Over the last three and a half months I have spent a fair amount of time each day in a London teaching hospital, in a ward for older people whose discharges will be complex, and this blog describes what I learned from being 'on the frontline'.
Unfortunately I had this experience because my mother had a bad accident. Obviously my focus was on supporting my mother but 'once a wonk always a wonk' it seems and I couldn't help but notice various things relevant to policy and practice as her hospital stay stretched into weeks and then months.
I doubt that the insights I gained would come as any surprise to an NHS-insider but I was observing from the perspective of Age UK's commitment to ensuring older people get the best possible care in every health setting.
A caveat: this was just one ward, in one hospital, so only a snapshot - but here is some of what I experienced :
- By and large the care my mother received was very good; in particular, I am incredibly grateful for the kindness and endless patience shown by almost all the staff my mother met. The truth is that looking after very sick older people is tough work requiring skill and resilience and I think it is all too easy for the rest of us to forget that.
- There were significant shortages of nurses at times and I have no doubt that the quality of care some older people (not my mother who needed one to one support) received on our ward dropped as a result. That's because many needed help with eating and drinking, or were disturbed and required constant reassurance, or just help to get to the loo. One older woman had waited 25 minutes for such support her relative said the other day in my hearing, for example. The staffing seemed particularly stretched over bank holiday weekends.
- The young, trainee clinicians and nursing staff I met were almost universally great and gave me confidence that the future of the NHS will be safe in their hands - if there are enough of them that is, they stay the course in their professions and the NHS gets the wider resourcing it needs so they can do a good job. They were cheerful, they worked really hard and they were mostly very person-centred in their practice.
- It strikes me though that we don't talk nearly enough about Health Care Assistants. They have the potential to make a huge difference. They do much of the hands-on work, or at least they certainly did on the ward I got to know, and yet they occupy an ambiguous position professionally. The great majority were terrific and I think they need more recognition and support.
- Don't forget the cleaners and porters too: the care of very sick older people in hospital is the ultimate team game and everyone on the team matters.
- As do the volunteers: I met several on the ward, all doing their best to help. Whether they were always deployed very strategically I am not so sure but for older people without many visitors, in particular, they could be priceless.
- I got to know some of the staff on the ward quite well and I was struck by how many had really long journeys home - living way out on the other side of London in some cases. Whatever happened to key worker housing? It would pay off in terms of performance and reduced absence due to sickness and stress I am sure. And/orsupport with travel costs? The staff were often working from 7.30am to 8pm and coping with an hour's travel or longer each way too - that is asking an awful lot for less than stellar rates of pay.
- In this London hospital there is an incredibly diverse workforce and it was impressive to see people from right across the world coming together and working as a team. I got to know nurses and doctors from Poland, Spain, Germany and Ireland for example, not to mention further afield. An inevitable Brexit point follows; we must ensure that these people who are making such a big contribution to the NHS continue to feel welcome here, or the consequences for this hospital, at least, simply do not bear thinking about.
- We sometimes hear of 'bureaucracy in the NHS' and I did see some; for example, it proved virtually impossible ever to get hold of a wheelchair. There was one on the ward but it belonged to the physiotherapy team and could only be used by them: how daft is that? Of course, staff who knew the ropes were able to circumvent this 'rule', but how unhelpful for it to exist in the first place!
- In terms of improving the experience of visitors - who often do play an important role in supporting patients - the two most obvious ways of doing so in this particular hospital would have been more public toilets - they were like hen's teeth - and a more reliable system of lifts - they were often offline, wasting time for busy staff as well as visitors and patients of course.
- And finally, 'the devil is in the detail of the delivery'when it comes to the quality of care. So for example, the food in this hospital was pretty good but, of course, many of the older people were unable to exercise choice due to their reduced capacity and there was little apparent learning of what they liked or disliked, or they lacked help in actually consuming it. In addition, there was usually a water jug and plastic cup in the vicinity, but not always near enough to the older patients to ensure they actually drank.
- Many sick older people need prompting with activities and without it they just don't happen, so having sufficient staff on a ward, who are well led and well trained, and with enough time, is key. Otherwise you can have the best intentions at senior management level but they probably won't translate into good practice.
I am pleased to say that a few days ago my mother was finally discharged, and the fact she was able to come home is due in large part to all the staff who cared for her in this hospital. They are a subset of the NHS workforce which helps many thousands of older people every day and, for me, my experience was a reminder of the imperative of ensuring we do everything we reasonably can to support them in the crucial work they do.