three hospitals. These were Sheffield Teaching Hospitals Foundation Trust, Wye Valley NHS Trust and Homerton University Hospitals NHS Foundation Trust.

The remaining six hospitals were found to be meeting essential standards.

What does the CQC do?

The CQC is the independent regulator of health and social care in England. Its job is to maintain and improve standards of care, whether in hospital, in care homes or at home. To this end, it regulates providers of medical and clinical treatment and providers of residential care.

The CQC licenses all providers of care services only if they meet essential standards of quality and safety. It then monitors them to ensure they continue to meet those standards.

The current Dignity and Nutrition inspection programme was launched by the CQC in response to a request by the Secretary of State for Health, following previous concerns raised about the care of the elderly. It aim is to provide a snapshot of the quality of care that older people are receiving in hospitals.

How does the CQC view these findings?

The CQC says that while the reports document many examples of people being treated with respect and given personalised, attentive care, some tell a ‘bleak story’ of people not being helped to eat or drink, with their care needs neglected and dignity not respected.

Recurring concerns relating to nutrition included:

• People not being given help to eat, meaning they struggled to eat and in some cases were physically unable to.
• People’s nutritional needs not being assessed and monitored; for example, not being weighed throughout their stay, meaning staff did not know if they were losing weight. Other patients were identified as malnourished without an action plan being put in place to address this.
• People not being given enough to drink. In some cases water was left out of reach or no fluids were given for long periods of time. In one case, a doctor described having to prescribe water on medicine charts to ensure patients got enough to drink.

Recurring concerns around dignity and respect included:

• staff not involving people in their own care, for example, not explaining treatment and addressing patients’ relatives rather than the patient themselves
• staff not treating people in a respectful way, for example, spooning food into people’s mouths from above without engaging with them
• staff discussing personal patient information in open areas in the hospital
• staff speaking to people in a condescending or dismissive way. One man told the CQC that the staff ‘talk to me as if I’m daft’

The CQC also points out that inspection teams observed examples of excellent care delivered by nurses and other healthcare staff. In many hospitals, nutrition and hydration were recognised as an important part of the patient’s recovery, and efforts were made to ensure that people got meals they enjoyed in a pleasant environment, and the help they needed to eat it.

What will happen now?

All the hospitals where concerns have been identified are obliged to tell the CQC what plans they have to improve standards of care and in what time schedule. The three hospitals failing to meet essential standards could face enforcement action if improvements are not made.

Jo Williams, chair of the CQC commented: “I will be writing to the Chair of every hospital where this inspection programme has identified poor care to ask what they plan to do address these issues. The key elements that every hospital must have in place are a compassionate staff culture which is driven by strong leadership and supported by good systems.

“These are the basics that help ensure every patient is treated like an individual – not a nuisance to be ignored or a task that must be completed. This is what we expect for ourselves and for our own families, and what every patient should expect from the people who care for them.”

Further reports are expected from the CQC throughout the summer, with a summary report looking at the overall findings of the programme to be published in the autumn.

What can I do if I am unhappy with my care or the care of an elderly relative?

If you're not happy with the care or treatment you or an elderly relative has received or you've been refused treatment for a condition, you have the right to complain, have your complaint properly investigated and be given a full and prompt reply. If you are not satisfied with the way the NHS deals with your complaint you can take your complaint to the independent Parliamentary and Health Service Ombudsman.

Under the NHS Constitution you can also make a claim for judicial review if you think you've been directly affected by an unlawful act or decision of an NHS body, and receive compensation if you've been harmed.

The NHS has its own complaints procedure, which is always the first step for any complaint.

You can find detailed information about how to make an NHS complaint on NHS Choices.

How can I give feedback on services I have received?

You can leave feedback on your hospital, GP or dentist on the NHS Choices through the Find Services section of the site. Simply find your organisation of choice, and use the 'rate and comment' button to add your views.