On a bleak September day three-and-a half years ago, my 88-year-old grandmother,
Irene Emmings, lay fighting for her life in a Bath hospital. After suffering
a stroke, she had been rushed into the accident and emergency department
where doctors stabilised her condition. At this point, she was abandoned
by a system that had lost the will to care.
After hours on a trolley in a corridor, she was eventually placed on a
mixed ward where nurses had no idea that she needed a drip to help her
diabetes or drops for her glaucoma. For five days, she was left without
food or drink because a speech therapist was unavailable to test her swallowing
Things were little better when she was eventually transferred to a women's
geriatric ward. On one occasion, relatives found her with her head on
a pillow sodden from a leaking drip and on another lying in her own faeces.
Unable to speak, in her desperation, she left notes by her bed about the
neglect and abuse she had endured. She wrote of how telephone calls from
relatives were left unanswered as the phone was left ringing all night
and how staff tried to force-feed her through the nose without her consent.
What she didn't know was that doctors had written 'Do Not Resuscitate'
on her file; if she had had another stroke or heart attack, the hospital
would not have tried to save her.
When this newspaper published details of her experiences, we thought it
was an extreme case, but the response from hundreds of readers showed
that her treatment was horribly and scandalously unexceptional. The 'Dignity
on the Ward' campaign which followed, backed by Help the Aged, led the
then Health Secretary Frank Dobson to intervene directly. He promised
immediate reform of the way older people were treated. In an article in
The Observer, he pledged to establish a National Service Framework for
an end to ageism in hospitals.
Last week, to the joy and genuine surprise of campaigners for older people,
the framework appeared, backed by £120 million to refurbish wards
for older people. Dobson's successor, Alan Milburn, has called it a 'radical
blueprint' and for once those tired words appear to be borne out by the
document. By the end of 2004, the NHS will undertake an additional 70,000
cataract operations, 16,000 hip and knee replacements and unclog 3,000
arteries - all on patients over 65.
Most profoundly, the framework commits the NHS to provide care 'regardless
of age and on the basis of clinical need alone'. By October, all hospitals
will be expected to end rationing on the basis of age, a welcome return
to the founding principles of the health service.
But behind the scenes, the health professionals and charities which backed
the Dignity on the Ward campaign are worried. Where will the extra nurses
come from to care for the 88-year-olds who no longer have 'Do Not Resuscitate'
written on their files? Who will pay for the doctors to carry out thousands
of extra operations?
A devastating report published on the Department of Health website last
week outlined the monumental nature of the task ahead. The Standing Nursing
and Midwifery Advisory Committee said that over-65s were still being denied
the basic rights to privacy and independence. It also voiced 'great concern'
at persistent negative attitudes to older patients, the motivation behind
The Observer 's new campaign - the Elderly Abandoned.
Alan Milburn knows that it will need far more than a lick of paint on
geriatric wards to improve conditions for older patients.
Last week's report made it clear that the NHS was still 'failing far too
often to meet their basic needs for food, fluid, rest activity and elimination
[going to the toilet]. Their psychological, mental health and rehabilitation
needs are often ignored... it remains the case that staff lack the basics
- clean bed linen, pillows and dressings - to allow for the humane treatment
of older patients.'
We should not belittle the genuine attempt at reform represented by the
National Service Framework, but many specialists now believe ageism is
so entrenched that it will take more than a blueprint, however radical,
and a set of targets, however ambitious, to transform the culture of a
lack of respect for the elderly.
It is a sign of how far we have drifted from the idea of universal health
care that the Secretary of State needs to make a public statement that
older patients in the NHS should have equal rights. Two-thirds of those
using the NHS are over the age of 65. Instructing hospitals to take their
needs into account is not far removed from telling those who run Disneyland
that it would be good if they catered for the needs of children.
with kind permission of Guardian Newspapers Limited