Why can't the NHS get basic care right?


The relatives of one patient say she went to hospital with a bruised leg and died from a fatal infection

Reading the 53-page dossier on poor patient care put together by the Patients Association, you cannot help but be moved by the harrowing stories.

There is the case of a man placed in a dementia-friendly ward with staff, who were given strict instructions to check on him because he had a history of going walkabout, but was able to escape and subsequently drowned in a nearby river.

There are tales of patients left in soiled sheets, their dignity stripped from them, and others being left for hours in pain, their cries for help ignored.

It is not the first time we have heard such accounts - and probably not the last.

Of course, in an organisation the size of the NHS - it sees 1m people every 36 hours - there will always be cases where standards have slipped.

But what is clear from this report - and others that have been published previously - is that it is still happening far too often.

The wrong patients?

Elderly Hands
  • Two-thirds of emergency admissions are patients with long-term conditions, such as heart disease and asthma. Many of these could be avoided with better support in the community.
  • At any one time a quarter of hospital beds are taken up by patients with dementia when studies suggest most would be better cared for elsewhere.
  • Half of the 500,000 deaths a year occur in hospital despite the majority of people saying they would prefer to die at home or in a hospice.
  • A report last year by a parliamentary group said a tenth of hospital beds should be closed to free up money for better community care.

Organisations, including professional bodies and the government, have been quick to call on staff within the NHS to blow the whistle on poor practice.


But it begs the question: why is it allowed to happen in the first place?

Some have argued the move to degree-level training for nurses - from next year all nurses entering training will have to complete a three-year course - has meant they have lost some of the ability to empathise and show compassion.

But this theory was rejected by the Willis Commission in its comprehensive report a few weeks ago.

Others have said resources are being stretched too thinly. But how much time does it take to place a glass of water within reach?

I recently asked a senior nurse working in a large hospital what she thought had gone wrong.

Her answer was quite clear. She told me: "We have had to become immune, desensitised, to cope with what we do. Every day we see suffering and we can't always help.

"That does not explain or excuse some of the clear examples of neglect we have heard about. But it has created a culture that means these things can happen."

She went on to say that at the heart of the problem was the fact that there were many people in hospital that should not be there.

It is an often-quoted fact that two-thirds of emergency admissions are among people with long-term conditions, which covers everything from heart disease to dementia.

With better care and support in the community, many of these could be avoided.

But that requires a re-think in how the NHS - and the social care provided by councils - is organised.

Mike Farrar, the chief executive of the NHS Confederation, has perhaps put it most succinctly in the talks he has given on the topic.

He describes it as a refocusing of what the health service is there for, saying the NHS of the future "will need to move from a medicinal service with a care dimension to a care service with a medicinal dimension".

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this

    Comment number 349.

    Suzanne 341: "Not like when nurses were not University trained, but cared" - I'm sorry but this is arrant rubbish. I'm sure you could find anecdotal evidence from every previous generation about bad nurses and bad nursing care. What has changed is our expectations and the role of nursing which has widened almost beyond recognition. A nurse CAN'T just be a bottom-wiper and hand-holder any more.

  • rate this

    Comment number 348.

    pauljwt - are you trying to say that because a person has qualifications they necessarily aren't caring? People seem to believe that nurses are going into the profession purely for the money. Yes, there are always going to be some poor nurses, but I think in general it takes a caring person to spend 3 years training solely to look after others. Why not get a degree in something else otherwise??

  • rate this

    Comment number 347.

    We need to stop the hypocrisy in our society.At primary level children in assemblies are taught to respect and be polite towards elders.Once they are in teenage volunteering,gaining work experience working in hospitals, care homes their experience is totally different.The children are told not to complain because of the net work,you never know who knows who and obviously you need reference letter.

  • rate this

    Comment number 346.

    @344 oakwoodbank
    Problem is you can't educate anyone to care neither can you pay them to care, people are just caring or they are not, what the nhs is trying to do is replace a caring nurse with a nurse who just has some qualifications.

  • rate this

    Comment number 345.

    It is a compulsory requirement for the sixth form students to volunteer in care homes and hospitals if they want to apply for medicine/NHS services.
    These 16 and 17 years old children are extremely unhappy and sad because of lack of care,abusing language being used,patients and old people calling for help and getting a response after an hour.
    What kind of example are we setting on the youngsters?

  • rate this

    Comment number 344.

    "It boils down to finance". No, it boils down to a lack of proper training which in turn is associated with poor selection policy; and that is tied into our poor educational system. If schools are not able to educate our young (for whatever reason) then poor job standards result.

  • rate this

    Comment number 343.

    Basic care is not good enough care. In making care standards policy and legislation, it should be recognised that most MPs and parliamentary draughtsmen have little experience of the patient's perspective.

  • rate this

    Comment number 342.

    In response to colsur123

    colsur123:- the nhs is not free we pay our taxes to cover it, if there isn't sufficient money in the system that's easy to sort out, that is take a pay cut! surgoens are well paid, executives are overpaid and nurses who don't care should to sacked, that's what happens to everyone who doesn't work in the health service.
    So now I have sorted out the nhs......

  • rate this

    Comment number 341.

    I have recently spent three weeks in hospital following a mini stroke. The stroke was not diagnosed until my third week.! I witnessed terrible care to a dying patient, she was not washed or fed, and could not do it herself. There was NO compassion or care shown to anyone. It seemed obvious that staff were just doing a job. Not like when nurses were not University trained, but cared.

  • rate this

    Comment number 340.

    I am a surgoen in a busy hospital where I am afraid standards are now slipping. We all see it and it saddens us, but despite our best efforts we seem powerless to stop it. It boils down to finance, and with an ageing population, more expensive techniques, as well as increased patients expectations, the NHS can no longer be provided for free. I know it is not right, but it is a sad reality.

  • rate this

    Comment number 339.

    As a graduate nurse I would like to disagree with the popular opinion that nurses with degrees are not as caring - why can't we be both caring and also academic, ensuring that our practice is up to date and evidence based?

    However what I have experienced is being newly qualified and expected to supervise 5 unqualified staff and the care of 20 patients. That's where accidents could happen.

  • rate this

    Comment number 338.

    Jamie - whether the NMC is fit for practice or not - we are still accountable to it and our employing trust. I know there is accountability even though yourself and the media appear to think there is not. We are accountable for our own practice and have to justify every thing we do - as it should be. It has always been so - previously with the UKCC and GNC.

  • rate this

    Comment number 337.

    WinterLily - nurses are accountable in theory to NMC, but the NMC is 'not fit for purpose'. Have you read all the reports?Anyone who has alerted the NMC to failings in 'accountable' nurses knows it takes the NMC years to consider, and to ponder, then to spend more years considering and pondering. By which time the nurses vanish, leaving behind a trail of disaster. So much for accountability.

  • rate this

    Comment number 336.

    Shels 335 Nurses are completely accountable for their own practice. We are accountable to our employing Trust and our professional body 'The Nursing & Midwifery Council'. Every nurse is accountable - its the same for all health professionals. As for graduate nurses not being able to care - this is so far from the truth it is laughable. However, the NHS is a bureaucratic monolith, an audit too far!

  • rate this

    Comment number 335.

    The entire structure is flawed - no one is accountable. GPs are supposed to assess their patients in a short time and send them to the right consultant. Health conditions are rarely so conveniently obvious that they can be diagnosed in a 10-15 minute appointment. Money is thus wasted sending patients to the wrong consultants, and the patients are still undiagnosed. GPs need more time.

  • rate this

    Comment number 334.

    Alans comment suggests that problems are only in the elderly's care, Alan I have news for you it's in mental health care too! In fact any area that patients are vulnerable. It says a lot about the management of the NHS when it's the most vulnerable who get the worst treatment.
    I know this as when I complained about my wife's care, things got so bad I had to remove her under the 72hr rule.

  • rate this

    Comment number 333.

    In the 1960s there was a Ford motor manufacturing plant in Dagenham.
    It created some of the most famous cars of the time.
    It closed!
    Why?Too many strikes.too many stoppages, bad management but good workers.
    US Management looked at the site, decided to close it.
    Ford Motors still make cars, just not at Dagenham.
    No fear of a Ford like axe in NHS! Shame,it could just be the best way to improve it

  • rate this

    Comment number 332.

    Why can`t the NHS get things right?
    Because those who (allegedly)"run"it are stuck with a 1940sStyle Top Down do as you are bid monolith which was designed as a SAFETY NET!!!
    As a child I remember we paid 6d a week per person per family before NHS.
    We had a doctor who we KNEW, a hospital with no massive bureaucracy, run by medical staff not pen pushers,with Matron in charge.It worked then,not now!

  • rate this

    Comment number 331.

    The NHS needs reshaping to make it fit for its modern day purpose. This should be done by someone from the outside who makes recommendations that are then authorised by the ministers who have the power to make the changes. Using existing NHS managers will not work as they will not challenge the status quo and probably could not implement new ideas even if they were capable of having them.

  • rate this

    Comment number 330.

    The rhetorical question you pose "Why can't the NHS get basic care right?" implies that the whole of the NHS never ever provides a good or reasonable standard of care which, of course, is misleading and worthy of the Daily Mail.
    "How can the NHS improve the standard of care for elderly patients?" would have been better and much more professional.


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