The deterioration in the quality of care

Two recent stays in hospital have left 78-year-old writer Eva Figes shocked at the deterioration in the quality of care

As an elderly person one must expect to be hospitalised from time to time, but I had the dubious privilege of being in hospital quite a few times when I was still in my twenties. As a result I have seen many changes in the way a hospital ward is run, and not all of them are for the better. Advances in medicine are one thing, but the way we look after patients is another matter, and sometimes new drugs and surgical procedures have a knock-on effect on actual physical care which is deleterious rather than beneficial.

In the 1950s being in a hospital ward was rather like being in a benevolent prison. The ward sister ruled like a stern queen over her kingdom. She knew every patient and every nurse. She accompanied the doctors when they made their rounds, but for a large part of the day they were excluded from her territory. As for the nurses, many of them were recruited almost straight from school, and at a time when there were very few job opportunities for young girls, other than elementary teaching or secretarial work, the fact that they cleaned floors and emptied bedpans had its compensations. They were following in the steps of Florence Nightingale, they had chosen a vocation rather than a mere job, and had rather glamorous uniforms to endorse that status. Who can forget the cute little caps perched on young heads, and the navy capes lined with scarlet satin? They lived in nurses’ homes, which provided both security and companionship, and their matron stood in loco parentis for these very young recruits.

As for the patient, once you were admitted, the authorities were in no hurry to discharge you, since bed rest was often the only treatment on offer. Visitors were only allowed in for half an hour a day, which could cause a lot of heartache, but the nights were relatively peaceful, since nurses on night duty tiptoed from bed to bed with a pocket torch, and would bring you a hot drink from the ward kitchen if you could not sleep.

I have recently had the misfortune to spend a good deal of time in an NHS hospital after breaking a hip, and I was genuinely shocked by some of the nursing care I received. I was first put in an orthopaedic ward to have surgery on my fractured femur, and I have nothing but praise for the nursing staff there, who seemed to come exclusively from the same village in the Philippines. Between themselves they spoke their own language and even shared jokes which I would like to have understood. They keep in touch with their homeland, and work hard to maintain their relatives back home. I have been told by a retired doctor friend who now lives in the US that the immigration authorities there welcome people from the Philippines because they are such good carers. I exchanged telephone numbers with one charming girl and seriously considered letting her move into my flat – the residential homes for nurses have long ago been sold off.

My original collapse had been due to internal bleeding with the result that I was re-admitted to hospital with pulmonary embolisms a few days after my discharge. This time I found myself in an enormous geriatric ward, staffed almost exclusively by men and women of African origin. Some were better than others, but the overall atmosphere, for the most part, was one of careless and often uncaring chaos.

On my first night in the ward, when the night staff came on, I had a row with a nurse who refused to straighten my bed, even though I had a broken hip and drips in both arms, making it impossible to do much for myself. It was only after I told her that she should not be in a caring profession if she did not understand my predicament that she reluctantly gave in. This was typical of what went on. Nurses now come into hospital after spending three years getting a diploma and they no longer work as a team. Any request is likely to be met with the reply, “It’s not my job,” whether a patient needs help with the bedding or wants a commode. The more menial jobs are left to auxiliaries, who take your blood pressure, make the beds and help you to wash, but there are few of them, and when they are off duty you are left to your own devices. I came to rely heavily on a nice young woman called Marta, from Poland, who would take me to the shower room, wash my hair and strip my bed. She made up for the neglect of the other staff.

During the day you were assigned to a particular nurse, but I found I had to rely on myself to make sure that my carer, who was called James, gave me the pills I had been prescribed. If you were very old or suffering from dementia you might not get them, and there have been cases of patients dying of starvation because food was left by their bedside and simply removed uneaten after a certain time. I myself had a narrow escape when the doctors decided to put me on more antibiotics prior to my discharge, on the assumption that I had been in hospital so long that I must have caught something. When the night staff came on duty a nurse asked me whether I had had an intravenous drip at 8pm. I said no, and the nurse was clearly in a quandary. Eventually she managed to get James on his home telephone and he confirmed that he had left the hospital without administering it.

I was given the IV by the night nurse, and nothing more was said. It was clearly a dereliction of duty which in the old days would have called for punishment, perhaps even dismissal. But, although I am assured that ward sisters still exist, they clearly exert little or no authority. The wards are too big, both patients and doctors come and go at all times of the day and night, and most seriously of all, according to a study I have read, ward sisters do not require their nurses to report back. The result can be mayhem.

The nights were the worst. Florence Nightingale might have emphasised the importance of a quiet atmosphere for the well-being of patients, but the idea of sleep as a great healer seems to have been forgotten. Lights were left blazing, nurses on the night shift talked at the top of their voices, shifted heavy equipment about, visitors were often allowed to stay long after 8pm, when they were supposed to leave, which was not exactly restful. If someone needed help during the night the night staff were often unavailable, since they all took their “break” at the same time, making a chatty tea-party of the event. And woe betide if you needed a doctor. I remember one night when every help bell was ringing and not a single nurse appeared. Eventually I overheard one conversation when an elderly lady asked a nurse who did come to see her why all the bells were ringing and was told that there was an “electrical fault”.

That night stands out in my memory for another reason. A prostitute had been brought in after being beaten up in the street in the small hours. A man who was obviously her pimp was in and out of the ward at all hours. As she was constantly on her mobile I knew a good deal about her, and listened to her talking to him, pleading with him not to spoil her “last refuge”, before I realised the man was actually in the room, by her bed. This was after one o’clock in the morning. Someone had given me a Zimmer frame and I hobbled into the office, where I asked for the police to be called. Needless to say not a single nurse had done the rounds and noticed the intruder. A security officer did come to my bed and the man was evicted.

I was doing what the nurses should have been doing, and I was now public enemy number one as far as this colourful couple was concerned. The woman glared at me, the man made threatening gestures – because he was in and out of the ward as usual. He had got a wheelchair from somewhere, and the two would go out for jaunts.

The story of this couple and their escapades brings me to one of the most disturbing features of my recent stay in hospital – the lack of authoritative supervision. The presence of the prostitute and her pimp frightened me, and I never saw a doctor or anyone resembling a ward sister in whom I could confide, or who could be trusted to regularise the situation.

When I was discharged from hospital I was looked after by carers for several weeks. I talked to quite a few of them about my recent experiences in hospital. I found that many of them had had similar experiences, either as visitors or as temporary nurses. The care service employed quite a few Australian nurses who had come to see Europe, and they took a dim view of our NHS. “We work as a team,” one of them told me drily.

Back home, I was able to get my usual paper delivered. Almost the first item that caught my attention was a report from the Patients’ Association, saying that complaints from patients had reached an all-time high, going up by 13 per cent. I was particularly struck by the very high number of complaints about nursing staff – about 20,000. I can’t say I was surprised. In the absence of senior staff to whom they could complain, angry relatives had inundated the PA with letters about the lack of help with eating and drinking, and with toilet needs; about painkillers not given, and neglected bedsores.

The NHS is clearly in dire straits, and it is by no means sure that extra funding, even if it were available, would improve matters. Or that putting GPs in charge of their budgets will not make things worse. They too seem to have been bitten by the “It’s not my job” virus, judging from my recent experience. There are all sorts of things they will no longer do, like coming out at inconvenient times. So A&E becomes the first rather than the last resort.

If you are worried about an elderly relative who is not getting proper care there is no one to speak to. Doctors come and go at all sorts of times, and ward sisters, if they exist, stay well out of sight. In this situation the Patients’ Association is doing an increasingly necessary job. They do have a helpline and they are trying to raise a large sum of money to make it more effective.

In 1948 we had reason to be proud of the new NHS. But anyone with recent experience will know that things have gone badly wrong. Did you know that babies born at night are at serious risk, on account of low staffing levels? Or that there is a shortage of doctors to cope with an increasing workload? The food is not too bad these days, which is fine if you are not too frail to feed yourself, in which case you are likely to starve. Anxious relatives bringing food have at times been denied admittance.

I have used the NHS all my life, but I hope I never need to be admitted again. Quite honestly, I would rather die.

Patients’ Association helpline, 0845 608 4455

Eva Figes is an author. Her many works include the feminist classic ‘Patriarchal Attitudes’, published in 1970. To comment on this article, e-mail magazineletters@ft.com