A pretty shocking report from the Health Service Ombudsman today exposed the lack of care given to frail, elderly patients in NHS units. There were a number of distressing case studies that highlighted neglect and contempt for dignity bordering on abuse. How can this happen in the new, modern NHS?
When more outright abuse of vulnerable people came to light (there were several high profile nursing home cases in the 80s), it had occurred in smaller units, away from the public gaze and was undertaken by a low paid staff who crossed the boundary between 'efficiency' and 'control'. The low status of the staff was, in effect, taken out on the 'difficult' clients, most of whom were severely confused through dementia. Ok, we can see how this situation might come about in such smaller units. But how does it happen in the public glare of NHS wards?
Some aspects are the same: the patients can be difficult because they are confused; the staff are probably stretched and striving to work 'efficiently' and the public are not on the ward most of the time to see what is happening. But what else has occurred?
I believe a few things have changed, albeit not overnight. The whole relationship between the carer and the cared for has changed through increased medicalisation. In the Middle Ages, treatment was based on a holistic principle: the sick person was just that - a person, first and foremost. They never lost their identity throughout any treatment they were given. The physician's diagnosis and treatment was all based on the needs of the person, the individual. The Renaissance began the revolution in medicine that led to the questioning of Galenic principles that had held sway in the field of medicine for hundreds of years. Certainly, change did not happen overnight and economic and social factors played their part, but over the years from that point, the patient as a person begins to disappear and become replaced with symptoms, a disease, a treatment. The individual is no longer present. Whilst this began with and was carried forward by physicians and surgeons, nurses too have followed the same path as their training becomes more medicalised. As the whole healthcare system has squeezed 'caring' out of the equation in favour of 'curing' (even though there are so many diseases we can do nothing about), so the needs of the elderly frail - who often really need CARE - have been marginalised.
The care and treatment of older people has always been a cinderella service, indeed it has not always been seen as 'health' care, being under local authority control in the past. I am sure there must be examples of excellent practice, but it seems that the whiff of the 'second class service' still hangs around. Perhaps it is the focus on cure (again, thanks you Renaissance pioneers) that is at fault; 'caring' seems so passive, so...unexciting. All the money goes into the sexy end of medicine - trying to find cures for things. Trying to get money to improve end of life care, aiding people in choosing where they die and so forth, is bloody hard! Of course, we all want to live for ever and not think about the other thing...
Maybe it is time to return to a greater degree of holism in the NHS. Perhaps if, from the moment one entered the the hospital system, one was dealt with as an individual and treated (medically and socially) as such, perhaps then it would lead to better care: it is surely hard to treat a person with whom you have a caring relationship with the kind of disregard today's report exposed. If the people on one side of the healthcare equation see only a disease or condition to be treated, beds to be freed-up and targets to be met, then those on the receiving end of 'treatment' may well be terribly let down.
No comments:
Post a Comment