Three weeks ago my mother, aged 93, in the last stages of terminal cancer was admitted to Compton Hospice in Staffordshire. When I got over my shock and emotion at visiting her there, a hospice is after all a place of death from which few return, I realised I was in a powerfully healing environment. They couldn’t cure the illness of course but the whole attention of the staff is dedicated to helping the patients to feel comfortable and out of pain, and assisting their relatives to accept the situation.
If she felt any pain she or a visitor pressed a button and someone would come almost immediately, question her in a quiet, soothing way, then attend to the problem. She was constantly moved to make her comfortable and avoid bed sores, the lighting was fixed as she wanted it, she was encouraged to eat and personal care was plentiful.
I had seen nothing like it before. I was a hospital visitor in London for three years from 2011, and I saw dying patients put into side wards and largely left alone. I would moisten their mouths with sponge and wonder how long they had been there without water. Touring wards supposedly meant for pulmonary hyper-tension and renal failure, I often found old people with multiple problems including dementia. Or at least they were so lonely they’d lost the power to communicate. These were the ‘bed blockers,’ seen by many nurses as an enemy.
‘He has no right to be here,’ a Polish nursing sister once told me furiously of an old man who was refusing to go home. In fact he had nowhere to go as the landlady of a room he rented had come into the hospital and returned his keys. She was eighty and said she couldn’t cope with having him back.
Becoming one of these unloved people is a fate that awaits any elderly person who goes into hospital and then finds they are too frail to return home. You have to be very ill to go to the quiet comfort of an hospice, so thousands of frail and dying old people are left in hospital, far removed from the nurturing atmosphere my mother found at the end.
I was first struck by the horror of this when I visited an old lady in hospital several times and saw how rapidly she was deteriorating. The third time I got there at 10.30am and saw her sitting up in bed with her head hanging down, dry toast and coffee untouched in front of her. A nursing assistant was busy removing all the breakfast trays.
The previous week she’d been chirpy and told me about her time in the RAF during the war, and her love of animals. Now she was silent, had a cut on her head and was wearing a hospital gown as her own dressing-gown was caked in dried blood.
“God help me,” she whispered to me, the only thing she managed to say.
I moved onto a ward where there are a lot of old ladies, demented and sane mixed together. I met one who was almost stone deaf so I couldn’t do anything except make her tea and hold her hand. Twice I asked a nurse to ask her friend who visited, to bring in her hearing-aid from home, but I knew it was never going to happen. NHS nurses no longer have the time or inclination for such details.
Another woman was suffering from Raynaud’s syndrome which causes freezing extremities. She told me she’d complained about being unable to sleep because of the cold in the ward where there was a problem with the heating. She desperately wanted some bed–socks. I scuttled off to the Friend’s shop to buy a pair for £2. She was delighted. I was later told they keep bed socks on the ward to give out to patients, it was just that no one had bothered to do it.
‘I am so worried because I can’t walk,’ a very thin man, aged ninety told me, his cereal clogged around his ill fitting false teeth. He was right to be scared because it is quite possible to die of starvation in an NHS hospital if you have no relatives or friends to help you.
On my last visit, on Tuesday 28th October 2014, I saw an old man asleep. On a tray in front of him just out of reach were two large hunks of uncut, unbuttered Mother’s Pride toast. If he’d been awake he wouldn’t have been able to reach it, and as his dentures had been left at home he could ever have tackled the toast successfully. As his tea was in a mug going cold, I woke him and encourage him to have something. I tore the door-step of toast into pieces as if I was feeding a bird and gave it to him. I will never forget the way he smiled withsuch delight, not just because of the toast, but because I’d given him some personal attention.
From what I saw as a visitor in London, cutting up food, washing hair, cutting nails and offering basic tea and sympathy are no longer part of the remit of the qualified NHS nurse. Of course a lot of this uncaring attitude is to do with the pressure on beds and the rapid turn over of patients. According to NHS England, 2015, over the past 26 years the number of available beds has halved, most markedly for the long-term care of the elderly. Then there is the mysterious lack of NHS staff.
Last year Unison, the UK’s largest trade union, an extremely left wing organisation, warned that cuts to the NHS could risk patient safety. They pointed out that forty five per cent of staff have to look after eight or more patients at once during their shift. Of 3,000 nurses questioned, sixty five per cent said they didn’t have enough time with patients. Fifty five percent said that care was ‘left undone’ as a result. But nursing has always been a very tough profession. Florence Nightingale went to nurse the wounded at the Crimea with thirty eight volunteers, including her Aunty Mai. They tended approximately 18,000 grievously injured men. For a more recent view of nursing under severe pressure, one can read on line, Civilian Nursing in Lambeth Hospital during the Blitz, by Doreen M. Abrahams.
She describes a situation of incredible privation, danger and courage, but where the patient’s needs always came first. The culture of nursing was very different in those days and until radical changes in the 1980s – a cross between a military campaign and belonging to a religious order. It was often a vocation. It is hard to imagine anything like that now and The Royal College of Nursing despises what it terms, the ‘ritualised nursing’ of the past. They want no return to the ‘angels without wings,’ of the past, without academic degrees,emptying bed-pans, washing and feeding patients by the clock, under strict supervision.
Over the last few weeks, I think, I did see again that old tradition of nursing in the hospice. It was obvious that the impulse for genuine altruism is still deeply rooted in British culture. About seven hundred volunteers work in Compton Hospice every week, including people in the cafe, shop, and drivers, all eager to help without pay, because of their own life experiences. Two thirds of the funding for the UK’s 200 hospices comes from charity, and being there it felt as if we were in a deeply charitable environment, going back to the Christian understanding of that word.
The Economist Intelligence Unit has just published a report ranking end of life care across the world. According to their document, ‘The Quality of Death’ the UK leads the world in this, ahead of forty other countries measured on their Index. The NHS however comes 27th on the list for its ‘Basic End-of Life Healthcare Environment.’
The report points out that few nations, including those with cutting-edge healthcare systems incorporate palliative care strategies into their overall healthcare policy, despite the fact that there is increasing need for such a service. In institutions like the NHS death has become medicalised and curative procedures are prioritised ahead of terminal care.
Many people actively want to avoid the NHS if they can in the late stages of their lives. Until she got cancer a year ago, my mother she had been in good health, slim, active, all her own teeth, and no artificial moving parts. That was her choice. She could have done with an artificial hip, but like many old people, she dreaded the idea of going into hospital the way her parent’s generation feared the Union Work-House.
About a fifth of people, 120,000 a year, seek help from hospices before they die. According to the official bereaved families survey produced by the Office for National Statistics last year, over 80 per cent of people feel hospices treat patients with dignity and respect compared to just over half in hospitals. A similar picture emerges with the crucial administering of pain relief. The other beacon of hope present inside hospitals comes from 3,942 Macmillan nurses, also a charitable trust looking after nearly six million people a year.
These charities put the heart back into UK medical care. Against them our hospitals look like terrifying factories. For political reasons, many NHS trusts are now burdened by debt and targets for delivery, merit resting on the number of knees, hips and scans performed. With harassed doctors increasingly robbed of their status and detached nurses who seek parity with clinicians, patients are just nuts and bolts to be fixed and replaced by the next chassis as soon as possible.