Older people and the NHS
Black Velvet
Posts: 702 Forum Member
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I was reading this earlier on.
http://www.dailymail.co.uk/health/article-2286275/Breast-cancer-betrayal-older-women-Only-seven-70s-given-chemotherapy.html
The goverment want to keep raising the retirial age yet older people as far as being treated on the NHS seem to be a burden.
My mother who is in her late eighties had to go into hospital last year and the way they treated the patients on her ward you wouldn't treat a dog like that.
I'm vast approaching 60 and its scaring the hell out of me. Not in a vanity way. It's the way older people are seen and treated if they are ill and have to go into hospital or if they need care at home.
It's frightening and I just hope down the line that things change.
http://www.dailymail.co.uk/health/article-2286275/Breast-cancer-betrayal-older-women-Only-seven-70s-given-chemotherapy.html
The goverment want to keep raising the retirial age yet older people as far as being treated on the NHS seem to be a burden.
My mother who is in her late eighties had to go into hospital last year and the way they treated the patients on her ward you wouldn't treat a dog like that.
I'm vast approaching 60 and its scaring the hell out of me. Not in a vanity way. It's the way older people are seen and treated if they are ill and have to go into hospital or if they need care at home.
It's frightening and I just hope down the line that things change.
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Comments
a big factor has been the conversion of nursing qualificatons into degrees ("nursing 2000") with basic care skills being seen as demeaning and degrading, and such mundane but essental tasks being left to the cheapest outsourced privatised contracts ........
As a nurse of 37 years (educated to masters level) this is wholly inaccurate.
Qualified nurses do not see basic care skills as demeaning or degrading. Registered nurses numbers have been cut while health care assistant numbers have increased. Hca's carry out much of the basic care skills for qualified nurses do not have the time to undertake these important roles.
Nursing education consists of 50% clinical placement and 50% theory (based in university).
I cannot believe people wish to advocate less educated, less qualified nurses? Allied health professionals such as occupational therapists, physiotherapists, speech therapists, dieticians etc., have long been degree professions. Why should nursing be so different?
You really should not believe everything you hear from the media regards the NHS.
I do not understand what you mean by 'essential tasks being left to the cheapest outsourced privatised contracts....'
Would be grateful if you could explain this sentence in a little more detail.
It's nothing to do with privatisation. If leftists thought they could credibly pin a single one of these deaths on privatisation they would be howling at the moon for criminal prosecutions, the way they do at deaths in police custody or prison. The fact that the Labour Party are absolutely stumm on this issue tells you everything you need to know about where the blame lies.
Way back I remember when nurses were called an SEN (state enrolled nurse) and an SRN was a (state registered nurse). The next step up I think was a staff nurse?
Of course that was back in the day when each ward had a matron and she would see to the running of her ward and check the nurses were clean and smart and doing their job. She was I think also responsible to see the cleaners did their job properly.
Back then hospitals were somewhere you knew you were in safe hands in and there were no infections as you could pick up today if you were in hospital as a patient.
I don't remember patients having to wait around on trolley's in hospital corridors until there was a bed available.
I know now that because of cuts that they are not replacing nurses and the nurses that are left have more of a workload which I think is causing a lot of the problems as they are doing the jobs of the nurses they have not replaced.
Back to when I was talking about hospitals were not as big as they are now and I think they were easier to run in every way.
We've seen that under the NHS as it is at present, so what is the evidence that privatisation would mean a greater trend towards that?
(not that I accept your premise that the NHS is being privatised)
Yes. Way back when I was an exploited SEN. That was way back then. Btw each ward didn't have a matron. There was a matron for the whole hospital. The management structure was far more simpler back then.
Hospitals, the NHS and nursing is far, far different today than it was 30 years ago. Care and treatment is much more technological and complex. Patients are more 'sick' than they once were with complex care needs.
Hospitals are much, much busier. Bed occupancy is now usually 100%. Pressure to discharge people and have the bed ready for the next occupant is extremely high. When I last worked on an hospital ward (2005) I remember several times informing the Medical Assessment Unit we were not ready for the next incoming patient. The doctor simply got onto the Bed Manager who pulled rank. I then got onto the Bed Manager and complained....to no avail the new patient still arrived before we had time to discharge the existing patient.
That rarely happened 20 years ago. Now is commonplace.
The rest of your post was very uninformed and apparently based on watching too much TV drama and carry-on movies. As a nurse, I am very pleased that times have moved on and that the nursing profession now has better educated staff capable of performing extremely complex and challenging work. The nurses of the past would never have coped with the demands of the present day (I know and am related to several retired nurses). Also, matrons have been back for many years! Just not the old fashioned sort (as portrayed in films) that the public seem to admire so much but who I'm sure I could never have worked under.
I am pleased you have acknowledged the cutbacks because ward, hospital and bed closures has led to the situation of long waits on trolleys along with the fact that the population is ageing and it is mainly elderly people who get sick. I have never really encountered real age discrimination except when other factors are considered such as pre-morbid conditions. When it comes to admitting the elderly to Intensive Care, age is not so much a factor as all their other health problems. A 90 year old previously well non smoking person who develops an acute pneumonia is likely to do much better than a 60 year old smoker with chronic health problems who also develops a pneumonia. In my ITU, the doctors frequently admit 90+ year olds if they have a fighting chance of benefiting from aggressive interventional support and therapy.
So there must have been a sister that was in charge of each ward? Is this the same now?
Scarey to think that patients are more sick now. You would have thought that patients in the past would have been more sick than now because back then we did not have all the technologically medicine and treatments unlike today.
I wonder why patients are more sick now?
If the government can't afford to look after us if we're lucky enough to survive into our eighties or nineties, then how the heck do they justify spending so much of our money telling us how best to live into advanced old age?
I am not far of being sixty so I do remember what hospitals back then were like and did not merely watch tv dramas and carry-on movies to base my opinion on.
Anytime in the past when I have been in hospital the nurses never stopped. They worked extremely hard.
As for infections back then it was common place for doctors and nurses to wash their hands with soap and water after attending to a patient.
According to a survey for our local hospitals there has been an improvement in doctors and nurses washing their hands.
That is something I can't get my head around. Surely common sense would tell doctors and nurses to wash their hands frequently after they have attended to each patients.If they don't that is the surest way of spreding bacteria between each patient.
You might think that things have improved in hospitals but I don't.
Because nobody is allowed to 'die' anymore. Because the advances in treatment and technology mean that we can at least try to save those who previously would have died. Because people are living longer and there are many more elderly people requiring hospital admission. The baby boom generation are now getting old and sick.
Well, perhaps the constant demands on nurses meant that they just didn't have time to wash their hands between patients. Also, there was often only a couple of sinks on each ward. This has changed with more handwashing facilities now available and alcohol gel dispensers by every bed.
I don't think the system in general has 'improved' because of the conditions and pressures healthcare workers work under and there are obviously and evidently deficiencies in providing high standards of care to all. I do believe that nurse training needed an overhaul and it is a positive advancement to have nursing recognised as a graduate profession. Nearly every developed country educates its nurses to degree standard - so why are we 'different'?
I am not far off sixty either. I remember working in hospitals back then. Nursing is now very different than it was in the 1970's, as I and Marella have previously explained. The education of nurses has, in my opinion much improved
The reasons for the rise of hospital acquired infections are complex. Good hand washing is simply one aspect. Btw on an hospital ward in the 70's you frequently had only a couple of sinks available for nurses to wash their hands. Infection control and its importance is something nurses have always been aware of. However, as the wards became busier and busier having only a couple of sinks did not help the matter.
Luckily, hospital wards now tend to have more sinks and alcohol gel is freely available. It still dries your hands but far better than the horrid red stuff we used for years, (cannot remember what it was called). Also hand cream is now also available to prevent your hands drying out with the constant washing.
Patients being more immuno-compromised, 100% bed occupancy, greater movement of patients around the hospital, overuse of antibiotics, greater use of invasive technology ie IVI's, catheters, lack of single rooms. These are simply some of the things which have caused greater rates of infections. However, recent studies suggest these figures are improving slightly but infection control remains an issue and probably always will.
However, by their very nature hospitals contain numbers of people are who very ill. They will always be a source of bacteria. One cannot make an hospital sterile, like an operating theatre, it is a case of managing the risk.
I certainly think infection control is one of the improvements in hospital care. Staffing levels and lack of resources remain a problem which impacts on the infection rates.
Sorry Black Velvet I forgot to answer your question.
The ward staff structure has changed only a little since the 1970's.
Back then the hierarchy was as follows:
Senior ward sister/charge nurse
Junior ward sister/charge nurse
Staff nurses (the old SRN's)
Enrolled nurses
Student/Pupil nurses
Auxillary Nurses
Cadet nurses
Ward cleaners
A modern ward structure is usually:
Ward Manager (the old senior ward sister)
Sister/Charge nurse (the old junior sister/charge nurse)
Staff nurses (all registered nurses) few EN's left now. Most have converted to 1st level nurses or retired.
Health care assistants with or studying for NVQ qualifications (the old auxillaries)
Student nurses are supernumerary. They are there to learn.
Cleaners are contracted out to private companies and rarely part of the ward team.
Of course this is a general description. On some specialised units like ITU & HDU the ward staffing structure could differ. However, in general this was the ward hierarchy when I last worked in an hospital environment.
Patients are now more sick precisely because of the all technologies/treatments we now have. They keep alive patients who in the past would have died. There are also now more obese patients who can generally have very complex health needs.
Visiting used to be controlled by time and number.
Yes this is an issue also.
That's because in economic terms old people are a huge burden.
Portion of total NHS spending by age group.
Live Births
25.81%
0-4 ---- 5.92%
5-15---- 2.35%
16-44 ---- 3.78%
45-64 ---- 5.27%
65-74---- 10.07%
75-84---- 17.85%
85+---- 28.95%
Source: Dept of Health
The over 85s cost the NHS 8 times as much, per capita per per year, as 16-44 year olds.
Yes, but the majority of all medical inpatients are over 65 and the over 85s often have multiple health problems which require repeat hospital treatment. These patients also commonly have social issues so can be difficult to discharge, they occupy beds for longer and this is why they can be labelled unkindly as 'bed-blockers' and cost the NHS so much money. When I started nursing in the mid 1980s there were many little cottage hospitals where we discharged elderly patients to where they had the time to recover and receive rehabilitation before discharge to the community. These hospitals were all closed in the Thatcher years.
I have worked in many hospitals in many specialities, CCU, ITU, ward manager of a Medical Assessment Unit, bed management and many others. The hospitals I have worked in have mainly been in London and I honestly have rarely encountered age discrimination where age is the only factor. Age is a factor when there are other co-morbidities which can, when looked at together, all point to a poor prognosis, I have encountered ageist attitudes on occasion, admittedly, but very rarely.
Winterlily has described the hierarchial structure of most hospital units. In addition, there are now matrons overseeing a group of wards though in specialist areas (such as ITU where I work) there may be just one matron followed by several senior sisters, then junior sisters, staff nurses and then unqualified healthcare assistants. In ITU and HDU the healthcare assistants act mainly as 'runners' - to keep up stock levels, help with preparing bed areas and provide staff (who cannot leave their patients) with support. The trained nurses (including the senior sisters) deliver all the nursing care, this can be as basic as performing mouth and eye care to as advanced as setting up and adjusting ventilators, renal dialysis, cardiac support and complex intravenous drug support - as well as guiding and advising the junior doctors and providing an outreach service for the hospital wards. When a junior doctor on a general ward wants advice and help on how to manage a deteriorating patient he will often call the ITU Outreach nurse rather than his own senior colleague. Who needs a degree to be a nurse?
I agree.
Tell people ONCE if something is bad for their health and then let them get on with it.
If you live to an old age you may well end up in a Care Home - and who wants that?
she went very ill on the 6th of Feb called 999.
from the start it was a farce.Owing to a new system unless the person basically is dying they wont send out a crew like the old 999 even though we gave them very detailed information about her medical problem that had been diagnosed just days earlier.A nurse would call back (basically NHS direct) we waited 10 mins the pain went worse as did the bleeding I rung again and this time wasnt polite basically told them no matter what happens this was going further.
A Crew were at the house in under 3 mins.Mum was taken into A&E at 4:15pm she was finally seen by doctors at 8pm.she then had to wait till 3:45 Am for a bed it was 5am before she went onto the ward and all that time one sip of water I only knew of this days later when we put in official complaint with Local health board and my MP/AM.
mum had 2.1 litres of Urine in her bladder its forced the bladder so big they dont know if shes got long term damage of the Kidneys and bladder the force of the bladder also pushed her bowel out of the rectum.the Doctors in charge were basically just keeping her rotting in bed we had a meeting earlier this week first thing I suggested because of her age they were treating her different.within 10 mins a new medical team turned up and finally said about the path to find out what the hells going on.
She is finally getting all the Scans/Tests that should have been done from Day 2 but for some reason they just didnt bother they were going to keep her weeks basically lying there THEN decide what to do.Shes already had Breast Cancer If this new team didnt give the answers I wanted we were getting her moved to another hospital we held fire because its 4 hrs away and I know mum would really suffer not seeing the Grandchildren nightly.
I wish I could write that someone 30/40 would have got the same treatment but I doubt it.I hear the way the staff talk to mum like shes some Fruit loop If they can talk to someone like that in Mid 60's I dread to think how people 75+ are being treated.
I think that you have touched on one of the major problems that needs immediate attention. The numbers of older people will increase and an immediate evaluation of their care is needed now.
Sorry to hear about your mum and the nightmare treatment she received.Hopefully she is improving now?
When my mum who is in her late eighties was in hospital last year for a few weeks she was admitted to two different hospitals. The first one was fine. She was put in a side room as it was a man's ward and she was treated well there. Then they moved her to another hospital and there were a lot of dementia patients in there. My mum doesn't have dementia but she hadn't been admitted for very long and this dementia patient hit her over the head with a book and my poor mum when me and my friend went up at night to see her she was in an awful state. she could not stop shaking. I went to see the sister in charge and she apologised. During my mums stay there both me and my daughter had to have words about my mums treatment. They would not leave her with a glass of water beside her bed in spite of her tablets making her thirsty. If they were lucky the patients got a shower once a week and the rest of the week they were handed a bowl of lukewarm water that they had to wash in.
This was last September and she still talks about it. Old ladies being treated like children and having their meals taken away from in front of them if they did not eat.
Last week someone we knew sadly died. she was in her eighties and got about fine. She was meant to get a valve in her heart opened but they said she would be fine. Obviously not! Then my mother's nextdoor neighbour in her eighties took a stroke and she was meant to go back in for to get an artery opened on her neck as this was meant to have caused the stroke. They changed their mind at the hospital and said she did not need it and she discharged after a week.
We do not have the luxury of wards devoted to patients with dementia, not if the reason they are in hospital is because of a medical condition not related to their dementia. There are very few beds available at all so many patients who do not have dementia will find themselves near patients with dementia. I am not sure what you suggest we can do about that situation? This government is closing beds, wards and even hospitals and people are living longer so there will be many poor elderly people with dementia. We cannot control the behaviour of dementia patients, they can be unpredictable, but it is not in their interests to 'sedate' them and our single rooms are generally required for patients with infectious conditions. I am sorry that you feel these patients were treated like children but it can be very difficult for staff to interact with dementia sufferers without exerting some bossy behaviour.
Surgery in elderly people is fraught with risks and, sometimes, the potential risks outweigh the potential benefits. Along with age (and therefore ageing organs) anaesthesia is also a risk for very obese patients and patients with severe respiratory and cardiac diseases. Doctors do act and make decisions in patients' best interests and there are usually meetings with several other senior doctors to discuss these decisions. Age is not a single factor because I see patients having surgery in their 90s all the time - many factors need to be considered when assessing risks of surgery.
I am not sure what the staff are supposed to do with uneaten meals except remove them? Sometimes, patients who are ill have poor appetites and will just not want to eat despite efforts to coax them. My own aunt (an ex nurse) just refused to eat in hospital in the last few weeks of her life and she refused artificial feeding (through a tube) also. The dieticians will generally prescribe supplementary drinks in these situations that provide nutrition and energy but we really cannot force patients to take food. Sometimes, there is an oversight and patients are not given a water jug and glass by the domestic, it could be because they are not sure of feeding or nil by mouth status - nurses are happy to supply water when this oversight is reported to them but we don't necessarily know until we are told. On the wards, most nurses are individually responsible for between 8-12 patients so it can be extremely difficult to be aware of absolutely everything that is going on at all times.
I work in Intensive Care, not on the wards, so am in a protected and rather priviliged position, but I am extremely conscious of the extreme workload and pressures and demands of general ward nurses. They are not perfect and mistakes will get made, patients and relatives will rightly complain when the standards of care are felt to be inadequate. It is better to complain at the time so the problem can be rectified. I have no problem with relatives complaining to me about something I have omitted or done or not explained to them, they are advocating for their loved ones just as I would do in the same situation - but people need to be realistic in their expectations of what is possible and achievable. If there are inadequate staffing numbers, inadequate resources, long waits for beds etc then don't blame the nurses, blame the current government policy and I must add that I feel there is excessive rather exaggerated media hype which is undermining the NHS at the present time - and people love a 'band-wagon'.
Nurses used to help clean the wards. I don't think they do that anymore.