Shaking with rage, can't sleep, NHS treatment of elderly

Unbelievably there are plenty of unemployed nurses, doctors and other HCPs in the UK. The problem is a decision by Boris in 2021 to get rid of the Resident Labour Market Test. Effectively no priority is given to those already here, and the NHS is obliged to treat all applicants, wherever they happen to be living at the moment, equally.

Applicants from overseas, encouraged by higher salaries in the UK and the chance to settle here with their family, are often more experienced and than new graduates from UK Universities, and will be supported in their applications by international employment agencies, some of which seem to be paid by both the potential employer and employee. It is therefore very difficult for new graduates to compete which is why there are increasing number of stories about unemployed doctors and newly qualified doctors leaving for jobs in Australia. Entry level doctor jobs can now expect to attract several hundreds of applicants.

DD is completing her second foundation year and only knows of one F2 in her Deanery (a collections of NHS Trusts) who has a place for specialist training. (To be a GP.) This year over half the training places have been allocated to doctors who did not graduate from UK medical schools, some of whom may never have visited the UK let alone worked for the NHS. It can be expected that many will then move on to private health hubs in Singapore or Dubai once their training is complete. Indeed some may never take up their post, especially if they are not offered a place in a London Teaching Hospital but in somewhere less attractive and out of the way. In DDs Deanery 50% of the training posts in an important speciality are vacant. Consultants there would clearly love to be able to appoint some of their more promising F2s into temporary roles, not least because they are having to carry the extra load, but they can't. Recruitment for temporary roles needs to be advertised worldwide, whilst eligibility to apply for training places is determined on a national basis.

The situation is just as bad for nurses.

Some doctors from overseas are very good, but not all. Improving the career path for doctors and nurses already in the UK, and with an education/employment history within the NHS would take out some of the risk that occurs in recruiting blind.

A rant, but the situation is mad and needs to be sorted quickly. Otherwise outcomes for patients will continue to deteriorate.

If the bed sores were from home they'd be written in her initial assessment.

I really agree with this. I’ve had to advocate against medical appointments for elderly frail people who were essentially dying but they also wanted them in for various scans and tests to keep an eye on things. I do think we need to look at whole patient care and come up with plans. Right now it feels like each department works independently.

My husband was left unattended in bed in the Acute Stroke Ward the day he had a stroke. No OT check, etc because it was a Saturday.

He tried to get up to the loo - forgot he couldn't walk. Was black down one side from where he'd hit the deck. I recall that his watch broke in the fall, much to his distress.

When he was admitted to the rehab ward a fortnight later, the nurses there demanded to know what had happened to him...They obviously thought that I was beating up an apparently frail old man. (Of course, they hadn't seen him prior to the stroke.) He was 75 at the time.

I explained and that shut down the accusatory looks. It wasn't until later that it dawned on me that the staff at the first hospital had failed to record the fall on DH's records.

At the first hospital, they complained that DH was refusing to eat...The charge nurse seemed quite angry and complained that they'd get the blame if he had a diabetic hypo. Then DH's food was brought in: quiche and peas on an ordinary plate with ordinary cutlery. His left hand didn't work at all and his right hand was shaking.

When I asked whether he'd been assessed by an OT yet - this was mid-week by then - I got blank looks. [Before anyone makes any of the accusatory comments that I've seen aimed at the OP, I was in that ward every single day, but this was the first time that they'd served a meal while I was there.]

A junior doctor was finally sent to see me. When I asked about the absence of OT intervention and the absence of input from the Diabetic Team, the reply was "Well...now that you've pointed it out to us..."

My not so diplomatic response was "Hello?! This is the Acute Stroke Ward!"

The Diabetic Nurse actually found that DH's glucose levels were sky high - a normal response to a stroke, I was told, but not something that had been picked up by the experts in the Acute Stroke Ward.

I gather that they were glad to move DH to the rehab unit so that they could get rid of me.

That's criminal.

This old lady DID have family who could help, but seem to have chosen not to. If people did their bit for their own loved ones, staff would have more time and capacity to care for ones that have no family.

What in the name of third-world-level expectations is this now? If people are in hospital, the staff should be caring for them propertly.

The sad reality is, very old people are extremely vulnerable and at extra high risk when anything traumatic happens to them. They need, at that point, every possible resource to be mobilised around them, and this includes family. It's unrealistic to demand that the NHS be able to provide perfect care to every old patient, particularly in a country with so many people living into their 80s and 90s.

It may take a village to raise a child, but it also takes one to support an elderly person in their last years of life.

I do wonder what OP's uncle's role in this situation has been; he certainly doesn't sound very capable or helpful.

Late Mum had yet anotgher fall. The District Nurse said they really try and avoid taking elderly people to hospital because they dont do well. We really tried to get some sort of home help but the Dr at the Hospital Day Care Centre wanted to see her and of course she was then admitted and it went down hill from there.

However, I have my tin hat at the ready for this.. we have got to recognise that the NHS cannot keep going in its current state. Everyone wants everyone else to put more and more funds into it to keep it going. There are few other countries in the world who dont expect people to co fund in some way. Its never totally free for everyone.

Add to that the fact that in my experience of looking after two very elderly parents the NHS will throw everything they can at them even when in both cases the parent was ready to go. Their quality of life was awful in the last few years. The care home for my Dad was making £££ and he was just carted off to hospital, patched up and literally wheeled or carried back to the care home.

Sorry haven't RTFT, what does the discharge letter say about your Grandma's hospital stay @Krupkrups ?
The ones our hospital send out say why you were admitted, what treatment you received, if they discovered anything else wrong, for example if someone developed Hospital acquired pneumonia, what medications were stopped or started and would also mention any wounds including pressure damage ? There is a term called MASD which describes moisture associated skin damage which can occur when people are incontinent, I wonder if this is what the carers have discovered if they are asking for creams ?
I think the best thing to do is contact the GP and ask the District nurses to visit to assess her skin integrity/wounds so at least you know she will be getting the correct treatment for them.
As another poster has mentioned you can get wards within the same hospital that are night and day in terms of the level of care and communication you recieve, it shouldn't be the case but it does happen.

We had to recently remove an elderly relative from hospital, as she would have died under their 'care.'

She had two bedsores, medication was left untaken/unchecked, not eating for days at a time, and several other distressing things. We were told that there was nothing to be done to help her, and she would simply decline. Once in private care, she's recovered and started thriving again.

The NHS has been hollowed out over the last 15 years - it's no surprise that we're in this situation.

Sadly this is going to get worse. Think of population and how the working age is going down. It's a disaster. Not enough beds and not enough people to safely staff them. Alongside many other issues with attracting staff to nursing and other professions. They got rid of nursing bursary so this hugely reduced the amount of students they are getting. I've been nursing for 14 years, always thought this would be my lifelong career but no way, the stress is not worth it. I'm so sorry your mother had to go through that.

We had a similar experience with my nan. She was 92 and lived independently, mobile, coherent and no problems with continence. Went into hospital for a few days observation after a fall where she was dropped by the HCA when being transferred from bed to a chair. This caused a huge wound on her leg, severe bruising and other injuries. The family weren’t told of this, it wasn’t until a day or so later we found out.

Due to her injuries, the hospital decided Nan needed rehab so they sent her to another hospital, over 30 miles away where her rehab consisted of 15 minutes with a therapist twice a week! It was difficult for family to visit and the deterioration was rapid and noticeable from that point.

They also stopped giving her her levothyroxine which was needed as she’d had a total thyroidectomy!

My nan went into hospital for observation after a fall and came out 4 months later immobile, incontinent and extremely distressed. Elderly care is this country is abysmal.

My elderly mother, recently deceased, had numerous hospital admissions in the last months of her life. She would spend up to 4/ 5 days on a trolley in a&e each time before being admitted to a ward. Because she had delirium she was usually kept right up beside the nurses station.The lights never dimmed and the noises never stopped.On one occasion when she did get admitted to a ward she was sent back to her nursing home without her salt reports which would have stated she needed level 4 thickened food.She was given free fluids in the home and aspirated, back to a&e where she spent another 4 days on a trolley.
Our elderly care is an utter disgrace.

Oh and this sounds ridiculous but get her some decent fitted to the foot slippers and use them. Vastly reduces falls from flimsy or no slippers and toe stubbing etc

Often older people enter hospital when they are on a downward trajectory, falls are a a huge sign. Obviously environment won't always help this if they are spending long periods in bed and becoming deconditioned etc or possibly with other confused individuals. Knowing hospitals and how bad bed situations are I don't think they would of kept her without concern about her managing at home. We had the opposite trying to discharge loved one who wasn't ready.

I don't think violence towards nurses who are likely incredibly overstretched is the right answer but you need to make your concerns and complaint known, things won't change . Also how quickly she has declined could she be suffering with delirium. Hope things improve with her OP

This old lady DID have family who could help, but seem to have chosen not to. If people did their bit for their own loved ones, staff would have more time and capacity to care for ones that have no family.

I would love to say this isn't the norm but it is. Get the GP to run some bloods for things like magnesium and Vit D - it caused devastating symptoms in my Mum during Hospital stays - she came out we used creams and supplements to boost her and it made immediate differences. Lack of magnesium for e.g. can cause delirium, loss of ability to form coherent sentences, lack of mobility etc.

Get some help with physio from GP/District Nurse team - they can refer and it is appropriate to have some so you can keep her home longer etc.

Focus on Micro meals and 4 or 5 times a day, if she will tolerate fortisip then that can be prescribed to.

Bed sores are considered neglect and you need to report them back to the hospital, they need treatment and investigating. GP to get referal to District Nurses who can come in and treat etc.

While you are at it I would speak to adult social services to get an assessment for what she needs at home and kit the home out so she can cope - ramps, handles, loo seats, bath aids, perching stools and even commodes if no dowstairs loo she can use. I know she is in incontinence pads at the minute but with help you may be able to reduce this - they are often to reduce the needs of patients in hospital - ie not always ringing the bell

@LadyBracknellsHandbagg not hyperbole sadly, lived experience.

That your Mum received excellent care, which should be the norm, is remarkable.

Not every NHS trust delivers the same standard of care for our vulnerable elderly though.

I am genuinely pleased that you and your family were not subjected to the neglect experienced by too many of our aged relatives.

It is endemic.

The main thing missing here is good communication. At the point of discharge, an open discussion can really help. An explanation of how an admission at this age can be destabilising. Elderly people can deteriorate after being away from their home environment. They may take a while to build up their muscle mass again. They might need some physio or an OT assessment at home. The pressure sores needed to be identified and a care plan created with clear follow up.

In the absence of this, an elderly loved one arrives home in a distressed state with pressure sores. It’s awful for everyone. A good discharge discussion could help so much.

I am not criticizing I'm simply pointing out that hospitals are NOT prisons and they simply cannot hold people against their will.

Many hospitals have signed up for John’s Campaign, whereby for instance they allow visitors 24/7 for patients, who are breastfeeding, or have learning disabilities, or mental health problems or dementia.

Have a look at the hospital’s website to see if they have signed up for John’s Campaign.

Agree. I am not white. I’m a doctor who has worked with many amazing nurses from Ghana, Nigeria and the Philippines to name a few. However, staff do need a good grasp of English, that is common sense.

I have been a patient recently and had a telephone appointment with a nurse who could speak very little English. She had no experience of the procedure she was discussing and admitted that she was just reading off her info sheet.

The appointment was a complete waste of time and a waste of NHS resources. It was not a good position to place the poor nurse in either. She was clearly recruited in a time of need and was not adequately trained in the job she was tasked to do. It is not racism to point that out. We could understand very little of what each other was saying. That is not acceptable, esp when discussing complicated treatments..

Anyone criticising OP and family for not providing more care during the actual hospital stay - does that mean you accept and elderly people with no family to help should receive substandard care?

So sorry to hear this OP - sadly we had a near identical situation with my grandparent so this is not an isolated case. All you can do is raise a complaint and ask for an investigation to be conducted, but from experience nothing will come of it as they cover for each other and parts of the investigation we were told can take over 12 months and the family won’t necessarily be told the outcome.
I know it isn’t the case for everyone, but our experience of NHS care of the elderly has been nothing short of a disgrace and unfortunately hasn’t always been through staff shortages, some of it has been through sheer neglect.
I hope your grandmother can get some rehabilitation - keep her moving, get her nutrition levels back up and hopefully she can recover - just do whatever you can to keep her out of hospital as from our experience, GP went drastically downhill with every hospital stay.

Is there a reason you didn't just pack her up and take her home at any point during those 5 weeks?! What can they do restrain you? Even if they phone social services you could have easily proven she was looked after.