Is the way our hospitals treat old people down to underfunding – or organised neglect?

In my three years as a hospital visitor, the picture hasn’t got any better

8 November 2014

9:00 AM

8 November 2014

9:00 AM

I am leaving London soon, coming to the end of my time as a voluntary hospital visitor working from a chaplaincy in a London teaching hospital. I have been roaming around a variety of wards for the last three years, only one day a week, but in those few hours I have seen quite a lot. The most disturbing things have been the poor quality food, which cannot aid anyone’s recovery, and the neglect of the very old and vulnerable, the patients rather ominously labelled ‘bed blockers’.

On my last visit, the Anglican chaplain was not in the hospital, so instead of attending a morning service with him in the hospital chapel, I went up onto the wards early, at breakfast time. In one ward there is a neighbour of mine, an old man I’ve known for years. At first I didn’t recognise him as he has become so thin. He was asleep and his meal, two large pieces of thick, uncut, unbuttered white toast, lay untouched on a tray near his bed. If he’d been awake he wouldn’t have been able to reach it, and if he’d been able to reach it, he couldn’t have chewed it, I happened to know, because his dentures had been left at home. Gumming his way through those big leathery slices wasn’t going to work.

As his tea was also sitting in a mug going cold, I woke the old man and encouraged him to drink — just to get something into his wasted body. He said that all he really wanted was some soup, so I went off to the kitchen to see if I could find some. It seemed like it must be quite a normal request in a big hospital: isn’t soup the food of invalids, let alone toothless ones, worldwide?

On my way to the kitchen a young Spanish-speaking supervisor suddenly appeared at the end of the ward. He became very agitated when I asked him for soup, quite excited as if it was something quite extraordinary. He began to agree with me emphatically: yes, build-up soup was what was needed, so off we set in search of it. Our mission met a dead end in the large but largely unused hospital kitchen. The catering assistant seemed decidedly affronted that I’d asked for soup for a patient at that time of day. The Spanish supervisor scuttled off, muttering about ‘build up soup’, but he didn’t reappear.

Hospital kitchens are as shiny as operating theatres but largely empty until the ready meals are brought in and loaded into microwaves. They contain tea bags, coffee machines, and lots of cupboards. I had the idea that there might be some simple, dried packet soup in one of the cupboards up there, so hell-bent on getting my friend something to eat I tried to have a look. A Chinese woman in a white coat was doing something in the corner of the kitchen. She said there was indeed some powdered soup in a cupboard, but unfortunately it was in a very large container which couldn’t be opened for one person. She didn’t seem inclined to help, so I returned to the ward without anything.

By then my ancient neighbour had also admitted defeat and gone back to sleep. It’s probably against some rule or other but I gave one of his unwanted toast doorstops to a little old man opposite who was senile and unable to speak. He’d finished a very small, shallow bowl of porridge and was still looking hungry. I buttered the toast and cut it up into small pieces as best I could with the blunt knife, and he ate it hungrily. As I walked away he smiled at me with such gratitude and delight, not just for the bits of toast, but also because I’d been attentive to him.

I worry about that little old man now. Because he couldn’t speak, or ask for anything, he relied on there being workers on his ward able and willing to observe his needs. I thought of being someone unable to speak, and feeling hungry. I’ve seen many patients go hungry just because they can’t eat without assistance. Food is banged down, left, then taken away untouched while the patient watches helpless and hungry.

Most of us can envisage what that would be like, but I am not sure that the NHS staff I met can or do. After three years of observation I seriously doubt whether any nurses or their more ubiquitous assistants on that ward ever butter any toast or even cut it up so that the older ones can eat it. As I left the ward, the woman I took to be a catering assistant came up to me and said very aggressively, ‘He says he wants the soup later.’ Her point was not about the patient, but that I had interfered unnecessarily. Lord knows whether he ever got his soup. Neither she nor the catering supervisor seemed interested in his immediate needs or really motivated to help him.

In my experience, looking after old people, or rather ‘bed blockers’, in NHS hospitals seems to be about finding the cheapest way to do the bare minimum: white bread, take it or leave it.

Nothing has changed since I first saw an old lady being left without food three years ago. When I consider my years on the ward I’m left wondering, and not quite knowing, whether the poor treatment I’ve witnessed is just a product of an underfunded and overworked hospital, or whether perhaps I have been witnessing deliberate, organised neglect.

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  • mandelson

    Possibly we are to ego centric and self absorbed today. Somehow our what should be empathy and respect has decayed into ’emoting’ i.e. Diana/X Factor blubbing which to me is sentimentality i.e. self centered ersatz feeling. Health care requires empathy and patience i.e. a motivation beyond that of financial remuneration. I wonder how much of the continual news of brutal neglect is down to our rather empty and narrow material and entertainment obsessions. Modern western society seems to be desperately trying to avoid any discomfort, suffering and effort at all costs. To me this is at least in part due to the loss of Christianity in our society along with a divine moral compass in relation to our actions (especially towards others) having consequences beyond this physical life. Unfortunately therefore all the noise from the media and governments declarations of enquiries, new procedures, extra billions will not change this.

    • Fergus Pickering

      Well I certainly try to avoid discomfort and suffering. I take it you embrace these things as a bride.

  • la catholic state

    Bring back Catholic hospitals please.

    • camjan2

      Yes a nun with a hot cross bun.

    • Gwangi

      like the one in Philomena?

      • la catholic state

        No…..like the ones where the nurses and doctors are caring and attentive and won’t kill you.

        • balance_and_reason

          Fantasy land….essentially the left and to a certain extent the right have sold a fantasy that the infinite and unlimited demand for total attention, especially when you are in decline , can be supplied by the state, each and every poorly old person with a hand maiden to mop their brow…total unattainable bullshit…never going to be possible….The marxist plan to remove the family has done wonders to throw more people onto the system and the reality of unlimited demand, not least exacerbated by the utter incompetence and dereliction of duty by the last Labour government, who put electoral manoeuvring above the public’s interest, and let in 2.5 million new punters for service,……people are just going to have to deal with reality.

          • Fergus Pickering

            Never get sick. Never get old. And stay out of jail.

          • balance_and_reason

            I am a middle aged worker…I’ve paid my way every year since I was 22, post college. If I get sick…BUPA, when I get old my children will support me with the benefit of my savings…..I see no need to break the law; if it becomes impossible to live in this country without breaking the law I will leave.

          • Fergus Pickering

            BUPA? Pray you don’t get ill.

          • balance_and_reason

            Sadly I don’t subscribe to that fictional channel.

  • C.U. Jimmy

    Hospitals have never been perfect and neither have their staff, but when I trained as a nurse thirty plus years ago we were taught about the importance of diet and vitamins and fresh air and cleanliness as essential parts of disease prevention as well as recovery, and to have a pride in the traditions of professional nursing. Much of our learning was practice-based, done on the wards under the supervision of ward sisters who, if they were good at their jobs, weeded out poor staff. Now that nursing has become university rather than directly hospital-oriented I wonder how much of an effect this has had on the overall culture. Care assistants seem to have replaced trained nurses as a presence on wards and with all due respect to them I think this has had a devaluing effect. What can be done now? I don’t know. And community care is even worse – fifteen minute visits from poorly-paid carers with little or no training.

    • Gwangi

      Well, the nurse may let you die of thirst or starve to death these days – buy hey, she’s a GRADUATE, so at least your death is being hastened by a professional! Hoorah!

      • Terry Field

        Hell is modern reality.

  • thomasaikenhead

    What is so interesting is surely that the experiences recounted here might possibly come as any surprise to anyone who is familiar with the NHS over the last few decades?

    How absurd is the very idea that Andy Burnham could possibly be considered as a contender to lead the Labour Party based on his performances to date?

    The last Labour government worked very hard to bury the three assessments of the performance of the NHS that they had commissioned because they are terrified about the truth coming out.

    Scandal after scandal has emerged in recent years with regard to the NHS but as long as ‘the system’ is blamed and nobody is ever responsible let alone accountable, nothing will ever change.

    People in the community need to reclaim the NHS by becoming visitors, questioning local councillors and MP’s and MEP’s and the boards of NHS Trusts.

    Until ordinary people take responsibility and are active, accounts like this will continue!

    • HD2

      One unintended consequence of the move to ‘mega-hospitals’ and the closing of countless local ‘cottage’ hospitals is that whilst every friend and neighbour might drop in a few times a week when it was just a short walk, they will only go once a month (if at all) if you are 20 miles away and they need to pay a fortune to park when they get there.

      As in every aspect of our lives, transferring responsibility from friends and family to the Great God, State, means a monumentally mismanaged, expensive bureaucratic behemoth has been built up, and the care and needs of the individual patient matter not at all.

      Someone, somewhere, needs to recognise that every small town and large village needs a small hospice/recovery/respite care unit, with sufficient beds to ensure there is ALWAYS space for the next person in need.

      Their care would be shared between friends, family and professional staff and the food would be ordered from a number of varied menus supplied by COMPETING kitchens nearby (local restaurants and hotels/pubs/takeaways) – and PAID FOR by the patient.

      The idea would be to get patients away from the expensive, high-tech, anonymous megahospital and back to a small, local, friendly, neighbourhood unit – maybe even staffed largely by volunteers, students, Duke of Edinburgh Award candidates and retired folk who truly understand what ‘care’ is.

      • red2black

        So if the patient can’t afford the food, they don’t get any? Why not apply the same rule to the medical treatment they can’t afford as well; or is the dietary aspect of care and treatment a separate issue?

        • Fergus Pickering

          But what were they eating before they came in? If they are beggars then the social services or someone will see to it.

          • red2black

            I’d suggest that a poor diet isn’t something that’s necessarily confined to poor people. As to who can’t afford three meals a day prepared by the people HD2 suggests, I think you’d find it would include plenty of ‘middle class’ people – those recently described as ‘the new deserving poor’.

          • Fergus Pickering

            It is not the job of the NHS to feed the poor.

          • red2black

            It’s currently the responsibility of the NHS to feed all the people in their care. I believe that a lot of people in their care would not be able to afford to pay for their own meals provided on the basis suggested by HD2.
            If you believe that they can, then we’ll have to ‘agree to disagree’, as they say.

          • Fergus Pickering

            Let me rephrase. It should not be the job of the NHS to feed the poor. It is a Health service, not a charity for the indigent.

          • red2black

            I agree with you on both points.

          • Fergus Pickering

            Noted. I withdraw any rdeness.

        • HD2

          Basic food (as now) free
          £5 a day (x3 current NHS budget) = 3-4* hotel food (as in boarding schools, which work on £3-£5/pupil/day)
          That’s roughly the same standard as in a typical French of Italian hospital
          And DON’T tell me a patient cannot afford £5/day for food, heating etc

          £20/day and you get 5* food from a wider menu and (again as in France and Italy) wine with your meals.

          • red2black

            Nice to see those with the most getting the best.

          • HD2

            So they should – they worked hard to get the best.
            And ‘rich’ people already have BUPA anyway, so this is simply giving those on very, very, average incomes some decent nutrition and decent choices.
            The NHS is run for the benefit of the staff, NOT the benefit of the patients (let alone for the ‘currently well’ vast majority of the population).
            Go and compare with France (private health insurance compulsory – or Australia, ditto)
            No waiting-lists.
            Operations taking place on the day YOU book – virtually without fail
            Three-course lunch AND dinner (with wine!)
            2-bed wards are regarded as ‘large’.

          • red2black

            i accept that there appear to be better ways of running certain aspects of a national health service in other countries, and I think it’s wrong, if it’s the case, that proven systems are in some ways being blocked or refused to the NHS. Private insurance is all well and good if people can afford it. As for ‘operations taking place on the day you book’, surely that must be limited in scope and not relevant if treatment is in an emergency or long-term? Of course people have worked hard to get the best, but I’d suggest that many of these people also support the principle of healthcare for people as and when needed, regardless of their circumstances. If you’ve been involved in a serious accident and ended up on life-support in intensive care, I’d suggest that ‘a three-course lunch and dinner with wine’ is probably about the furthest thing from your mind, and the minds of the people caring for you.

          • HD2

            You DO realise that the vast, vast majority of operations and hospital visits are pre-planned and scheduled?
            And that these cease in the NHS around lunchtime on Friday and recommence on Monday mid-morning?
            And that A&E is a State-run operation (sorry!) in virtually every country, as is health care for those on benefits?

            Placing dry toast next to a sleeping man with no dentures and then taking it away (untouched) when meal-time is over is hardly a sound way to nourish a sick elderly man back to health, now IS it?

            The question is always the same. Why is the NHS being run for the convenience of those who work in it and not for the convenience of those who are in its care?

            The obsession with ‘free at the point of use’ and the mythical ‘same standard of care for everyone, regardless of wealth, status (etc)’ is such utter b*****ks that no sensible person would repeat the mantra, instead saying ‘You buy food from a variety of competing firms, so why not buy your health-care too’?
            You have to buy compulsory car insurance from a variety of competing insurance firms, so why not buy health insurance on the same basis?

            A monopoly is ALWAYS bad for the consumer and a State-run (and so politicised) monopoly is the worst of all.
            I give you:
            State rationed and designed new housing (small, dark, over-crowded slums)
            State rationed roads – the main cause of the high death rates on rural A-roads is the fact that they were last improved when ‘Macadamised’ in the C19th
            State-rationed education – see PISA ratings to document our international decline (meanwhile, our PRIVATE schools are the best in the world)
            State-rationed runways; London, as Europe’s premier hub airport has 3 runways at present, and needs 8-10, with the option to expand to 12+ by 2030 – to cope with 2.5 billion Asians flying to Europe as often as 450 million Americans do now.

            The list is endless and the solution is always the same – abandon centrally, State-directed, Marxism and replace with individually-run competitive suppliers (also known as Darwinism)

          • red2black

            I agree with you about the need for change – which doesn’t amount to abandoning the core principle for some reason. As you say, car insurance is compulsory, so people who can’t afford it should make do without a car. I don’t agree that it should be the same for healthcare, and the same goes for education. There are more options than either the competitive ‘laissez faire’ free market or what you call ‘Marxist’. In any event, most systems are a compromise, purely out of social and economic necessity.

          • HD2

            Food’s compulsory too. If HMG nationalised that, we’d still be on ration cards (as Attlee intended in 1951)
            HMG has interfered in power generation. We’re now likely to have brown-outs this winter.

            Go figure.

          • red2black

            The Conservatives have always enjoyed support from women of all social classes – as was the case with the housewives’ protests that contributed to Mr Churchill’s post-war success. It’s been noted that had it not been for working class women voting Conservative, the Conservatives would never have been in power in the Twentieth Century.
            Your comment about ‘power generation’ seems a little odd in view of the amount of privatisation that’s taken place in recent years.
            Exactly what anything of this has to do with healthcare provision escapes me. Thanks for your replies.

          • HD2

            The number of power companies fell to just 6 under the Brown/Blair years.
            It then rose again as subsidies for the ‘Green’ insanity transferred money from poor people buying power) to rich people (owning the land on which the wind-farms sprout).
            Allegedly, the biggest transfer of money from poor > rich since the Corn Laws.

          • red2black

            Mrs Thatcher introduced a laissez-faire free market system when she was in power, which was furthered when Mr Blair was in power. The transfer of wealth from the poor to the wealthy is a feature of such a system. Wages are cut and jobs are lost in order to pay higher dividends to shareholders. Economists call this process ‘shareholder value maximisation’. The claimed ‘trickle down effect’ is virtually non-existent, perhaps best-exemplified in a Private Eye cartoon that showed a City gent pissing on a tramp.

          • HD2

            On the contrary. Everyone with a pension befitted, as the shares & dividends paid for their retirement income.
            And most were ‘Sids’ with privatisation shares too.

            Power station employment, through the ‘dash for gas’ dropped by 75-90% over the decade after privatisation.

            and power prices consistently FELL.

            Now, once the greenery idiocy took over, your argument is perfectly true – but ‘Greenery’ is only credible to politicians without the smallest inkling of a even the most basic of science., let alone how AGW scientists get their money (hint: tell the politicians who make grants available what they want to hear)

            Here’s some simple truths:
            Mankind’s total CO2 output is around 8% of the global total (the rest is natural – mainly respiration)
            The Uk produces roughly 0.2% of global CO2, so if we reverted to a Medieval life-style, it’d make no measurable difference to CO2 levels.
            None whatever.

            It would, though, lead to mass starvation, disease, and worse-than-Third-World poverty, wars, riots, dictatorship – and worse.

            CO2 is ‘plant food’ – higher CO2 levels mean faster plant growth – meaning more food for all non-photosynthetic life-forms. Including us.
            Historically, periods of higher temperatures than anyone is now predicting, were associated with periods of civilisation growth – and the reverse is equally true
            The Sun is at the start of a ‘Maunder Minimum’ meaning a repeat of ‘The Little Ice age’ of 500 years ago is near-certain

            Now go and bury the AGW delusionists under a bird-shredding windmill.
            Which, ironically, are not only staggeringly inefficient and unreliable, but are also CO2- generating, rather than CO2-saving.

          • red2black

            Sorry, but I’m finding your more recent replies closer and closer to incoherent. The original point at issue was the provision of meals to NHS patients.
            This is my last reply to you on this thread.

          • HD2

            Apologies. was just replying to your previous point in each case.
            Hospital patients should be able to choose from meals from competing firms, at varying costs, to be delivered at the patient’s convenience (but obviously excluding certain time-frames).
            The patient, and ONLY the patient should be in charge of their food consumption (all meals being of minimum nutritional standards, obviously).

            It’s the ‘one kitchen, one menu, one choice, one budget, one meal time, one meal concept (sandwiches at 6pm); no charge to the patient’ which lies at the core of the problem: patients are there to be treated, not the customer of the service.

  • Cymrugel

    Probably a bit of both – wilful neglect and institutional failure.

  • La Fold

    I cant remember where I read it but I always say “when its my time please god dont let me die with caring professionals but rather caring amatuers!”

    • balance_and_reason

      Used to be called family….

  • trace9

    So that lot of immigrants not a blessing nor any vibrant enrichment to this country, then. Notwithstanding whatever their taxes (unavoidably) paid. Perhaps there should be applied to them a ‘witholding’ tax on earnings – & points lost on ‘residency’, ‘right to remain’, ‘fear of persecution’, etc., etc., etc…

  • Tom M

    Interesting, apart from the total failure to do their job you get the idea that the Mid Staffs scandal was on another planet and couldn’t have any worries or lessons for them.

    In the private sector (the better parts that is) if there was some sort of scandal in a similar industry or even department there would have been a management reaction. Someone would have seen the comparison with their own part of the business and second guessed that there would be people round checking up and made sure they weren’t going to be caught out.
    I regularly had Government H&S inspectors round following mishaps elsewhere and checking to see in these could happen in my domain.
    That being the problem of a state run industry.

  • Swanky

    Why have all the original comments on this article, including mine, disappeared? Or are they elsewhere in another ‘edition’ of this article?

    • red2black

      This article seems to be a rehash of the one headed ‘Old, vulnerable and hungry – the shocking scenes from inside the NHS’.

      • Swanky


  • monsieur_charlie

    Just start prosecuting the wrongdoers. No accountability equals no change.

  • Sian

    My father – then 87 – walked into hospital with a chest infection not responding to antibiotics. three weeks later he was dying from neglect. Unfed, unwashed, dehydrated and uncared for. Every day I rang up ( from 200 miles away) to be told he was the same today. I paid a carer £100 a week to go in and shave, wash and feed him. This marginally improved matters. I gave up my job and came home to assert myself. I had him moved to a cottage hospital who nursed him back to health in four months. If anyone suggested he went in hospital I absolutely vetoed it and he died in his own bed with all his marbles aged 95. The incident I refer to was in 2001.
    It doesn’t change. THere is NHS institutional indifference to the elderly. It is heart breaking. I do not subscribe to the whole NHS is a sacred cow, nurses are saints la la la rubbish we are continually fed. The whole thing needs complete reform.

    • Lydia Robinson

      This story is so widespread and familiar to everyone who has elderly relatives in hospital. I know of one friend’s husband who lay in bed for three weeks because nobody was allowed to lift him – “elf and safety innit” – one nurse told her. They appeared to be oblivious to the fact that their patient’s “elf and safety” came low down on the list of priorities. Eventually, after her constant complaints, they got him onto a hoist and then dumped him into an upright chair and he promptly fell forward. When asked if they had a reclining chair, the reply was “yeah but it’s broken innit.”

  • lozerama

    Until the direct funding of the NHS is removed and given to the citizen as healthcare “social buying power”, to go choose from providers who have to serve well or go bust, nothing will change. £1800 per annum per person from cradle to grave is what the NHS costs us. That’s more than enough healthcare “social buying power” when spent by the citizen into a mutualized, charitized, and privatized service market; the problem would simply go way.

  • Terry Field

    ”The most disturbing things have been the poor quality food, which cannot aid anyone’s recovery, and the neglect of the very old and vulnerable, the patients rather ominously labelled ‘bed blockers’”

    I thought that Jamie bloody Oliver had made all things good in the holy NHS. And the Lord said ”render unto Jamie that which is Jamies, and leave fried MarsBars for the pictic peoples”.

    And lo it came to pass that bed blockers would eat gruel.

    And Billimand saw that it was good, and said ” This is the doing of the Labour Party, and it is wondrous in our eyes”

  • Joe Sixpack

    Ah, yes, the modern religion that is the NHS. People, this has nothing to do with “underfunding” or “overworked” (read the article carefully. There was soup available and the workers didn’t seem run off their feet). It can be cured by some technocratic solution. Rather, this anecdote is simply more evidence that socialism doesn’t work. That old man has no control or influence over the care he gets it. The bureaucracy decides what care he will get and that’s that. No accountability to the patients is not a good thing. Read Hayek’s 1946 book “The Road to Serfdom” (I think he won the Nobel Prize for it).

  • Joe Sixpack

    oops. forgot “not” before “cured”

  • Liberty

    Regarding the food, that is the food they would eat at home [have you seen how obese most nurses are?] so for them white bread, butter and jam plus tea is the norm for breakfast and as long as it IS food and delivered it is a box ticked. Whether the food can be eaten is not ticked so it is not done. They then busy themselves with all the things that they must tick off then have a sit down, mars bar and a fag.