Care Of The Elderly
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One of the reasons why I flagged up the seriousness of the financial position at St George's was because apart from the fact that it was my professional duty to tell the truth I also believed the point had been reached where clinical services and patient safety were being severely compromised through the continual pressure to achieve a cost reduction programme to bridge the governments NHS funding gap. If I had any doubts at all about whether I was doing the right thing, those doubts have been completely dispelled by my personal experience of how my own mother has been treated following a fall at home in which she fractured her hip.
One would hope that the elderly would always be treated with respect and consideration, but I have to say that the experience that I have had with my seventy-nine year old mother, is that this is not always the case.
My mother has been suffering from vascular dementia for the last couple of years and on the 5th October, although perfectly mobile up to that point, had a fall at her home which resulted in a fractured hip. She was taken by ambulance to Mayday Hospital in Croydon and operated on a couple of days later, although as the CHI report conducted at Mayday in 2001 said, "The number of people who die after being admitted for a fractured neck of femur (broken hip) operation is unusually high. Many patients admitted for this procedure have to wait up to five days for an operation, the recommended wait is 24 hours." Although my father and I never got to speak to the surgeon who operated on her, we were told that Dr Diggory was the consultant geriatrician who would be responsible for my mother's care and he then told my father that there was a risk that my mother's dementia could worsen as a result of the operation. Nevertheless he said that if it was his mother he would go ahead with the operation so my mother was operated on a couple of days after she had been admitted.
The day after the operation my mother looked to have made a good recovery and the nursing staff, who are completely stretched and have my complete admiration for what they have to do, had got her sitting up in a chair. During the days that followed her condition slowly improved and then on the morning of the 20th October Dr Becky Borham a Senior House Officer spoke to me on the phone and said that my mother had made a good recovery and that they were starting to consider the next step in my mothers rehabilitation and that this might involve a transfer to Purley Hospital. When I asked why this needed to be done and when she would be moved, Dr Borham said it was because there was pressure on the acute beds at Mayday and that the clinical opinion was that my mother needed less intensive care and as my father who is also in his seventies and undergoing medical treatment for a number of conditions was unlikely to be able to give my mother the rehabilitation help she would need and that therefore she would not be able to return home immediately. Dr Borham went on to say that, before any decisions were taken about moving my mother I would be fully consulted about what was going to happen to her and that the Care Manager would speak to me to discuss my mothers care plan. Later that day when I visited my mother Dr Borham told me that there had been a complete change of plan, as my mother had taken a turn for the worse and now had a urinary tract infection and that an x-ray they had taken had shown that my mother now had several new fractures to her hip. I asked how that this could have happened and Dr Borham said that although no one had seen her fall, or recorded that they had had to pick her up after a fall, they were making the assumption that this is what had happened and that there was now no question about transferring my mother out of Mayday in the foreseeable future, as they would not be operating on the new fractures and instead would keep her in bed for a period of about six weeks to allow the fractures to repair themselves. My mother therefore continued to be an inpatient on Fairfield Two ward and we heard nothing more for a couple of weeks. My father and I taking it in turns to go in each evening to feed my mother and administer her medication in order to assist the nursing staff who are clearly at full stretch dealing with all the dependent geriatric patients in their care.
On Thursday 30th October it was clear that my mother had contracted another urinary tract infection and that she had been prescribed antibiotics which were being fed to her intravenously and when I visited her she was also being given oxygen and was in a very poor state. The next day when I visited I asked to speak to a member of the medical staff who could inform me about my mother's condition and waited over an hour before a Senior House Officer from the Accident & Emergency Department came up to see me. It was immediately apparent that he had never even met my mother before and had no knowledge of her medical condition and so could not tell me anything about her long term prospects for recovery. I told him that I could come in at anytime to see a member of the medical staff who did know something about my mother's medical condition and he suggested that I speak to the consultant Dr Diggory and suggested that I wait till the following Monday, when if I asked the nurses, they would get Doctor Diggory to speak to me.
On the Monday I was going to speak to Dr Diggory my Father rang me to say that he had received a phone call from the hospital ward to say that my mother was either that day, or the next being transferred to another hospital. He was distressed at this news because we had not been told about her condition or the long term prognosis. I immediately rang the ward to try and speak to Dr Diggory, but was told that he had just left the ward and could not speak to me. I therefore rang his secretary who told me that she would give him a the message, that I was trying to speak to him about my mother. I also left a message on the Chief Executive's answer phone to say that I was not satisfied with the way my mother was being treated. A couple of hours later I had a telephone call from a lady called Gwen from the Patient Advisory Liaison Service who told me that she was contacting me as a result of my call to the Chief Executive and that she would go up to the ward to try and find out what was happening to my mother and would get back to me. When she got back to me she told me that my mother was being transferred that day to Purley Hospital and that Dr Diggory would not be able to talk to me until the evening at the earliest, well after my mother had been transferred to another hospital. I said that I was not happy with that, as I had attempted since the previous Friday to speak to a member of the medical staff about my mother's medical condition and that I had been promised before she was moved that I would be fully consulted about her care plan. I said that I was now so dissatisfied about what was happening to my mother that I would now make a formal complaint about how my mother was being treated and report the matter to the media. I also said that if Dr Diggory was going to contact me in the evening I would actually be at the hospital from about 5.45pm, as I would be going in to feed my mother and give her that night's medication. About twenty minutes later Gwen phoned me back to say that because of my concerns they had decided not to transfer my mother to Purley Hospital that day. I told her that this was an equally wrong decision, as if my mother needed to go to Purley Hospital on medical grounds that is what should be happening and the move should not be delayed simply because I wanted to speak to a member of the medical staff to find out about my mothers condition. I told her that my concern was the fact that despite earlier promises to be consulted about my mother's medical treatment, these promises had not been kept and my mother was not being treated with the dignity that all elderly patients in the NHS deserve and was effectively being treated like a "sack of potatoes" and moved at will without any reference to her next of kin. The Elderly Care Charter given to geriatric patients at Mayday clearly states among other things that patients are entitled to nominate a person to discuss issues of their care with hospital staff and as I had made clear on every visit to the hospital and on the telephone this was not happening.
While I visited my mother at Mayday on the 3rd November, despite having said that I would be on the ward in the evening, Dr Diggory telephoned my home. My nine year old son answered the telephone and told Dr Diggory that I was not at home, when he asked for me. My son said do you want to speak to Mrs Perkin and Dr Diggory said, "No, I just want to leave this message for Mr Perkin. When Mrs Perkin goes down to Purley tell him she will still be under my care, she is likely to need long term nursing care as I don't think she will ever walk again". So this devastating piece of news was delivered by Dr Diggory to my nine year old son.
Dr Diggory telephoned me the next morning and we had a very unsatisfactory conversation. He was clearly not prepared to discuss my mothers clinical condition with me. Basically what he said to me was that patients with my mothers condition often fall over and that basically he did not think that her hip would ever support her walking on it again. When I complained that he had communicated that message to my mothers nine year old grandson, he said that was the trouble when you communicate by telephone. When I said that I had tried to see him for several days to talk to him about my mothers condition and could have come in to see him at any time he simply said, "This conversation is getting us nowhere". So I thanked him for his time and told him I would be making a formal complaint about the way that my mother was being treated and the fact that I have never had a proper conversation with any member of the medical staff since I spoke to Dr Becky Borham a week after my mother was first admitted to Mayday.
On the Tuesday 4th November my mother was transferred from Mayday Hospital to Purley Hospital, without any discussion taking place between myself or any member of the medical staff. Because of this on the morning of the 5th November I wrote to the Chief Executive of Mayday Keith Ford someone who I knew well from time as Finance Director of St George's, complaining formally about the way my mother was being treated. At lunchtime on Thursday 6th November, I visited my mother to help assist the nurses in feeding lunch to her and spoke to the Ward Sister. It was clear that my mother's condition was deteriorating and I asked if I could talk to a member of the medical staff. The Ward Sister told me that this was not possible as the only doctor attending the patients that day had left the hospital and would not be returning. However she asked me not to judge Purley Hospital on the standards that applied at Mayday and said they would do their best to look after my mother and her condition might improve as they were giving her a general antibiotic, as they believed she had picked up another infection. She also went on to say that the transfer to Purley Hospital may not have been appropriate because they did not have physiotherapy and occupational therapy services available at Purley and that she thought that in view of my mothers hip fractures, access to these services might have assisted my mothers rehabilitation had these services been available to her. Indeed another of the "Rights" outlined in the Mayday Elderly Care Charter is to, "Be treated individually by a multi-disciplinary team as appropriate i.e. Consultant, Ward Sister, Physiotherapist, Occupational Therapist, Social Services Care Manager, District Nurse/member of the Elderly Hospital at Home Team who will meet weekly to discuss your progress and discharge plans. Other therapists such as dieticians etc will be involved in your care if necessary." Well if any of this had gone on regarding my mothers care it was well hidden, as I was still waiting to have my request granted to see a member of the medical staff to discuss my mothers condition. The other piece of advice I got from the Ward Sister was that I should ring Sheila Black, who she told me was the Care Manager responsible for my mother.
I rang Sheila Black that afternoon and she gave me yet further information that indicated my mother was not being properly cared for. Firstly she told me that she had requested that a Nursing Needs Assessment be completed on my mother on the 24th October, when she had been at Mayday, but for a reason she did not know about, that assessment had never been completed and that it should have been done before my mother had been transferred to Purley. When I told her that my mother now had several fractures, she said that this was not recorded on the file she had been given and that according to the information she had received my mother was only suffering from the original single fracture. When I asked her how all this could have happened, she said that the problem was that when the Mayday acute beds came under pressure, patients were often too rapidly transferred to Purley because the clinicians used it as a "Holding Bay". In view of all this information I sent a further e-mail to the Chief Executive Keith Ford outlining the further complaints I now had as a result of the information I had been given by the Ward Sister and the Care Manager.
On Friday 7th November I had a call from Janet Blackman the General Manager for Medicine & Elderly Care who told me that she had been asked to investigate my complaint and asked me what my primary concern was and I said that it was to meet with a senior clinician to discuss my mothers clinical condition. Janet Blackman said that she would arrange this and telephoned me later in the day to say that a meeting with Dr Diggory was being arranged for Monday 10th at 4.00pm and a letter confirming the arrangements subsequently arrived.
In the meantime, exactly as I feared if my mother was transferred to Purley Hospital, her condition was clearly deteriorating and on the Saturday lunchtime when I visited, she was in a very poor state. I spoke to the Staff Nurse and said I was extremely concerned that my mother should be examined by a member of the medical staff. He said he had put a call out for the Doctor on call to see my mother, but unfortunately there had been no reply to his call. I said I would not leave until I had seen a doctor to discuss my mother's medical condition and after a short while I was introduced to a Dr Arora. Dr Arora said he was a visiting GP who helped out at Purley Hospital and that he had not seen my mother before and asked me to tell him about her condition. For the first time in over a month since I had spoken to Dr Borham, I was having a proper conversation with a medical practitioner who was interested in my mother. I explained to him what had happened to my mother and at the end of the discussion he said he would examine her. When he had completed his examination he told me that my mother was in a poorly condition and was continuing to deteriorate. He said she probably had an infection the impact of which was being increased because she was dehydrating and that both these problems need to be dealt with intravenously. He also said that he had concerns about her blood and that blood tests needed to be done urgently. He told me that Purley Hospital did not have the requisite medical facilities to treat my mother and that if she stayed at Purley, he thought she would continue to deteriorate and would probably die there. He therefore recommended that she should be transferred back to Mayday Hospital, where he said she could receive the appropriate treatment and if I was agreeable he would arrange for her to be transferred. I of course agreed immediately and thanked him for his concern and consideration. For the first time in eight days of asking, I had finally got to meet with a clinician who had explained to me the positive steps that needed to be taken to address my mothers clinical condition. The staff nurse told me that Mayday Hospital would ring me once my mother arrived there, but as usual with the Mayday Trust no call came through, so I rang Mayday early in the evening to firstly be told that I could not be told anything, as how did they know I was Mrs Perkin's son. After getting over that hurdle, I was told my mother was being treated in A&E and that they would contact me in due course to let me know what the position was with my mother. Later that evening I received a telephone call from the A & E sister to say that my mother's condition had been stabilised and that she had been admitted to Thornton Two Ward of Mayday Hospital.
Over the next two days my mother's condition continued to improve and on Monday the 10th November, I finally had the promised meeting with Dr Diggory and Nikki Luffingham Deputy Director of Nursing/Director of Quality. Dr Diggory apologised to me for many of the problems that had taken place and both he and Nikki Luffingham agreed that I should have kept informed of my mothers condition and the clinical decisions that were being taken regarding her care. At one point Dr Diggory told me that my mother had been seen by a Psychiatrist and that anti-depressant drugs and a mild tranquilliser had been prescribed and administered to my mother without any consultation at all. Dr Diggory told me that his prognosis for my mother was not brilliant, because he believed that in remaining in hospital with a fractured hip, she would remain at great risk of picking up a hospital acquired infection that could prove fatal. He told me that they would be keeping my mother in Mayday Hospital for the foreseeable future to allow the hip fracture to mend as far as possible and then would contact me to discuss the next steps in my mother's care.
My impression of the Care Of The Elderly at Mayday is not that the Doctors and Nurses are not caring, hardworking individuals. Indeed I found Dr Diggory a very pleasant and I am sure from a layman's prospective a very competent doctor and I have always found the nursing staff at Mayday extremely kind and concerned. The reality however, as in so much of today's NHS, is that their efforts are betrayed, because they are asked to do too much and therefore because of tiredness and overwork are unable to provide the care and clinical cover that the elderly both deserve and are entitled to. I think this point was illustrated when Dr Diggory at out meeting, tried to tell me when he would be able to update me on my mother's condition and found it almost impossible to find a time slot in his busy weekly schedule, which leads me to the conclusion that while he may fit in a meeting for a complainant, it would be impossible for him to devote, that level of time to all his cases, despite the fact that the Mayday Elderly Care Charter suggests that patients are entitled to nominate a person with whom issues related to their care should be discussed. I think that there should be a review of elderly care at Mayday and Purley Hospitals and that this should include the proposed transfer of the in-patient beds at Purley to Mayday, which Janet Blackman the General Manager for Medicine & Elderly Care at the Mayday Trust told me would be happening next year, despite the fact that Dr Diggory told me that elderly patients suffering from dementia problems often did much better at that hospital than they did at Mayday. When I asked Janet Blackman whether, when they closed the beds at Purley, they would be opening an equivalent number of beds at Mayday, the reply was predictable. Her answer was to be expected. No, less beds would be opening at Mayday than currently exist at Purley. In a society that has to deal with an increasing number of frail elderly patients, one simply has to ask is this the right way to deal with the problem of caring for an increasingly aging population by cutting down the number of beds available to the elderly when there is clearly a huge need for them.
I think that my mother's experience shows that that elderly patients at Mayday hospital are not always treated with the respect and dignity that they deserve and when pressure is on for an acute hospital bed the elderly can be the first to suffer. Elderly patients don't just need their broken bones mended, they need to be helped with feeding and encouraged to drink enough to cut the risk of them picking up other infections and falling over again, within days of having had a serious operation. These are questions that need to be answered if the elderly are truly to be treated with the respect and dignity they deserve and which politicians claim they are getting.
My mother's case has been covered by the Croydon Advertiser click here to read their article.
Since my mother's case received publicity I have been contacted by other patients relatives who have related to me the problems they have had with the care of their elderly relatives when their medical problems have required that they need NHS treatment. Typical of the information I have been given is a letter published in the Sutton Post which I think accurately mirrors the experiences I have had with my mother. In addition I have been contacted by some relatives who feel so strongly about what happened to their loved ones that they tell me that they will never get over the experience. One such patient was Mrs Patricia Perry who died in the Mayday and her daughter Mrs Henning has given me the details of her mothers case, because she feels strongly that her mother was not treated with the dignity and respect that she was entitled to expect, when she also was admitted to Mayday Hospital. Click here to read Mrs Perry's distressing story.
Another relative of a patient who was being treated on the same ward to which my mother was originally admitted has sent me a copy of a letter she has sent to the Mayday Chief Executive stating amongst other issues that in relation to an incident that took place in September 2004, "Staff rarely came to the ward when required and the poor patients seemed to have to fend for themselves. In fact, another patient had a fall and was left on the floor for thirty minutes and it was not until the Monday that it was discovered that she had a fractured hip." The problems in treating the elderly in line with the Patient's Charter have been highlighted in another letter I received from a patient whose mother died after a very poor experience of care provided at the Epsom St Helier Trust. Indeed that particular Trust has recently received adverse publicity over another incident that involves the care of the elderly which has been widely publicised in the local media. Click here to read the report that appeared in the Sutton & Cheam Advertiser Newspaper on January 13th 2004, about where the St Helier Hospital failed to inform the relatives of a patient that he had died and that they only found out when the found another patient in their fathers hospital bed. The interesting thing about the article is the St Helier Trust's comment about the incident, "Our matrons will be making sure that nursing staff across the trust are made aware of this incident and learn from it." No responsibility accepted by the Trust's senior management about how they can have let hospital services get into this state. How do they intend to deal with the situation? Simple, issue another instruction to the hard pressed nurses working on the front line who already mop up the vomit and help patients on to the commodes. I don't think you have to look much further to identify the real reasons why things go wrong, when hardworking dedicated staff are so betrayed by the people who supposedly manage them.
In my mother's case, although she will now always need nursing care for the rest of her life, she has made significant progress and despite of Dr Diggory's gloomy prognosis she is no longer in imminent danger of dying and is quite happy now she has been with family involvement transferred to Purley Hospital. However, I know that if it had not been for my intervention in her case I would no longer have a mother to visit and I have therefore requested that an independent inquiry set up into the care she has received at the Mayday Trust, not just for her own sake, but also for all of those elderly patients who may not have a relative or friend to speak up for them and who current NHS arrangements effectively downgrades as the