Care And Compassion? - Parliamentary And Health Service .

Care and compassion?Report of the Health Service Ombudsman onten investigations into NHS care of older peopleFebruary 2011

Care and compassion?Report of the Health Service Ombudsman onten investigations into NHS care of older peopleFourth report of the Health Service Commissioner for EnglandSession 2010-2011Presented to Parliament pursuant to Section 14(4) of the Health Service Commissioners Act 1993Ordered byThe House of Commonsto be printed on14 February 2011HC 778London: The Stationery Office 15.50

Parliamentary and Health Service Ombudsman 2011The text of this document (this excludes, where present, the Royal Arms and all departmental and agency logos) may be reproduced free ofcharge in any format or medium providing that it is reproduced accurately and not in a misleading context.The material must be acknowledged as Parliamentary and Health Service Ombudsman copyright and the document title specified.Where third party copyright material has been identified, permission from the respective copyright holder must be sought.Any enquiries regarding this publication should be sent to us at phso.enquiries@ombudsman.org.uk.This publication is also available on http://www.official-documents.gov.ukISBN: 9780102971026Printed in the UK by The Stationery Office Limitedon behalf of the Controller of Her Majesty’s Stationery OfficeID: 241316402/11PHSO-0114Printed on paper containing 75% recycled fibre content minimum.2Care and compassion?

Contents5 Foreword7 Introduction11 Mr and Mrs J’s storyHospital staff at Ealing Hospital NHS Trust leftMr J forgotten in a waiting room, denying himthe chance to be with his wife as she died.13 Mr D’s storyRoyal Bolton Hospital NHS FoundationTrust discharged Mr D with inadequate painrelief, leaving his family to find someone todispense and administer morphine over a bankholiday weekend.17 Mrs R’s storyMrs R’s family were concerned that she wouldnot receive food and drink while in SouthamptonUniversity Hospitals NHS Trust unless theythemselves helped her to eat and drink.21 Mrs Y’s storyMrs Y died from peritonitis and a perforatedstomach ulcer after her GP Surgery missedopportunities to diagnose that she hadan ulcer.23 Mrs H’s storyWhen Mrs H was transferred from Heart ofEngland NHS Foundation Trust to a care home,she arrived bruised, soaked in urine, dishevelledand wearing someone else’s clothes.27 Mr C’s storyStaff at Oxford Radcliffe Hospitals NHS Trustturned off Mr C’s life support, despite hisfamily’s request that they delay doing so for ashort time.29 Mr W’s storyMr W’s life was put at risk when Ashford andSt Peter’s Hospitals NHS Foundation Truststopped treating him and then discharged himwhen he was not medically fit.31 Mrs G’s storyMrs G’s doctors at her local surgery failed toreview her medication after she left hospital,with serious consequences for her health.33 Mr L’s storyThe care and treatment that Surrey andBorders Partnership NHS Foundation Trust gaveMr L contributed to a loss of his dignity andcompromised his ability to survive pneumonia.37 Mrs N’s storyWhile doctors at Northern Lincolnshireand Goole Hospitals NHS Foundation Trustdiagnosed Mrs N’s lung cancer, they neglected toaddress the severe pain that she was suffering.Report of the Health Service Ombudsman on ten investigations into NHS care of older people3

4Care and compassion?

Foreword by HealthService Ombudsman,Ann AbrahamI am laying before Parliament, under section 14(4)of the Health Service Commissioners Act 1993(as amended), this report of ten investigationsinto complaints made to me as Health ServiceOmbudsman for England about the standard ofcare provided to older people by the NHS.I encourage Members of both Houses to read thestories of my investigations included in this report.I would ask that you then pause and reflect on myfindings: that the reasonable expectation that anolder person or their family may have of dignified,pain-free end of life care, in clean surroundingsin hospital, is not being fulfilled. Instead, theseThe complaints were made about NHS Trusts across accounts present a picture of NHS provision thatEngland, and two GP practices. Although eachis failing to respond to the needs of older peopleinvestigation was conducted independently,with care and compassion and to provide even theI have collated this report because of the common most basic standards of care.experiences of the patients concerned and thestark contrast between the reality of the care they The report is also available to read and downloadreceived and the principles and values of the NHS. on our website at www.ombudsman.org.uk.Sadly, of the ten people featured in this report,nine died during the events described here, or soonafterwards. In accordance with the legislation, myinvestigations were conducted in private and theiridentities have not been revealed.Ann AbrahamHealth Service Ombudsman for EnglandReport of the Health Service Ombudsman on ten investigations into NHS care of older people5

These accounts present a pictureof NHS provision that is failingto respond to the needs of olderpeople with care and compassion.Ann Abraham, Health Service Ombudsman6Care and compassion?

IntroductionThis report tells the stories of ten people over theage of 65, from all walks of life and from acrossEngland. In their letters to my Office, their familiesand friends described them variously as lovingpartners, parents and grandparents. Many of themwere people with energy and vitality, active in theirretirement and well known and liked within theircommunities. Some were creative, while otherstook pride in their appearance and in keeping fit.One enjoyed literature and crosswords and anotherwas writing a book.One woman told us how her father kept busy,despite recurring health problems: ‘My dad reallyenjoyed his work as a joiner. Even after he retiredhe still did that kind of work, usually for me andmy siblings. We used to ask: “Dad can you do this,Dad can you do that?” and he always would’.Another relative described her aunt to us: ‘Shewas very adventurous and very widely travelled.She even took herself off, at the age of 81, toDisneyworld in Florida’.These were individuals who put up with difficultcircumstances and didn’t like to make a fuss. Likeall of us, they wanted to be cared for properlyand, at the end of their lives, to die peacefully andwith dignity. What they have in common is theirexperience of suffering unnecessary pain, indignityand distress while in the care of the NHS. Poor careor badly managed medication contributed to theirdeteriorating health, as they were transformedfrom alert and able individuals to people whowere dehydrated, malnourished or unable tocommunicate. As one relative told us: ‘Our dad wasnot treated as a capable man in ill health, but assomeone whom staff could not have cared lesswhether he lived or died’.These stories, the results of investigationsconcluded by my Office in 2009 and 2010, are noteasy to read. They illuminate the gulf between theprinciples and values of the NHS Constitution andthe felt reality of being an older person in the careof the NHS in England. The investigations reveal anattitude – both personal and institutional – whichfails to recognise the humanity and individualityof the people concerned and to respond to themwith sensitivity, compassion and professionalism.The reasonable expectation that an older personor their family may have of dignified, pain-freeThese stories illuminate the gulf betweenthe principles and values of theNHS Constitution and the felt realityof being an older person in the careof the NHS in EnglandReport of the Health Service Ombudsman on ten investigations into NHS care of older people7

Introductionend of life care, in clean surroundings in hospital isnot being fulfilled. Instead, these accounts presenta picture of NHS provision that is failing to meeteven the most basic standards of care.The nature of the failings identified by myinvestigations suggests that extra resource alonewill not help the NHS to fulfil its own standardsof care. There are very many skilled staff withinthe NHS who provide a compassionate andThese are not exceptional or isolated cases. Ofconsiderate service to their patients. Yet the casesnearly 9,000 properly made complaints to myI see confirm that this is not universal. Instead, theOffice about the NHS in the last year, 18 per centactions of individual staff described here add up towere about the care of older people. We accepted an ignominious failure to look beyond a patient’s226 cases for investigation, more than twice asclinical condition and respond to the social andmany as for all other age groups put together.emotional needs of the individual and their family.In a further 51 cases we resolved complaints directly The difficulties encountered by the service userswithout the need for a full investigation. The issues and their relatives were not solely a result ofhighlighted in these stories – dignity, healthcareillness, but arose from the dismissive attitude ofassociated infection, nutrition, discharge fromstaff, a disregard for process and procedure and anhospital and personal care – featured significantlyapparent indifference of NHS staff to deplorablemore often in complaints about the care ofstandards of care.older people.Sadly, of the ten people featured, nine died duringthe events described here, or soon afterwards. Thecircumstances of their deaths have added to theIt is incomprehensible that the Ombudsman distress of their families and friends, many of whomneeds to hold the NHS to account for thecontinue to live with anger and regret.most fundamental aspects of careSuch circumstances should never have arisen. Thereare many codes of conduct and clinical guidelinesthat detail the way the NHS and its staff shouldThese complaints come from a population ofwork. The essence of such standards is captured inhealth service users that is ageing. There are nowthe opening words of the NHS Constitution: ‘The1.7 million more people over the age of 65 thanNHS touches our lives at times of basic humanthere were 25 years ago and the number of people need, when care and compassion are what matteraged 85 and over has doubled in the same period.most’. Adopted in England in 2009, the ConstitutionBy 2034, 23 per cent of the population is projected goes on to set out the expectations we are allto be over 65. As life expectancy increases, so does entitled to have of the NHS. Its principles includethe likelihood of more years spent in ill health, with a commitment to respect the human rights ofwomen having on average 11 years and men 6.7 years those it serves; to provide high-quality care that isof poor health. Nearly 700,000 people in the UKsafe, effective and focused on patient experience,suffer from dementia, and the Alzheimer’s Societyto reflect the needs and preferences of patientspredicts that this figure will increase to 940,000and their families and to involve and consultby 2021 and 1.7 million by 2051. The NHS will needthem about care and treatment. Users of NHSto spend increasing amounts of time and resourceservices should be treated with respect, dignitycaring for people with multiple and complex issues, and compassion.disabilities and long‑term conditions and offeringpalliative care to people at the end of their lives.8Care and compassion?