No food, no water, no dignity: how Scottish hospitals are still failing elderly patients

Issues over dementia care planning accounted for almost one-third (111) of the improvements needed. Nutrition was the second highest category at 80 improvements required, followed by "dignity and compassion", where 58 improvements were issued.

However, the number of improvements verified as complete after follow-up inspection was just 14. In total, 97 improvements were said to be completed, taking into account NHS boards reporting on their own progress.

Earlier this month a report from HIS revealed inspectors found the Victoria Hospital in Kirkcaldy, Fife, was continuing to provide poor care to older people in December last year, seven months after a previous inspection which raised concerns.

In one shocking case, a frail elderly patient who had been assessed as unsafe to swallow food or drinks, had been left without nutrition for 10 days after staff were unable to fit a feeding tube. The patient was found to have lost a "significant amount" of body weight since being admitted.

Duncan McNeil, Labour MSP for Greenock and Inverclyde, who obtained the HIS figures, said: "Over a period of two years, since the inspections in the acute sector have been taking place, improvements on the very basic things like nutrition and hydration and dignity are constantly being raised.

"It is disappointing that we continually see throughout that two-year period of these inspections more than 300 concerns that have been raised, too many of which are around the basics.

"What concerns me is the same issues seem to just keep on happening. I am concerned about how much learning is going on and how these reports are shared and acted upon."

McNeil, who is also convener of the Scottish Parliament's Health and Sport Committee, raised concerns over the small number of improvements which had been verified as completed by inspectors.

He said: "It obviously raises questions such as whether they have sufficient resources to carry out their work and the appropriate follow-up work. It is important that they are resourced to do the job they are being required to do.

"The inspection regime has got to be achieving long-term and permanent change, and to me it doesn't look as if we are getting that change, we are dealing with the same issues time and time again."

A spokesman for charity Age Scotland said the general picture emerging from the HIS reports was one of hospitals "struggling to provide the quality of care and dignity that older people deserve".

He added: "Age Scotland is particularly concerned by the slow progress in addressing areas where improvements are required.

"With wards too often failing to provide suitable environments for, and meet the basic care and nutrition needs of, people with dementia and cognitive impairment, there are alarming implications for the future as incidence of dementia is expected to double over the next quarter century.

"Scotland's politicians and service managers must up their game to ensure hospitals are well run and sufficiently resourced."

Jim Pearson, deputy director of policy at Alzheimer Scotland, said the charity was "acutely aware" of the problems faced by people in hospital care.

"That is why we are working closely with the Scottish Government and NHS boards to ensure consistency of care and support for people with dementia in these environments," he said.

Hospital inspectors request an update on progress made no later than 16 weeks after initial inspection, an HIS spokesman said.

He added: "The inspection team then determines if follow-up activity is required based on the progress update provided by the NHS board. Follow-up activity ... can include an unannounced inspection visit or a meeting with the NHS board.

"In all our inspections, we inspect to ensure that older people are treated with dignity and respect. The other areas of focus for each inspection are determined largely by the intelligence we review prior to the inspection."

A Scottish Government spokeswoman said: "Scotland has a robust scrutiny regime in place across NHS Scotland and the care sector, and we have confidence that this system is continuing to drive improvement.

"Healthcare Improvement Scotland (HIS) works closely with health boards to ensure that any issues picked up through the inspection process are promptly acted upon and that a full action plan is in place. HIS will then take follow-up action to ensure any issues have been addressed."

She said inspections have taken place on a phased basis, which means a number of improvement actions may still be ongoing, adding: "We expect HIS to continue working closely with health boards to ensure these are addressed."