CARE of the elderly in many hospitals has fallen below basic standards because of the pressure on services, according to a new report.

 

The Royal College of Nursing Scotland is warning that frail patients are being moved from bed to bed or looked after in the wrong ward for their condition because hospitals are struggling to manage the rising number of older people admitted for treatment.

The college has trawled through the findings of official NHS inspections and found most hospitals fail to assess the elderly properly for problems such as dementia and malnutrition.

Furthermore, their analysis shows that hospitals are not learning from each other - with a poor inspection report on one facility being followed within months by another critical assessment of a different site in the same health board area.

Theresa Fyffe, director of RCN Scotland, said: "When older people come into hospital, they are often acutely unwell. If our hospitals don't have enough staff or enough beds and resources to manage the flow of patients coming through their doors, it is hard for them to provide the best possible care for their patients."

The RCN, which described the report as an "amber warning," examined 35 inspection reports on the care of older patients produced by official watchdog Healthcare Improvement Scotland (HIS).

While the majority of patients praised the treatment they had received, the RCN found:

* 31 out of 35 inspections found hospitals did not appropriately assess older patients for cognitive impairment

* 27 out of 35 needed to improve the way they checked elderly people for low nutrition

* 23 out of 35 needed to improve the flow of patients through the wards, ensure people were treated in the right place for their medical problem or improve discharge procedures,

Planning the discharge of patients appears to have deteriorated - rather than improved - since the inspections began, with it being raised as an issue in 50 per cent of inspections during 2013-14 and 66 per cent so far in the current financial year.

The RCN report added: "There does not appear to be learning and improvement across different hospitals in the same NHS board area.

"A poor inspection in one hospital may be followed a few months later by a poor inspection in another hospital in that board where the same issues are revealed. Some NHS boards are evidently struggling to share learning and make the improvements needed."

In one health board, inspections in four different hospitals over the course of two years resulted in 67 areas for improvement being identified.

Ms Fyffe said: "Scotland has a growing population of older people, who are living longer, often with multiple and complex health conditions, and with the number of people aged over 75 predicted to rise substantially over the next 25 years, the pressures that this will put across the whole system are only set to increase.

"We know that providing quality care for older people takes time, resources and support. Yet HIS's improvement programme that helps NHS boards improve the quality of care for older people in hospital is only guaranteed funding until March next year.

"The Government must commit to long-term funding and invest in sustainable services so our older people can be assured that their care will be effective, safe and person-centred."

Angiolina Foster CBE, chief executive of HIS, said their own analysis showed improvements in the care of older people in Scottish hospitals, as well as areas which required attention such as shifting patients from ward to ward because of space shortages.

She added: "In addition to inspections, HIS is currently leading a programme of work to improve care for older people in acute care and this has focused on the two priority areas of delirium and frailty, specifically the assessment, identification and management of individuals with frailty or delirium."

Health Secretary Shona Robison said the Government had introduced the inspections because Ministers were "committed to driving up standards in the care of older people in hospitals".

She said: "These inspections are already reviewed regularly by Healthcare Improvement Scotland, whose most recent review already identified the points raised by the RCN and action is under way to address them.

"Through the inspection process HIS also found that 'on average, 99 per cent of patients said the quality of care they received was good."

She said that an extra £2.5 million was being provided to HIS to continue their work and this would impact "positively on improvements to the care older people receive".

"I have also asked Chairs of NHS boards to proactively look at their individual services, including for older people, and report back to the Chief Nursing Officer who is overseeing this work," she said.

"We know our NHS is facing challenges which is why this Government has protected the budget of the NHS despite massive cuts from Westminster. This is supporting the record staffing levels that we have currently in NHS Scotland."