The 'don't really care' of elderly people in the NHS

Yesterday's report from the Health Service Ombudsman about the inhuman care of elderly people in the NHS  generated  predictable handringing about the standard of nurse education in the UK. As in 'should be more of it'. Contrast that with a contrary view, also expressed, that nurses are now too well educated and think they are above contact with patients as that's too grubby, too menial.

It's both much simpler and more complicated than that. I think the nurses are both the problem and the solution.

Where were the whistleblowers amongst the registered nurses?  If there weren't any, why the hell not? More education would make them more assertive. So, more education please. If ward nurses did complain about workload and standards, who was ignoring them? Senior nurse and managers perhaps - well, why were they ignoring them, then? More respect of valid professional opinions by management, please. But were they any registered nurses? What level of education and specialism did the ward staff have? Was it the bare minimum - from the 'you'll do' form of NHS recruitment? That will certainly work as a way of keeping things crappier than we expect.

Why does there seem to be a non-existent sense of professional self worth, amongst registrants with the Nursing and Midwifery Council, such powerlessness amongst the staff, to change things? If ward nurses don't think they have any professional weight worth throwing about, on staffing, standards and workload, what are the senior Trust nurse executives up to? Oblivious to what is going on, on the wards? Or something much worse, if there can be such a thing?

It's reminiscent of those terrible child abuse cases that crop up - once again we are spotting a major NHS scandal. Once again it involves care of the elderly. Once again some staff seem third rate or even personality disordered. How are these undereducated, demoralised, struggling staff recruited? Are they sociopaths? Or do they start off normal but terrible working situations erode decent hardworking nurses into misshapen, sullen, knackered passive aggressives -maybe even aggressive aggressive? 

These repeated case studies of neglect and active disregard look like a naturally run version of the Milgram experiments conducted in the early 1960's.  The voices of authority are the senior managements of various Trusts, encouraging everyone to do more with less, with no way of recognising when the tipping point comes - when you can only do less with less. So the nurses carry on regardless, unaware that they are now numb to the horrors they are perpetuating.

The patient group - elderly people - are, of course, very conspicuously, not high status. They are old, weary and can be wearying to look after. And this lack of status spreads, by proximity, to the staff. Some staff will have chosen geriatric care as a preferred career path. Good for them. Many staff however, will not have done. It can be physically hard work, often repetitive, sometimes, like the toils of Sisyphus - there's no feeling your work is going anywhere, or changing anything. Geriatric medicine does not have a popular profile as an heroic application of cutting edge medicine. It's definitely not heart or brain surgery. It's seen as routine, drudgery, even just containment. Not life saving either. No matter how hard it is intellectually and spiritually - and it is - the physical capacity to do it is the current bottom line, not the mind and heart you might bring to any situation. 

Once exhaustion sets in, and over-work overwhelms, standards plummet. Then the cheery nurse advocate for the patient becomes an acute danger to the patient. If memory serves, if you looked on the disciplinary pages of the NMC website there's an over representation of complaints from settings where older people are the client group....

So time to:

• respond to the demands of an ageing population; recognise the impact of dementia and other diseases of ageing in complicating care across all areas of health in the elderly
• up-end the hierarchy; instill respect by senior nurses of their ward based collegues; use management to help the doctors and nurses do their work, not the other way around.  
• audit education and training of staff with responbility for older patients; improve it; count vacancies; count the number of clinical nurse specialists per head of patient population; compare with other clincal areas; count complaints; interpret all the counting, see where it leads. 
• grasp how to elevate the status of work with old people to aspirant, rather than effluent, as it sometimes is, where 'difficult to place, difficult to sack' staff from other areas can land up.
• clearly recognise current clinical leaders as the ones with patient contact, not the ones with cubicle space, potted plants and time. 

Should anyone ever notice job adverts where nurses for entry level patient care are recruited for their wit, creativity and leadership skills, let me know.

You won't, of course. That is where a lot of the problem arises. If we expect nurses to be nice and kind but not very bright we are not expecting enough. Nice and kind does not challenge the status quo.