WHEN elderly people are admitted to acute hospitals it is a basic requirement that any needs for additional care or assistance are met as part of their treatment.
Two years ago, following disturbing incidences of older patients left without help to eat or reach the toilet, the Scottish Government instigated a programme of inspections by Health Improvement Scotland (HiS) into care for elderly patients.
Yesterday, HiS published its second overview report, covering seven inspections at major hospitals between August 2012 and April 2013. This should have provided reassuring evidence that the recommendations from earlier inspections elsewhere had raised standards by being adopted across Scotland. Inspectors observing practice on the wards at first hand found that the majority of staff treated elderly patients with compassion, dignity and respect. But there were also examples of inappropriate and disrespectful language when referring to older people and a failure to respect patient confidentiality. This would be unacceptable in any profession and is a serious failing among those charged with the care of sick and vulnerable patients. Even more alarming is the failure to identify whether an elderly patient is at risk of malnutrition and to complete food and fluid balance charts when there were concerns about intake.
The inspection overview of nutrition and hydration should serve as a warning that there is too often a gap between policy and practice. Protected mealtimes to allow older patients to focus on eating a drinking did not prevent non-essential interruptions or ensure patients did not have to wait a long time for help to eat.
It is a particularly welcome improvement that hospitals are now making considerable efforts to assist patients with dementia through practical measures such as picture signs and colours to help them navigate round wards. But it is a measure of the growing extent of the problem that specialist dementia nurse consultants are now in place and a reminder that with an ageing population, the pressures in the NHS will continue to increase.
The latest overview follows an independent external review of an inspection last year by HiS of Ninewells Hospital in Dundee, which was controversial because the chief executive of NHS Tayside was also a member of the HiS board. Improvements to the HiS inspection regime recommended by the external report are being put into action but the case has prompted a proposal by the Scottish Labour Party that HiS should be merged with the Care Inspectorate to create a more powerful regulatory body. As we have already argued, there is a case for strengthening the regulatory regime with powers to implement change immediately where hospitals are not meeting the required standards.
The NHS is under severe pressure but good communication and basic care for elderly patients are as essential as sophisticated treatments. Failure to properly assess and meet their needs will risk the miserable prospect of them becoming long-stay patients. Healthcare Improvement Scotland must live up to its name and ensure that all its recommendations become standard practice in every hospital.
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