Kieran Walshe shares an account of his aunt’s treatment that raises serious questions about the quality of care for the frail elderly
This is a hard, and quite personal column to write. I’ve spent most of the last three decades as a health services researcher trying to help people understand how to improve healthcare organisations, and learning myself about the clinical, technical and social complexities of health services.
It has been by turns fascinating, dramatic, exciting, frustrating and always intellectually stimulating – and working with doctors, nurses and other healthcare professionals has given me a healthy respect for the skills, motivations and values they bring to bear on their work.
But none of this prepared me for dealing with what happened when my frail 82-year-old aunt fell at home in her flat one night last September, and was admitted to King George Hospital in Ilford – part of the Barking, Havering and Redbridge University Hospitals Trust which often features in the HSJ – usually because of its many problems.
She is an ex-nurse, living alone with no family close by, but she had been just about coping at home despite her early Alzheimer’s with support from neighbours, family and friends, until that fall.
So what happened? Fortunately, she wasn’t badly injured in her fall, though she was dehydrated and confused when she arrived at accident and emergency.
And I refuse to believe that things have to be like this – there are organisations where my aunt’s care would have been dramatically different, and better, because they are well-run, well-led organisations
Explaining the saga which followed is hard to do in a few words. She spent a month on one of BHR’s care of the elderly wards at King George Hospital, and then was moved to a rehabilitation ward there which, confusingly, is run not by BHR but by North East London Foundation Trust.
In two months on the rehab ward, she had at least six more documented falls, culminating in one where she sustained a serious head injury, and was transferred back to BHR’s A&E where they diagnosed a subdural haematoma.
She returned to BHR’s care of the elderly ward, and there she stayed for another three and a half months – until March 2019 – while Redbridge’s clinical commissioning group and council argued over her eligibility for NHS continuing care and her discharge destination.
After over 160 days in hospital and that subdural haematoma, her cognitive decline, increased frailty and reduced capacity for self-care were such that there was no option for my aunt but to go into a nursing home.
A serious incident investigation undertaken by NELFT – after a lot of prompting from me and my cousin – details a long catalogue of errors, lapses and failures in my aunt’s care, and raises all sorts of wider issues about poor falls management, inadequate ward staffing, failures in communication, absent ward management, lack of training, failure to follow clinical protocols, and the like.
But at least NELFT has engaged with her family to address those problems. BHR declined to get involved in the investigation as they apparently thought her care was just fine and they had nothing to learn. How wrong could they be?
Having worked in and with the NHS for most of my career, I feel ashamed of how it has treated my aunt. A frail old lady, instead of being helped back to live at home with community support and care after a fall, has been mistreated and harmed by the very organisations which are meant to be there to help and care for her, and as a result she is now much more dependent and will need long term nursing home care for the rest of her life.
I can also see what a gross waste of resources this was – almost six months in an acute hospital, and then a lifetime of care costs both of which might have been avoided.
Of course, I would like to see the doctors and nurses who were responsible for her care held to account – but I know they were working in an NHS which is grossly overloaded, where vacancy rates mean there is widespread use of bank and agency staff, and where discharge planning is fraught with difficulty because of our broken social care system.
So who is responsible? If things are really going to change, it has to be the senior leaders in these two organisations who make them change.
And I refuse to believe that things have to be like this – there are organisations where my aunt’s care would have been dramatically different, and better, because they are well-run, well-led organisations.
So, I’m offering to come and tell my aunt’s story, and discuss what we could learn from it about healthcare improvement, with the boards of BHRUHT and NELFT. I wonder whether they will want to hear what I have to say.