The Care Quality Commission (CQC) has published the first 12 reports from an inspection programme which examines whether elderly people receive essential standards of care in 100 NHS hospitals throughout England.
The programme focuses on whether people are treated with dignity and respect, and whether they get food and drink that meets their needs. A national report into the findings of the programme will be published in September.
These first 12 inspection reports identify three hospitals as failing to meet the essential standards required by law; Worcestershire Acute Hospitals NHS Trust, The Ipswich Hospital NHS Trust and Royal Free Hampstead NHS Trust. Less serious concerns were identified in a further three hospitals, with the remaining six found to be meeting essential standards. All the hospitals where concerns have been identified must now tell the regulator how and when they will improve. The three hospitals failing to meet essential standards could face enforcement action by the regulator if improvements aren’t made.
Whilst 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 and drink, with their care needs not assessed and their dignity not respected.
Recurring concerns relating to nutrition included:
people not being given the assistance they needed to eat – meaning they struggled to eat and in some cases were physically unable to eat meals
their nutritional needs not being assessed and monitored – for example, not being weighed throughout their stay, making it impossible to determine if they were losing weight; or identified as malnourished without an action plan being put in place to address this
people not being given enough to drink – water left out of reach or no fluids given for long periods of time. In one case, a member of clinical staff described having to prescribe water on medicine charts to ensure patients got enough to drink.
Recurring concerns around dignity and respect included:
People not involved in their own care – their treatment not explained to them; being told what would happen to them without consent being sought or concerns addressed; staff addressing patients’ relatives rather than the patient themselves
Staff not treating people in a respectful way – spooning food into people’s mouths from above without engaging with them; discussing personal patient information in open areas.
Staff speaking to people in a condescending or dismissive way. One man told us that staff “talk to me as if I’m daft. “
However, inspection teams also observed examples of excellent care delivered by nurses and other healthcare staff who took the time to explain every aspect of a patient’s care to them in a way they could understand, interacted with each patient as an individual, spoke to them with respect and ensured their dignity was maintained. And in many hospitals, nutrition and hydration were recognised as an important part of the patient’s recovery, and real efforts were made to ensure that people got meals they enjoyed in a pleasant environment - and the help they needed to eat it. One patient told us “I cannot praise them enough. I am made to feel that I am the most important person.”
Commenting on the publication of the first reports, Jo Williams, Chair of the CQC, said:
“CQC inspectors have been joined by a practising nurse and an ‘expert by experience’ in our dignity and nutrition inspections ,This has been invaluable to help us build a detailed picture of the care that older people are receiving in NHS hospitals today.
“Many of these reports describe people being ‘cared for’ in the truest sense. Sadly, however, some detail omissions which add up to a failure to meet basic needs - people not spoken to with respect, not treated with dignity, and not receiving the help they need to eat or drink. These are not difficult things to get right – and the fact that staff are still failing to do so is a real concern.
“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.”
Commenting on the publication of the first reports, Rt Hon Andrew Lansley the Secretary of State for Health, said:
“Everyone admitted to hospital deserves to be treated as an individual, with compassion and dignity. We must never lose sight of the fact that the most important people in the NHS are its patients – that’s why I wanted the CQC to look into the treatment of older patients and stamp out poor care fast. I also believe nursing expertise is vital to improve patient experience, which is why I asked the CQC to ensure these would be nurse-led.
“The inspection teams have seen some exemplary care, but some hospitals are not even getting the basics right. That is unacceptable.
“Where the inspections uncovered appalling levels of care, the CQC will be able to use its enforcement powers to ensure that real improvements are made. By measuring what is important and then publishing the results, I believe we can enter a new era of high quality NHS care for patients.
“In the future, I want our proposals for local HealthWatch organisations to be able to carry out unannounced independent inspections and hold local services to account by drawing on experience from patients and their families.”