Health care and the dignity of humans
The Health Service Ombudsman’s report on how the NHS is failing to treat elderly people with care, dignity and respect begs the question of how a service whose raison d’être is to look after people can so dehumanise them.
The report highlights the cases of ten people who suffered grievous neglect. Many of them were fit, active and healthy before treatment but all but one died during or soon after the events they experienced in the care of the NHS, and in circumstances which caused distress and anger to the patients and their families.
Four examples taken from coverage of the report in The Guardian:
• Alzheimer’s sufferer Mrs J, 82, whose husband was denied the chance to be with her when she died at Ealing hospital in west London because he had been “forgotten” in a waiting room.
• Mrs R, a dementia patient, who was not given a bath or shower during 13 weeks at Southampton University Hospitals NHS trust. She was not helped to eat, despite being unable to feed herself, and suffered nine falls, only one of which was recorded in her notes.
• “Feisty and independent” Mrs H, who had lived alone until she was 88, was taken from Heartlands hospital in Birmingham to a care home in Tyneside but, when she arrived, was bruised, soaked in urine, dishevelled, and wearing someone else’s clothes, which were held up with large paper clips.
• Mr C suffered a heart attack soon after undergoing quadruple coronary artery bypass surgery at Oxford Radcliffe Hospitals NHS trust. Trust staff turned off his life support machine even though his family had asked for them to wait for a short while longer.
Why does this happen? Reaction to the report has focussed on “the need to modernise the NHS” (a health service minister), staff and funding reductions (the Royal College of Nursing) and a lack of matrons to supervise standards of care (the Patients’ Association).
A more fundamental question for me is: does the NHS know why it exists? In the introduction to her report, the Ombudsman, Ann Abraham, points to the wide gulf between the values and practice of the NHS that is revealed by the stories:
“The investigations reveal an attitude – both personal and institutional – which fails to recognise the humanity and individuality of the people concerned and to respond to them with sensitivity, compassion and professionalism. The reasonable expectation that an older person or their family may have of dignified, pain-free end of life care, in clean surroundings in hospital is not being fulfilled. Instead, these accounts present a picture of NHS provision that is failing to meet even the most basic standards of care.”
She says that 18 per cent of complaints to her office about the NHS concern the care of elderly people and she upholds more than twice as many complaints as for other age groups.
The experience of elderly people is extreme. But it’s not hard to find signs that the tendency to treat patients as technical problems, rather than as human beings deserving firstly of respect and dignity, is woven into the culture of the NHS. I observe this routinely at my local health centre, where patients approaching receptionists are interrogated about their symptoms in a public and humiliating manner. I observe it at my local hospital where patients can wait half a day for a simple blood test. The people who use the NHS in north London are treated as petitioners, fortunate to be granted free health provision, rather than as the paymasters of the health staff that they actually are.
I suspect some of this culture has its roots in the very origins of the NHS in 1945. An expectation that patients should both respect the authority of medical professionals and feel gratitude for the socialised model of healthcare was institutionalised into the relationship the NHS established with its users. But the culture also reflects the market ideology that was introduced later, that embedded too narrow a focus on financial efficiency while losing sight of what constitutes effectiveness – the real experience of the NHS for those it serves.
Ann Abraham is right to point out the need for the NHS to live up to its professed values. In practice, this begins with those who lead NHS institutions complementing their focus on the rational and technocratic aspects of delivering health outcomes with serious attention to the emotional and experiential characteristics of health care.