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Features

It's time to admit it: the NHS is unable to look after our elderly

Encounters with the NHS’s most despised class

18 May 2013

9:00 AM

18 May 2013

9:00 AM

I decided to become a hospital visitor last year, after being a patient and finding myself in something more like a factory than an old-fashioned ward. A terror of infection in 2011 (there were 2,053 deaths involving Clostridium difficile) has ended the cosy world of side tables covered in flowers and cards. Concerns about data protection have put paid to WRVS ladies pushing trolleys, and vicars walking around offering solace. There aren’t even many nurses about, and even if there were, you wouldn’t want to bother them for tea and a chat. It’s OK if you have family or friends nearby, but if you don’t, being a patient in today’s NHS is a bleak experience.

This isolation gets worse the older you are; in fact, if you are old and alone in hospital, you can practically become a missing person. On wards with grand-sounding names like ‘pulmonary hypertension’, I met people who have little wrong with them except old age and a lack of visitors. These are the ‘bed-blockers’, a 30,000-strong scourge of the NHS, resented by everyone from the government down for clogging up the system: the loneliest, frailest members of our society.

There was a tiny lady of 93, no longer ill but too frail to return home. At first she was very jolly and told me in her fluting, refined voice about her father, who managed a famous biscuit company, and about courting in the Wrens. Over three weeks I saw a change; her voice became faint, she sat with her head hanging down, breakfast untouched. No one helped her to eat. She had a cut by her eye and her hospital gown was stained. I asked a nurse if she could have something else to wear but they don’t keep any spare clothing. If a patient has no visitors, their only option is a hospital gown. Toothbrushes are also no longer supplied.

A nursing assistant appeared, attending to the four old women in that bay. While she was washing one, another wanted to go to the loo, and my old lady started crying. If I hadn’t been there, she would have been left hungry and crying by herself. No one thought to investigate how and why she had suddenly become so weak. ‘God help me,’ she whispered as I held her hand. I think he did, because her only relation appeared from Leeds and, some weeks later, got her into a private nursing home.

Bed-blockers come from all manner of different backgrounds. Even if you are wealthy, without family it can take a long time to sort out your assets — and there is a long, long wait for council placements in care homes and sheltered accommodation. Before Christmas I met Peter, an Irish bachelor aged 75. He was sitting quietly in a corner of the ward hardly raising his head. His eyes had a blank look and his legs had turned black from diabetes.

I’d say, ‘Why have you got Nelson Mandela’s legs?’ And he’d give me a toothless smile. I think no one had engaged him in conversation for weeks, but once I got him going, he gradually became very talkative with me. He described his life as what he called ‘a worm disturber’, digging roads in Connaught and London. ‘There were two Kerry girls I could have married,’ he said wistfully.

Staff said he could walk with a frame, or ‘mobilise well’, as they put it, so there was no reason for him to be there. They were determined to return him to the rented room in Harlesden where he’d been for 37 years. Peter said he couldn’t manage the steps, and his landlady, aged 80, didn’t want him back. But the nurses considered this obstructive. The matter was settled when the landlady arrived and removed his keys, so the hospital decided to get him into a flat, without a ‘care package’, meaning assistance from social services. I couldn’t see him looking after himself. ‘This is a hospital, we are not here to deal with their social life,’ said the Polish ward sister.

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Wouldn’t he’d be better in an old people’s home? ‘No chance,’ said a male nurse brusquely. ‘He’s way down the list.’

Brent housing failed to put him anywhere, however, and he was still there chatting to me in late April. ‘It costs £300 a night to keep him here,’ a nurse complained.

According to Department of Health figures from August 2010, the wait for a place in a residential home has increased to over 30 per cent. Delays in nursing home placements have increased by 40 per cent.

Figures from the charity Age UK indicate that the number of days waited per patient for a care package in their own home has increased by almost 25 per cent since August 2010. Delays in providing equipment and adaptations have increased by 13 per cent.

I saw other, less successful blockers being ejected, scuttling away sadly on spindly legs. Some returned a few weeks later, having failed to ‘mobilise efficiently’.

The nurses became increasingly cross with Peter, and he became a little demented. At one point he thought we were on a ship, ‘one of those that takes you away and you never come back’, he said. ‘He isn’t demented,’ said the Polish sister furiously. ‘He’s doing that because he wants to stay here.’

On 22 April, after six months he was discharged and sent off to a flat in Kensington. He looked baffled. He didn’t want to be in Kensington, he wanted to go back to Harlesden, where he knew a few people. ‘See what we are giving to him,’ said the sister, as if she was handing over a prize that he didn’t deserve. I watched Peter shuffle out of the ward on his Zimmer frame.

Later that day, I heard the health minister Earl Howe say he was examining whether ‘the Scandinavian model of hospital hotels’ could provide care in England.

I am not sure if the Euro Hotel in Wembley, where Peter ended up, is what he had in mind. It includes a whole street of terraced houses owned by an Indian family, divided into 84 units rented to the council for released bed-blockers at £16 a night, with continental breakfast thrown in.

Using a stick, as his Zimmer was retained by the hospital, Peter showed me through a scuffed hallway, up 18 laborious steps to his room. He sat puffing on a narrow bed which occupied almost the whole space. No wardrobe or cupboards. Come to that, he had no lamp, radio, TV, kettle, mug or cutlery. The old strip light flickered badly and the lavatory seemed to have been put in by a prankster: you couldn’t use it without sitting sideways with the door open. Peter went to McDonald’s for his breakfast and made that last most of the day. From about five, he sat in the hotel although there was no tea on offer. He went to bed at 7p.m. This seemed to me as near to homeless as you can get without being on the street. Worse than homelessness in many ways, for lacking the camaraderie.

One day, to my surprise, Peter mentioned that he had a sister living in London, so I phoned her. ‘What has it to do with me? The state should look after him,’ she said furiously, adding, ‘You should get your finger out,’ as if it were my responsibility to prompt the state. I asked her if she could possibly take him a kettle. ‘Will I be recompensed for that?’ she squeaked before I put the phone down. She’ll get a surprise, Peter’s sister, when her own turn comes.

It’s a terrifying future out there, especially for the next generation of elderly people: the children of the 1960s who relished a level of personal autonomy unknown to previous generations; who often chose to remain single or childless but will now pay the price.

The new Queen’s Speech, announcing the government’s ‘Care and Support Bill’, offered little of either and certainly no comfort. Although the demand for care among those of us now hobbling on bunioned feet past middle age is increasing by 3 per cent a year, since 2010 councils have lost 20 per cent of their budget for social care. The government intends to remove a further £800 million in adult social care over 2014, £104 million of that through the direct removal of services.

Over the past six decades, we in the developed north took a rather patronising view of people in southern Europe who seemed to cherish family above any civic sense, or those in the developing world for relentlessly having babies to care for them in their old age. But our own experiment in cradle to grave care seems to have failed, so maybe they were right all along.

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