“Neglect Shames Britain 2”

Posted on December 22, 2010 by john graham

Two days after the Patients’ Association and Daily Mail campaign to improve NHS care of the elderly started, it continues to attract attention.  Thanks to the information provided through the Patients’ Association helpline and the continued excellent coverage in the Daily Mail.  No reports yet on how the appeal to raise £100,000 to expand the helpline service but the Daily Mail donation of £50,000 got it off to a great start.  So far so good, but:-

How can the helpline help?

The £100,000 will only fund an additional 2 or 3 full time workers, which will only help process a few more complaints.  Surely, raising an army of volunteers to man the helpline might be a better option, and this would allow the money to be used to promote awareness of the Patients’ Association helpline service in every NHS hospital.

But you still have to ask – will it tell you any more than you already know?

And – how can it reach beyond the tip of the iceberg and reveal the full scale of the problem?

What it can do is help build up a fuller picture, but the media is hungry for new news, more of the same won’t do.  Both the press and their readers can be notoriously fickle friends.  They need constantly feeding with new stories and most of all new angles.  So that’s the challenge for the helpline story.

So what are the angles:-

The first and most obvious angle that people pursue is to seek to blame someone for their wrongdoing.  Whilst this is a natural response, it is the least likely to lead to long term change.  Pursuit of blame leads to defensiveness, concealment and often obstruction.  If there is an outcome at all, it will probably be a grudging apology.  If there is a compensation payment, it will usually be without admission of guilt and with a required vow of silence.  Neither of these leave the complainant really satisfied. 

A second more challenging approach is to cry “Health and Safety.  For issues like serious falls and unexplained deaths, this may well bring down the might of the Health and Safety Inspectorate, but it takes an interminable amount of investigation and time; as a result few individuals decide to take this route.  Maybe more should since the fines for a conviction are considerable. 

Another angle is to look at health outcomes, which should be the most obvious and constructive way of learning from bad experience. 

 Is the patient cured or at least healthier when they are discharged? 

 Are they now incontinent? 

Have they acquired an infection like MRSA or C.Difficile?

 Are they able to go back home or move into a higher level of care? 

Do they quickly return to hospital through the revolving door?

Sadly, the NHS does not feel like a learning organisation.  The systems are too heavily geared to maintaining the status quo, and the staf are too busy getting on with the next mistake.  If the Care Quality Commission, with its newly established powers become involved, the most likely outcome is a blizzard of paper and audit reports.  This only focuses the staff on avoiding blame in future and takes them even further away from the patient.

Gather figures from the helpline and you will build hard evidence of the effectiveness of hospital treatment.  Clearly the people who complain don’t think they or their relative are getting good care, but the scale of the problem is where the news story is.

The last angle, and the only one that will ultimately make the Government listen is MONEY (and then only if it is a money saving measure).  So gather evidence from the helpline cases and extrapolate them to achieve a broad health-economic picture of just how much could be saved by providing better health care e.g.:-

Reduce Waste – unnecessary

treatment /unesscessary    tests/ unused food /high absence levels

Eliminate Infection – which extend stays due to hospital acquired MRSA / C.Difficile

Outcomes – The higher cost of care post discharge / revolving     door re-admissions

 Waste money will grab attention – don’t you think?

Drip feed these stories into the Daily Mail publicity machine.  Continually raise awareness of the justifiable fear older people now have that they are no longer safe in the hands of the NHS.

Then the answer is:-

“Yes the helpline can help”

Donate to the Patients’ Association helpline appeal

www.patients-association.com

Posted in ELDERLY UK POLICY | Tagged , , | 1 Comment

“Pilly Galore”

Posted on December 19, 2010 by john graham

A follow up to “Pills for Everything” dated 7th September 2010.

This is the story of Pilly Galore and her GP, Astroglaxo.  Pilly is 85 now and each new year brings more ailments. She lives alone and rarely goes out, except to the local shop once a week.  Her only other regular trip out is to see her doctor, who she calls “Astroglaxo” after her favourite drug company.  Pilly has had the same GP for 30 years. Although there are lots of new doctors in the surgery now, Pilly says “they are all too young and only training”.  She always insists on seeing “Astro” (they are on first name terms) because “he can cure everything”.  Equally Astro has a soft spot for Pilly and so never sends her away empty handed.  Their brief conversations always end with Astro confidently saying “take one of these a day Pilly and you will soon be better”.  Pilly leaves reassured until the next ailment comes along.

That’s the psychology of quick fix consultation today.  GPs are expected by their masters – the Department of Health, to come up with instant cures like a McDonald’s fast-pill-take-away-service. Equally their patients feel cheated if they don’t come away with a prescription for something.  Luckily for Pilly she does not have to keep going back because she can just phone up Astro’s assistant Pharmacuti and get a repeat prescription with the new McDonald’s express home delivery service. Thanks to Astro, Pilly has always got lots of pills in the bathroom cupboard.

• Every year millions of people are given unnecessary or inappropriate drugs

• It is estimated £400m of drugs are wasted every year

• Multiple prescription drugs often have side effects in the older people

• Up to 30% of all hospital admissions in the elderly are caused by inappropriate prescribing – British Geriatric Society.

 

 

Posted in HEALTH | Tagged | 2 Comments

“Neglect Shames Britain”

Posted on December 6, 2010 by john graham

I have often criticised the “Daily Mail” for it’s over sensational headlines, particularly those that raise unnecessary fears for older people.  The title of this blog is their front page headline of the 2nd December and for that they deserve CONGRATULATIONS!  More so because it was followed up the next day with a double page spread and a £50,000 donation to the Patients’ Association.  Then on 4th December yet another double page spread (albeit by now relegated to pages 20 and 21), this time with politicians and celebrities jumping on board – from Andrew Lansley, the Minister of Health and Stephen Dorrell, a former Health Secretary to Jack Charlton, Ulrika Jonsson, Carol Vorderman, Duncan Bannatyne, Ann Widdecombe, Simon Cowell, Esther Rantzen (obviously none of them just wanting to step in the limelight of publicity).

The touch-paper of this “campaign” was lit by a report from the Patients’ Association which focussed on the significant increase in complaints about the care of older people in the NHS.  This is far from a new issue, but it is one that has fallen on deaf ears so many times in the past.  Let’s hope the legacy of Claire Raynor, who was until recently, President of the Patients’ Association, will put wind under the wings of this initiative. 

They are a very small organisation who deserve the highest praise for managing to raise the profile of this issue on behalf of thousands of older people, past and present.  The challenge for them now is can they keep up the momentum, and are they able to resource themselves, both financially and strategically to promote a major change in health care.

If we go back to the source of this issue, it is a rise in complaints about elderly patient care to over 5,000 a year.  A number which has doubled since 2008, and will almost certainly be on the tip of an iceberg of real concern by residents and their relatives.  Many patients are reluctant to complain, either for fear of stimulating a negative reaction or because they have no confidence anything will change.

The NHS management and the medical professions are renowned for their defensiveness when criticised.  Yet many of the complaints highlighted in the report are indefensible:-

  • Failing to feed people
  • Failing to give them a drink
  • Failing to provide personal care
  • Failing to give relief from pain
  • Not providing dignity or respect

All these things are at the lowest level of meeting Maslow’s hierarchy of needs, are the very basics of good nursing care.  They are neither expensive nor technologically difficult to provide, so why are they so frequently not available?

Step out of the NHS box for a minute and imagine we were talking about DOGS.  Dogs that were not fed or given water; dogs that were never groomed or washed; dogs that were left sitting in their own urine and faeces; dogs knowingly left in pain.  There would quite rightly be uproar.  Neighbours would report owners to the RSPCA.  The RSPCA would step in and take over care of the dogs.  The dogs’ health care would promptly be attended to.  Prosecution of the previous carers may well follow.  Widespread neglect would attract the attention of animal rights campaigners and the general public would be fully behind them.

Perhaps the key difference is that pet care is provided by owners and animal support organisations, either voluntarily or through charitable donations.  There is little Government support or intervention in support for pets.

You have to ask if the malaise which affects the lack of care of the elderly rather than blaming the medical carers on the wards, really starts at the top with the Government.  Successive Governments have consistently under-funded elderly care while simultaneously increasing the burden of legislation that bears down on the care sector.  I will write more about this later.

In the meantime, let’s wish well and God speed to this Patients Association report and Daily Mail campaign.  Is £100,000 anything like enough – shouldn’t it be at least £1m?  And will independent matrons really be able to turn around an elderly, careless NHS culture?

More later, what do you think?

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“No Gumption 2”

Posted on November 27, 2010 by john graham

On the 11 June 2010 I wrote a post about the problem of chewing gum on the pavements of Westminster City Council.

Looks like this problem is going to increase.  Kraft have opened a new gum research centre in Switzerland to cash in on the growing chewing gum market by developing new flavours.  Apparently the market is worth $23,000,000 annually.

How about inventing a flavour that appeals to dogs like Boneo gum, Winelot gum or Pedigree gum.  That way there’s a good chance that everybody walking their dogs will be hoovering up the mess on the pavement at the same time.

Otherwise we are all destined to be stuck with the problem for a long time.

 

Posted in SMILES | 2 Comments

Breakfast Exercise 2

Posted on November 21, 2010 by john graham

This morning I woke up early – 5.45 am, tired and in my natural stupor first thing in the morning.  It’s a time for an autopilot routine – not a time for a challenge.  Still half-asleep – grumpy is my default behaviour.

Put on the kettle, brew the tea, reach blindly into the overstocked kitchen cupboard for the cereals.  At least today nothing falls out and makes a mess on the floor.  A familiar friend – the green, yellow and red of a Kellog’s Cornflakes box; brand new, unopened in great big print written down the side of the box CORNFLAKES.   I turn the new box on its end and the first unwanted challenge of the day awaits.  Where’s the little easy-to-open tab – can’t find it – can’t see it – damn it – they must have changed the packet design.  They are always doing that!  I am sure the box used to be easy to open.  It’s no doubt on things like that that wars are started.  Start off grumpy, hassle before you’re even out of your pyjamas; belligerent for the rest of the day.  All thanks to Mr Kellogg!

Undefeated, I charge into battle and manfully tear open the tightly sealed down lid of the packet.  Open the inside un-resealable airtight bag and at last the welcome crunch of crispy flakes fall into the breakfast bowl.  The now forever opened box goes back in the cupboard, no doubt ready to fall out and become tomorrow morning’s natural disaster.

It’s too early for the daily papers, so I sadly decide to get the cornflake box out again and investigate how this change in Kellogg packaging policy had come about.  Of course I have to be especially careful not to spill the contents in the process.

All the usual small print.  The key ingredient details on the front – calories, sugars, fat, saturates and salt to the nearest tenth of a gram.  Who on earth ever counts all these up through the day? 

The amounts are also in percentages but strangely the totals only add up to 18%?  Where have the other 82% gone?  Am I being short changed?

Turn to the side of the box and there is an encyclopedia of further information about the ingredients, including vitamins I have never heard of and lots of small print I can’t read.   I hope it’s not important!

The other box side is equally small print but I can just make out it’s the details of how to complain.  I’ll bet Kellogg’s don’t get many complaints this way.

On the back of the box the marketing claims really go over the top.  Apparently there is a “whole lot of sunshine in each and every bowl”.  No health warning about ultraviolet light but you probably get wrinkles for free.

One final side to the box which I can only read by carefully holding the ripped open opposite end.  It says in small print “to open, slide your finger under the tab and break seal to left and right”.

Grrrrr!

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“Walk for life”

Posted on November 14, 2010 by john graham

This is the conclusion of a review done by Bangor University of recent research into where best to exercise.  The study points out that exercising outdoors is better at helping your mind to relax.  It helps cut anger, fatigue and sadness.  After a walk in the open air, people felt more energetic and found it easier to concentrate.

It would be good to see some research on how frequently older people do go outside after they retire.  There are lots of intrepid travelers abroad and closer to home ramblers in the countryside or window shoppers in the town.  Nonetheless I would guess that people are less active as they get older.  The image of more leisure time is curtailed by limited financial resources and replaced by the easy option of daytime TV.  Add to this the limitations of impaired mobility and worries about street crime and gradually we are creating a generation of “her indoors” as Arthur Daley would say.

For the older elderly this is especially true, particularly for those in residential homes who very rarely get outside simply because of the shortage of staff to assist them.

This study reaches a simple conclusion but one with important consequences for how people should be looked after in later life.  The opportunity to get out and enjoy some fresh air and gentle exercise should be an essential ingredient of housing and support for the elderly.  This relatively inexpensive activity can be the start of a virtuous circle that improves well-being and reduces social isolation.  In turn there is ample evidence to suggest that this lifts people out of the downward spiral of loneliness, depression and deteriorating health.

It’s not a cure-all but it is a positive lifestyle change that could be encouraged and supported.

Maybe we should start a “Walk for Life” campaign ?

Posted in HEALTH | Tagged , | 4 Comments

“Pop memories dashed”

Posted on November 14, 2010 by john graham

One of my earliest childhood memories was the excitement of looking up the street every Thursday to see when the Corona pop man was coming, bringing my weekly treat – a bottle of pop. In fact a whole crate – 4 bottles – bright yellow lemonade not like the cloudy white colour you get now – sweet red cherryade – the mystically named dandelion and burdock and the fizziest of all orangeade.  You had to be good for the week before you get it, but I rarely missed.  That pop must be responsible for keeping me on the straight and narrow.

Only now sixty years later, do I find my memories dashed.  Research at Harvard University suggests that pop can accelerate ageing.  Maybe I am only 40 after all.

Apparently too much pop can lead to wrinkles and even worse, damage to heart and kidneys.  I don’t remember there being any warning on the bottle, perhaps I could sue the Corona pop man!

How many more happy memories will be dashed?

Posted in SMILES | Tagged | 1 Comment

TODAY OF ALL DAYS !

Posted on November 11, 2010 by john graham

       I have complained a lot about over-sensational newspaper headlines which only succeed in worrying older people, but today I would have been pleased to see this as a front page headline   –    “Widespread neglect of elderly patients revealed”.   Instead it made Page 22 of The Independent (but only a small paragraph), page 20 of the Daily Mail and page 18 of The Guardian.  It was missed altogether by other press.

   I’m talking about a comment from a Report published on the very day that we commemorate the high sacrifice made by our parents and grandparents, which should bring shame on the rest of us for the complacency and neglect we give to the care of generations who were called upon to give up so many lives.

     The Report entitled “An Age Old Problem” is published by a quietly under-the-carpet and awkwardly named organisation called the “National Confidential Enquiry into Patient Outcome and Death”.      Maybe it’s a deliberately obscure and marginalised organisation because its conclusions in this report are such a devastating indictment of the medical profession and the NHS as a whole in terms of its treatment of older people.   The study looked at elderly patients who died in hospital within 30 days of undergoing surgery.

     Here are some of its shocking findings:-

  •   Two thirds of patients do not receive good care
  •   Most patients were poorly nourished and had other serious illnesses
  •   Yet two thirds of cases were not seen by a Specialist in Elderly Care
  •   A fifth of patients had significant delays between admission and surgery
  •   A quarter of hospitals had no Acute Pain service

     Commenting on the Report:- 

     Katherine Murphy, Chief Executive of the Patients’ Association said “It’s unbelievable that any Acute Hospital can think it’s safe to admit elderly patients without the correct Specialist team.”   (I agree  –  so what’s the Patients’ Association going to do about it?)

     Jo Webber, Deputy Policy Director of the NHS Confederation said “There is absolutely no excuse for poor care, regardless of the age of the person involved.”  (This is a complacent understatement if ever there was one.)

     Michelle Mitchell of AGE UK said “This Report is a stark reminder that too often older people receive second or even third rate care in hospital, condemning many of them to an early death.”     (Time to Rage against the Dying of the Light don’t you think Michelle?)

     Paul Burstow, Care Services Minister said the Study “paints a disturbing and unacceptable picture of the Quality of Care experienced by older people.”    (Well Minister, like it or not, your Government is now responsible for killing people rather than curing them.   Time for Action don’t you agree?)    

     The findings of this Report will not be news to many older people who have experienced surgical NHS care, where stories about mistakes and complications are commonplace.   However, tragically, this important Study deserves far greater media coverage than it has been given and a sustained Campaign for change NOW is called for. 

      Sadly and with great irony the significance of today’s date has been missed by Journalists and Editors alike. 

                                                         TODAY OF ALL DAYS!

Posted in HEALTH, N.H.S. | Tagged , , , | 2 Comments

“Spectacle wipes”

Posted on November 7, 2010 by john graham

If ever there was a product that needed to be easy to open it has to be spectacle cleaners.  You would also think that the makers of these would be highly aware that without their glasses, 50% of the elderly can’t see clearly enough to fiddle with opening packaging, nor can they read small print.

I am beginning to think that product designers must all be young people with 20/20 vision and a perverse interest in puzzles and guessing games.

Out in my car in Northampton, I noticed fog had slowly descended – strange on a sunny autumn day?  I suppose it could be the windscreen misting up but I couldn’t see the demist switch on the 747 cockpit of dials on the dashboard in front of me.  Finally, it dawns on me it just might be that my glasses need cleaning!

A quick rub over with my hankie only succeeds in making the lenses look like they have been smothered in Vaseline.  As a former boy scout I have to confess that the years of being told to “be prepared” made little impact on me.

My wife and all other ladies who wear glasses would undoubtedly have been able to reach down into the bottomless pit of her handbag and just like Paul Daniels, magically from nowhere be able to pull out a lens cleaner.  Where are wives when you need them!

With the luck of the devil I catch a glimpse through the mist outside of a “Boots” sign.  A quick U-turn – there is a sound of sharp breaking behind me but I didn’t see anything in my mirror.

Rescue at hand I go into the shop which like all big chemists has at least fifty similar products for every possible medical condition.  Dry eyes, sore eyes, sticky eyes, —I suppose I should be pleased I am in the right part of the body.  I could have spent hours peering at pile creams!  Now I have narrowed my choice down to the last fifty spectacle cleaners.  Handy plastic bags, big economy boxes, individual wipes, sprays, own brands, two for one offers.  I can’t see to read any of them so I settle for the first thing I come to – “wipe and shine – spectacle wipes”.

Back in the car all I have to do now is open the packet.  It should be simple enough but obviously it did not occur to the package designers of these “spectacle wipes” that you might not be able to see too well without your glasses.  After a fair amount of pulling and tugging on the plastic I finally give up and bite the corner off the packet – good job I’ve still got my own teeth!  They should make strawberry flavoured wipes in future – these don’t taste too good, in fact I think I’ve just they have just spoiled my appetite for lunch.

The good news for Carr Day and Martin, who make this product, is that when you can finally get at them, the wipes are O.K.  Or at least the first one is,only now I can see I bought a packet of 20.  Unfortunately, the remaining unused 19 will probably dry out now that I’ve torn the re-sealable pack apart.  What’s more, even though my glasses are now clean, I can barely see the small print instructions on the back of the packet.  I certainly can’t understand the diagrams and only with a magnifying glass when I get home, can I eventually see the tiny tab that has written on it:-

                                                             “ LIFT HERE TO OPEN”!

Posted in ELDERLY MARKET | Tagged , | 5 Comments

“I Spy – small print”

Posted on November 7, 2010 by john graham

“I spy with my little eye” was a fun game when I was a child.  We especially used to play it to pass the time on long journeys with my parents in the car.  No motorways then and roads which twisted and turned making 30 miles a long way.

Now with over 50% of older people having impaired eyesight, “I spy” is a whole new game re-invented by the advertising industry and hidden in the small print.  Virtually all adverts these days are accompanied by footnotes in unreadable small print, usually disguising a host of disclaimers which protect the seller not the buyer.  So beware !

To play “I spy” now you need a magnifying glass and then these are just a few of the phrases you will see – and my guess at what they mean:-

“Prices are correct at time of going to press”

I Spy – they want you to think prices are going up shortly.

“Discounts are for first call incentive offer”

I Spy – no discount left when you ring up.

“If we are out of stock we may substitute garments”

I Spy – goodness knows what you might get.

“A 3% balance transfer applies”

I Spy – an extra charge hidden in the small print.

“Delivery surcharges may apply”

I Spy – we may overcharge for delivery.

“Subject to terms and conditions available on request”

I Spy – if you don’t ask we won’t tell you.

“Tick if you don’t want to receive information from other companies”

I Spy – you will soon receive lots of junk mail.

All the above were in very small print in SAGA MAGAZINE.  So they are aimed at older people and are certainly not designed to give you clear information about the advertised product.  Surely this type of advertising should be outlawed under the Trades Description Act !

Get your magnifying glass out and tell me if you can spy other examples of small print ?

Follow up comment to “I Spy”

In the same Saga magazine, was a loose leaf flyer from British Gas selling boilers.  It was all written in small print and in even smaller print still was a helpful little note:-

“If you would like this leaflet in alternative format such as large print ………………………”

I’ll bet they didn’t get too many requests !

 

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