“Neglect Shames Britain 3”

The blaze of publicity in the Daily Mail about the Patients’ Association helpline appeal is beginning to die down.  So now let’s look at their longer term strategy for improving elderly care, which is to appoint independent matrons to hospitals all around the country.

Intuitively, I am uncomfortable with this approach, but I don’t have a better alternative so until I do, I will go along with trying any new idea, in what is a desperate situation.  My reservations are that as “independent” people, they maybe able to be critical friends but they won’t have the teeth to change things.  There are lots of good nurses and ward managers working inside in the NHS who are well aware of its deficiencies but seem powerless to change the system, so how will someone from outside reminding them of their shortcomings help.   It could work if it is done co-operatively and with the full support of a senior management team who genuinely want to improve their service to older people.  So perhaps it would be best to pilot the approach first with a few Health Authorities who are given the freedom by the Department of Health to step outside of the current systems and procedures.

The Health Secretary, Andrew Lansley, was quick – almost too quick – to support the Patients’ Association.  Cynically you might think he was just trying to jump on board the Daily Mail publicity band wagon or at least trying to contain an issue which might otherwise get out of control.  The problem is Mr Lansley, health care of older people is already out of control, and needs more than sticking plaster solutions.  What a happy coincidence that Mr Lansley was able to announce his intention to set up “health watch organisations all around the country to act as a voice for patients”.   In my own cynical way I would say they are very aptly named – designed to  make small ticking noises but not be loud enough to disturb anyone.  It sounds like a remake of Community Health Councils which were abolished by the last Government.

Mr Lansley goes on to say that he also intends to send senior matrons and nurses around hospitals to do spot checks on standards.  Forgive me but shouldn’t they already be doing that, it is a fundamental part of any manager’s job.  The Minister goes on to say he wants to see unannounced inspections and a national report to shed light on standards of care in hospitals.  Isn’t that what the Care Quality Commission is supposed to do?  Mr Lansley increasingly sounds like a guilty suspect who under the pressure of difficult questions will say anything, but one who has no intention of changing when he gets out of the spotlight.

It’s not long ago that the Labour Government introduced the concept of “modern matrons”.  These were to be the superwomen of a new millennium nurse-led health service supported by a degree qualified infantry of project 2000 nurses.  Sadly they seem to have crashed and burned in the headlong rush to achieve Government targets for discharging patients as quickly as possible; a sort of McDonalds fast health service.  It’s quick but not very satisfying or healthy in the longer term.

Perhaps we should look further back for an answer.  To the 1950’s and 60’s of ITV’s “The Royal”, where matron Wendy Craig ruled over her empire of cleanliness, starched -uniformed nurses and all knowing doctors.  Wendy would shred today’s nurses of paperwork and risk assessments and just walk the floor setting standard in her every word.  She would answer the information demands of management with their targets and e-mails by telling them to get off her ward and mind their own business.  In The Royal there were more nurses and carers and far less Administrators and Managers.  At what point did we conclude that more bureaucracy would improve health care? 

Harking back to the past, while offering some interesting insights, is unlikely to lead to a solution.   Nostalgia is only tinged with truth.   So I doubt that “independent matrons” on their own will be able to change very much.

Fundamentally the problem is that the health service is being overwhelmed by the rapidly increasing numbers of older people.  Particularly the older elderly with multiple health needs.  Advances in health care, whilst a blessing, compound the problem further by making new and often expensive treatments possible.  We can’t, nor should we want, to turn the clock back.  But we must recognise that our vastly improved health service capacity to keep people alive longer will only be a success story if we also extend the quality of life.

To do this we need a much more radical reform of the health care system for older people.  It needs a new vision, new resources and thinking way outside the box.  That’s what I will write about next.

 

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3 Responses to “Neglect Shames Britain 3”

  1. David Freeman says:

    Difficult to reply to this blogg, and heart felt comments.
    Trying to detach emotion from reality is very difficult.
    The older population of the UK are now tomorrows voters, but they/we have had our time and the likes of the health service must be realistic as well as us at what is called a health service!
    We the older generation need the younger working population to provide our countries future wealth (Ours is limited and I suspect as individuals stagnent or moribund-No future income growth), so we must face reality and give to some extent priority to the younger working generation, so they return to work within the shortest possible time after a health hazard of miss fortune of illness.
    Possibly in growing up as we did after WWII we where to some extent compassionate to our older generation, and to those less fortunate in our society, and now we expect/demand/require payback??? In Reality we must rely on our children and childrens children, did or have we educated then with compassion, respect and feelings for their fellow citezens? I fear we will have to wait to see the answer and trust that we did invest in our children and their generation wisely.
    I do not envy the decisions that the young will have to make about the older generation and (The physically disabled-Serving service personnel, and mentally disturbered people who are ill: and those who through the progress of the future drugs and treatments remain with a limited outlook on life.).
    We live in or at a time when we must rely on our teachings and past actions have we been good of heart and thought? and at 3 score years and ten do we derserve to be in a position to demand? I wonder? All I ask is for is a little compassion.
    I do have faith in the younger generation, and trust them to do the right thing, I still have my vote, and a little influence, but that is all: We all have to face reality at some time in our life.

    • john graham says:

      David, I think you have raised an interesting perspective. The generation of children born around the second world war have certainly been lucky to have grown up in a time of great post-war prosperity, and I believe that it is the wealth they have accumulated in their lifetime that will have to sustain them in their old-age. Whilst have great faith in our childrens generation, I don’t think we can rely on them too look after the elderly. Firstly, because at least at a political level they have not shown much ability to look after older people so far. Secondly, I am sure you would agree their first concern needs to be to secure a great future for their own children.
      To me what this means is that all those who are over 60 will need to fend for themselves and each other with all the compassion and financial resources they can muster.

  2. david Freeman says:

    Interesting John. You and I are I suspect looking at the same coin, maybe from the same side, but not the same view. I must bow to my parents and the views they held, and to the way they led their life, and how they influenced their peers, and as a society made the opportunities for me to live my life. I may have been fortunate, but I was always told hard work, honesty in life has its own rewards. Besides taking we must give. Some of us do not have the financial reserves to directly benifit the rest: However if one has paid ones taxes and financial burdens to society and discharged our responisibilities to our personal families, we have done our duty, then what is left is time. This commodity shown without restictions has its rewards, and John as you have shown in your vision of the EXTRACARE way of life: That if one can be encouraged to be independent, and yet responsible and active in ones society, without the total recourse to excesssive amounts of money.
    How one address’s that our generation had opportunities to buy one house, earn a decent living, I think besides the ‘Hard Nose Facts’ that this may be correct. I think we still have to reflect,as to how this was achieved? By that I mean as a society, and as I have said it is a hard fact of life that as one grows older and reaches the top self of expectations one has to reflect and take stock, and ask what did I do for my fellow man? I still as I say have the vote, and as part of the aging population of the Greater UK, if I have not the resources to sustain my self and family to house, clothe and feed ones self, then I am dependent on my fellow citezen, especially ones family and society in general. The opportunities of the younger today are clouded by the heady messages of ill concieved good will promligated by today’s politician’s: This is where I think we have the opportunity to guide them to speak the talk, and to believe in the truth, and give out the ‘hard’ messages of life that encourage all members of socity to act and think for the benifit of all, not just for a small majority.
    The end of todays sermon!!! AHHH!!!

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