2011 will be remembered as the year that the image of the caring nurse was shattered by widespread evidence of neglect on NHS wards. This was the year we realised the disturbing truth that inspecting services could not prevent abuse. It was also the year we were confronted with the knowledge that complaints even serious complaints were all too often not taken seriously.
It is comforting to think that those who neglect and abuse vulnerable people are bad people. Better that than acknowledge they are the same as you and me and that given a certain set of circumstances we are all capable of the indifference recently revealed to be widespread in the care of elderly hospital patients. A few bad apples can be removed and better recruitment and supervision could identify the wrong un’s at an early stage. So why is abuse and neglect of people with a learning disability and older people such a recurring and widespread problem?
Neglect and abuse persists despite recruitment practises aimed at selecting people who have a positive attitude to old age. Bad practise and indifference to the discomfort of individuals continues despite renewed emphases on supervision. We should acknowledge that the problem is not simple one or two bad people. We need to recognise that disciplining and dismissing the worst offenders and providing more training for the rest won’t stop abuse and neglect from happening if the causes lie outside of the individual.
Of course we should dismiss those who abuse older people but we know this is just the tip of the iceberg. Those who shout or swear at a patient for being incontinent or steal their money and valuables or burse them through rough handling are easily identified and dealt with. But neglect and indifference is subtler than this, it is ignoring requests for assistance so that the individual soils or wets themselves, it is putting off cleaning them up in the hope that it can be left to someone on the next shift. It’s making the individual feel that they are being a nuisance with their requests for a drink or to be helped sit up when you are so busy. It is giving a patient a bath whilst carrying on a conversation with a colleague as if you were washing a car not a person as you share what you did last night and what you are having for tea to night. This is the real problem the staff group as a whole stop seeing patients as individuals they are just another incontinent, confused, feeble body that needs washing, feeding and toileting. The way things get don is organised to make life easier for the over worked under resourced staff. The good patient is the one who places no demands on staff but is grateful for any help, the good patient is cooperative and cheerful.
We cannot rely on inspections to prevent abuse and neglect although we can reasonably expect that a properly resourced inspection service will make it harder for it to go undetected. We cannot assume that just because a complaints system is in place mangers will act decisively all though we have a right to expect they will. We should not think that abuse and neglect is down to one or too bad people because the persistence of abuse and neglect despite dismissals disproves this.
Blair McPherson author of Equipping managers for an uncertain future published by www.russellhouse.co.uk