To be furious after tonight and feel the NHS is not good enough

[DespairingofNHS]

My mum is in hospital with a chest infection. She's bedbound and has little mobility after suffering from a series of strokes over the last several years. She can speak but has absences, forgets she's talking, eating etc. She needs help to eat and make sure she's eating enough.

I arrived at the hosp. tonight at 7pm and a tray of food was sitting next to her, untouched, cold and still sealed. It was clear no attempt had been made to get her to eat or even to take the film lid off so she could try to feed herself. I asked to speak to a nurse who advised that the doc had decided at mid day to put her on nil by mouth. I had to ask a series of questions to find this out, nothing was willingly volunteered. Apparently they were worried about her swallowing. I asked what the plan was and they said they were waiting for the SALT (I had to ask what this was - speech and language therapist) to come by. When I asked when that would be they said 'tomorrow or the day after'. I said 'so your plan was to let her go potentially 48 hours without food or drink?' the nurse said 'well no one ever died from not eating for 48 hours'. She advised me that mum had eaten loads yesterday including lots of chocolates fed to her by the nurse (wtf - she's diabetic), This begs the question why the next shift decided she couldn't swallow to the point where she shouldn't be fed. She can be a bit absent and forget she's eating/sit with the food in her mouth. This had been communicated to the next shift as 'she's refusing to eat'. I asked why they didn't intubate or put her on a drip. not procedure apparently! why didn't they consult us? because they have 55 patients on the ward and can't check with people's families about treatment...or deciding to starve them.

Needless to say I requested the doctor to come and attend - the doctor assessed her and saw that my mum was able to swallow liquid fine. BY the time we finally got her some food it was gone 9pm and my dh had to stay to feed my mum personally while I took dd home to bed.

I am furious that this could happen and that if I hadn't visited (some of the patients on the ward had no visitors at all) they would have happily left her with no food or water for 48 hours till the SALT could attend after the bank holiday!

Partly I'm writing this to remember it accurately later. But I also really want your thoughts and advise on how to properly complain about this in a way that ensure it gets dealt with. The nurses and docs simply said 'we've only just got on shift'. Nothing was written in the notes to say why the nil by mouth was put in place or even that it had been (the ward manager showed them to my dh although said he wasn't really supposed to). Their response was simply to hand us a complaint form...we had to ask them to sort her out some food. I have no confidence the same thing won't happen again tomorrow. I feel like they unilaterally decided to put her on a Liverpool care path and let her die. She just has a chst infection and is not terminally ill. I am shocked by the lack of care and compassion and feeling very scared about getting old one day and having to be entered into this NHS system.

PALS, ward manager, consultant, department (presumably medicine, but the name may vary), hospital manager. See if you can find any management list/structure on the hospital website, start at the top and work down. CC them all in to any communication - email or paper. Mention of the local press may help as well, local papers LOVE writing about hospitals, the hospitals hate it.

Sadly I've found that the only thing that really works is being the squeaky wheel.

It's so depressing. These wards who have no idea, no resources, knowledge, training, desire to care for our most vulnerable elderly people.

We need to wake up. Those elderly people are us. We can't pretend otherwise and to neglect this area is just, from a selfish point of view, unhinged.

When my grandmother was ill in hospital, my family took it in turns to go and feed her. It would take hours to get her to eat. I can't see how a nurse could take 3 or more hours out of their day to make sure one person eats..of course, their needs to be a solution but I am not sure what it is. Imagine if someone died or didn't get vital medication because the nurses were feeding people? I know its unacceptable but this is a big problem as a result of an aging population.

Op...I really hope your mum is better soon.

I am so sorry to hear about mothers experiences, OP. Sadly, it doesn't really surprise me. This kind of thing has been going for years. I was in hospital, several years ago, to have my appendix removed. My treatment was great and I had no complaints about that, but I did get very vocal about the treatment of several elderly patients on the wards at the same time. I filled in complaints forms on their behalf, but I'm sorry to say that I didn't follow anything through afterwards. I was told that the hospital couldn't comment to anyone who wasn't family.
One elderly lady, who had had a stroke and struggled to talk, was treated as if she was daft. Totally ignored, not even the courtesy to explain what was happening when they decided to move her to another ward. She was panicking when they just started packing all her things away and walked off with them
Another elderly gentleman with dementia, spend 3 days walking around the ward, disturbing very sick patients. I woke up (5 hours after going into surgery) to find him sitting on my bed, waiting for a train. The following night, I woke up to find him having a wee in my sick bowl. I spent 3 days running round the ward after him, taking him to the toilet, making sure he didn't wake patients who were seriously ill and sleeping etc.
It's a total disgrace.

Please contact PALS.I recently did, my DF has cancer (returned) and he was waiting and waiting, being fobbed off whilst waiting to hear when treatment would start. He is elderly and would just rely on phoning. I decided to email PALS who in turn contacted the right department who then spoke with me. The upshot is is that his treatment has started.

Just for laughs- I think you have inadvertently hit the nail on the head- you went into hospital for an appendix operation, and found yourself surrounded by geriatric patients with dementia. 'General' wards aren't set up to deal with dementia patients; their staffing levels aren't designed for it, for a start. Every ward in DGH has become a geriatric wards, even the ENT ward my DH found himself on 3 months ago: in his 6 bedder, 3 of the patients there were at the crying out, wandering and pressing the buzzer every 2 minutes stage of dementia.

I am not excusing the behaviour on the ward in the OP, but it's my opinion that years and years of under-staffing is what's brought about current conditions- I think many of the staff do toughen up and become less compassionate etc after too many occasions of having too many demands placed on them with too little time.

Thanks all for the very good advice and in a way it's good to know that I'm not overreacting, your point about the diabetes issue is an excellent one LisaD as I think that definitely would present a real risk of complications. I heard no evidence that that was a consideration. I am now researching the contact details of the people you've all recommended contacting so that I can properly kick off about this.

Unfortunately lots of nurse leave NHS every year precisely because of this kind of scenario. You go into nursing as you are bright caring and motivated, then you start work on a ward which is grossly understaffed, you may be on the only qualified nurse on duty, you are not well paid do hard work that even relatives don't want to do for their elderly family, then you get shouted at and abused by relatives. It's why out of my class of 40 student nurses only 2 are still practising on general wards in the NHS, quite a few have gone to the states or Australia

i agree ghana.
they are appallingly short staffed.

make your complaint.
the managers have to listen, not just shut wards, but actually to listen to how short staffed most wards are. and employ more staff to do the work.

Please do complain formally. There is a chance at least someone will listen if enough people do. It is all logged so the volume of complaints should say something.

As a dr I can say that it may have been right to put her nil by mouth if she was at risk of choking or aspirating food into her lungs which causes pneumonia and often death. This is seen as the safest thing to do but I must admit there can be a lack of consideration of the downsides. Usually there would at least be a drip put up and especially if diabetic.

It is true that it is hard to find time to explain every clinical decision about every patient to their families. People vary in how much they want to know and sometimes various different family members all want to be told individually. I guess I would usually rely on nurses or the junior Dr to communicate a decision like this. A senior Dr should explain very serious decisions.

In general it is a very hard job to care for elderly, frail, vulnerable, confused people to the high standard they deserve. It needs high staffing levels, high staff morale and good leadership to get it right every day. As a consultant I sometimes despair how to make it right short of doing everything myself. Changing a culture is slow and hard work.

For the poster whose dad was discharged too early from hospital what he needed was a rehab bed in a community hospital to convalesce but these are all being closed meaning people are staying too long in the acute hospital getting infections or getting pushed into care homes. The acute hospital is actually not a good place for frail, elderly people who need rehab. It is so hard to manage a wandering confused person on eg a surgical ward. They would need 1:1 staffing to stop them getting in others beds etc and that isn't possible.

I probably come across defensive but just trying to explain the other side. It isn't defensible and you should complain maybe it will do some good.

The fact that the staff asked you to make a complsint is very telling. Managers don't listen to staff, they do listen to complaints. It frustrates me immensely that wards which already have staffing and quality issues are effectively 'abandoned' over holiday periods by senior medical, nursing and allied health care professionals.

Rabbit, why on earth is your mother still living in the circumstances you describe ?

I work for the NHS and can assure you that not all wards are like this. If this happened to one of my patients I'd go absolutely apeshit.

You need to write down all the details as soon as possible including who said what ( in quotes), when and to whom ( ie witnesses ). If possible write it in business like matter of fact way as too much emotion can blur the facts.

List questions you want answers too such as why was someone nil by mouth given a tray of food, why was no alternative form of hydration planned and ask about their policies in these situations (which they blatently have not followed).

I wouldn't worry about finding out their staffing numbers. Whilst that might be the reason for their behaviour that's for them to identify when answering your complaint.

Personally I would stick to one complaint at a time eg pals or direct to the consultant or ward manager, rather than a scattergun approach of complaining to everybody others have listed. If you get no joy from one you can then complain to the next rather than using all your options up at once and potentially looking like a malicious complaint.

One of the big problems is that the last time the NHS had huge amounts of money pumped into it was in about 1998 to 2000 and rather than being pumped into the coal face and clinical care it was pumped into setting up lots of primary care trusts which added an additional layer of bureaucracy, increased chat and paper and political correctness and employed rafts of additional managers and admin staff. Absurd, absolutely absurd. Unfortunately, those in the NHS at the welcomed it rather than saw it for what it was because those within it are too political and had spent the last several years braying for a labour government. I well recall midwives telling me in the mid nineties that they were grossly under-resourced due to the conservatives - they were still under-resourced in the mid noughties - it is worse now but not because of government. It is worse because the staff who work in the NHS think not good enough is actually good enough and standards in all things have been allowed to decline. Staff are no longer polite, people are messed about all the time and treated as lumps of meat, nobody knows who they are dealing with, proper uniforms that identify levels have disappeared as part of the mirrors and veils exercise.

Somehow better management and common sense needs to be injected into it. Nobody speaks up and when one does raise an issue all one hears are excuses - "oh well you could complain, here's the PALS number". Why should it be patients complaining; hospitals are packed full of supposedly professional staff - why aren't they speaking up and complaining if they don't think it's good enough. One can only assume they do think it's good enough and it really really isn't and that is why I have lost respect for many who work in the NHS. They are in there watching it deteriorate, making excuses and doing diddly squat about it when they are the ones best placed to do it. What I'd really like to see are nurses and doctors striking - not in relation to pay and terms and conditions but in relation to the poor standards that are now rolled together to make up the NHS. Something has to change because frankly I don't want to use it.

I agree. Staff are probably painfully aware of shortcomings but, harassed as they are by the suits to pursue meaningless targets so that said suits can do a Powerpoint presentation at some stage to other suits, they are unable to instigate the changes needed.

I work for the NHS and could write all day about the Kafkaesque shenanigans endemic at its heart.

Diabetes UK , who are a fantastic organisation (I have a diabetic in my family so deal with them a lot) have been very proactive in campaigning about the care of diabetics in hospital. They will be able to help you add weight to your complaint.

I know that I for one do try very hard to rise standards of care on my ward. I feel that my small, local day to day efforts are more useful than going on strike.

I'm not sure it is all about money. It is ethos, continuity and team spirit we seem to have lost. You need a good, cohesive team to do a job like this but care is so fragmented now with drs and nurses working crazy shifts all over the place, patients being moved all over the hospital so you are never looking after the same people for their whole stay. Things like praise where it's due, getting together to talk over things that went wrong and right, an open culture where anyone can make a suggestion or raise a concern, a team where people care about one another. These don't cost money but it is really hard to build that where it doesn't exist.

Some thought into the ways that structure support or work against good care is what is needed not more stupid reorganisations.

What mamadoc said

I think it's grossly unfair to say NHS employees have accepted substandard care. The majority of us are still fighting to maintain and improve services despite what you might read in the daily wail.

Surely the doctors lead the teams mamadoc. Perhaps they need to be a bit more proactive and start demanding that other staff start cutting the mustard. You know things like being polite to people, coming to work looking like clean professionals, let alone having the clinical ability to do the clinical aspects of the job.

Why doesn't the correct ethos, continuity and team spirit exist? It isn't because of the patients, it's because those who work in the NHS have allowed them to be eroded.

Let's not forget as mentioned above, the two whistle blowers in Staffordshire were honoured in the New Years List. Honoured for standing up and being counted because what it going on in the NHS cannot continue. I for one am not prepared to see my taxes raised to pump more money into something that needs root and branch overhaul - I would rather that money be pumped into a new system because the old one has become a mish mash of complete incompetence underpinned by a culture of excuses and political correctness.

I don't care what colour of nurse or doctor I am treated by, what their religion is but I expect them to be clean, I expect them to treat me with respect, I expect them to be professional, I expect them to be properly dressed in a professional manner. That is not happening, it has been replaced by diversity audits, statistics breaking down local ethnicity and whether that is represented amongst the staff. It is absurd - the emphasis needs to return to what the patient needs not to serve a bunch of lay trustees and non execs who have nothing better to do than attend meetings, navel gaze and who seem to have lost touch with the absolute basics.

Oh, and I've been a non exec - I visited wards and when I complained that a ward was dirty and lavatories were disgraceful the ceo told me there was no dirt in the hospital. I was only one person - I gave it up after three years because the entire culture was designed to pretend things were super and they weren't. The problem was those working there were happy to go along with it because they were inculcated in a fractured system designed to deliver poor standards. If a nurse thinks a skid covered bog and grubby seat are acceptable then in my opinion they are not fit to nurse.

I agree the problem is almost definitely within management. Do complain to the director of nursing as well - it may not get you far, but nothing will happen without complaints.

I can't even begin to tell you the way the mother was treated (as a staff nurse) after she and colleagues raised concerns about patient safety. I can tell you it has scared other nurses into not raising concerns though. Certainly in our area NHS management is rotten to the core (I am actually staggered at the lengths they have gone to to avoid addressing the problems). Many frontline individuals do their best to make a difference - but often whether than can happen depends on the first line of management - between the suits and the people doing the caring. If that level is weak and uninterested in patients you have a problem. If that level looks after their team and patients you should still get good care.

windmill - there's often not a lot doctors can do. When my mother and colleagues were treated appallingly after they raised concerns, the doctors they worked for wrote to the head of trust and nursing and expressed their disgust at the way they had been treated and confirmed that they were right to be concerned. They confirmed they had the same concerns about patient safety.

The doctors were told to butt out basically. They couldn't do anything even though managements actions and responses were affecting their patients.

I think we also need to hold this government to account. They are the ones who completely sidelined the main recommendation of the Francis report, which was that there should be minimum staffing levels. That is where it all starts. It's easy to point the finger at 'the NHS'. but ultimately it's the politicians who are driving it into the ground.

Having said all that this is clearly a ward/hospital that needs a metaphorical bomb dropping on it, so the OP should definitely use the advice above to get things in motion. I wouldn't extrapolate from this case to 'all wards in the whole NHS are shit' though.

Well, it's got to change. I really do think we need to hear the doctors professional groups start talking out about this - along with the royal college of nursing, etc., because regrettably we just aren't. You look at any thread on here when people complain about nursing standards and it's just the same for teachers - they are regarded as above and beyond criticism - yet they are not speaking up to protect the needs and the rights of the people they serve. They speak up but it comes across as being about them and their needs and the emphasis needs to change for it to be properly considered in the right places.

I well recall the community midwives who visited me nearly 20 years ago - they complained and complained to me, the patient, about how over stretched they were. They were with me for half an hour or more at a time. Their job was done in five minutes - they spent the rest of the time complaining - to the patient - they had more time to complain and chat than they did to do the work and actually they missed something fairly crucial because they were chattering and not focusing on clinical issues. It really isn't a new problem and the root cause wasn't over work.

I'm a nurse, I don't think dirty toilets are acceptable, I don't think failing to answer buzzers is acceptable, etc etc etc, but the reality is when you are responsible for 8,10,12,14, 16 or on occasion even 30 patients with complex needs, some of whom are very sick indeed, you CANNOT clean a toilet, you cannot feed a patient, you can only firefight, ie try and make sure nobody dies and that you complete the paperwork you are legally bound to do, eg prescription charts.

You can fill in all the incident forms you like and complain to who you can but the will to change must come from above too and it is not there.

I no longer work on a general ward and I never will again. Thankless, terrifying work which leaves you feeeling a failure and a worthless human being when you cannot help those in your care. Newly qualified staff are unsupported as senior staff just don't have time, they are often never supernumary at all despite what trusts say about preceptorship.

Nursing has a bleak future. The government and media conspire to blame 'cruel' "lazy' nursing staff for most NHS shortcomings, those who do care leave the profession in droves. I love nursing and when I started in the late 90s on a general medical ward it was the best job in the world. I never had more than six patients, there was always at least one HCA on shift, we gave amazing care to all our patients and we loved doing so. When I left the general wards in the mid 00s i had 14 patients and no help on my last shift.

Even if you're super nurse you can't do an adequate job in those circumstances never mind a good one.

OP complain, complain, complain. You shouldn't have to but please do. Hope your mum is doing better today.

Oh and the NMC is not fit for purpose but still take out money every year, the RCN is a royal college AND a union, we've got no chance. We need proper separation of functions like the medics.

OP, look above her bed to see who the clinician in charge of her is and complain to them. If you can't get anywhere with them then phone the Care Quality Commission hotline on 03000 616161, PALS or march down to the chief exec's office.

NTW do I lead the team? Well yes and no. People do look to me for leadership so I have some influence but I am not the line manager of any of the nursing staff so I can only complain to their manager. I need good nursing leadership to make changes. I have discovered that it really is not as easy as I tell people off and things get better.

Many, many high level systemic reorganisations costing lots of money have done nothing to improve day to day basics. I don't therefore think that either more money or another new system will work.

It is as Francis says a new culture and that is much harder.