I am very grateful for the opportunity to raise the issue of patient care in this debate. I also put on the record my thanks to the Minister for the generosity that he showed to a constituent of mine, Mrs. Donoghue, who visited him with a representative from Headway. I hope that, during the debate, my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) will also be able to catch your eye, Mr. Taylor, as he would like to make a few important points, and I am happy to facilitate that.
The St. Helier hospital and the Epsom and St. Helier University Hospitals NHS Trust have not escaped media attention in the past few months, following the trust’s decision to remove one out of every three light bulbs from its communal areas. However, in today’s debate, I shall raise a much more serious matter: the quality of patient care generally in the trust, and specifically at St. Helier hospital. I shall ask whether it is affected by the trust’s need to balance its books and to hit its efficiency savings targets, which amount to at least £24 million over the next two years.
It is always dangerous to draw conclusions from anecdotal evidence, so I acknowledge that the two patient cases to which I shall draw the Minister’s attention—the cases of a man whom I shall call Douglas, and a Mr. Kent—do not amount to a pattern of neglect. The many constituents who have contacted me recently to express their gratitude for the care that they have received at St. Helier hospital would, I am sure, want me to make that point.
However, the two cases require the trust and the Minister to set out what the trust and the Government are doing to ensure that the quality of patient care is acceptable and is not affected by the trust’s cutbacks. In my view, the trust has in those two cases failed to achieve that standard of acceptability. The debate is not about high-tech equipment or the availability of expensive drugs; it is about the washing and feeding of patients, communication with relatives, respecting patients’ dignity and keeping their loved ones as well informed as possible at a time of great stress.
In those two cases, and others, which had time allowed, I could have raised, the source of patients’ and relatives’ complaints has been problems concerning poor communications with relatives, medication not being administered, soiled bedding not being changed, inadequate levels of hydration, strict diets not being implemented in a timely manner, and relatives having to clean up their loved ones. The issue is not about a postcode lottery for the latest wonder-drug.
I shall first relate some of the details about Mr. Leonard Kent. In September, he went for a total hip replacement in Epsom. After the operation, he was discharged with a weeping wound. The wound was discharging clear liquid, but I understand that it is normal practice to discharge a patient in that condition. In October, he was admitted to St. Helier hospital with signs of jaundice, and there then ensued a number of incidents. For instance, his CT scan was delayed, because the portable oxygen bottle that he needed to take with him for the scan was not available. He was also put in B4 ward. From the letter that the trust’s chief executive, Graham Smith, sent to the Kents, I understand that B4 had recently moved, and that there were more bank staff on the ward than was usual.
Mr. Kent suffered the indignity of soiling his bed because he was not attended to, and his wife had to clean him. Water, which he needed, was not always available, and cannula changes were not carried out promptly. Charts relating to his strict diet were completed three days late. It is not clear whether it was simply a case of the charts not being completed, or whether the diet was not adhered to in those first three days. The trust’s letter does not make it clear. Fortunately for Mr. Kent and his family, none of the errors or delays proved life-threatening. However, they left him and his family with the feeling that he had been neglected. I am pleased that in that particular case, the trust has issued a full apology.
The second case is that of a patient, Douglas, who very regrettably has since died. His family are still recovering from that loss. He was admitted in January for a broken hip and transferred to B4 ward, the ward where Mr. Kent was placed. Douglas was transferred to the ward three months after its reorganisation, so any issues about the ward’s move and reorganisation three months previously should have gone away. However, I am disappointed to note that his and his family’s experience of patient care was very similar to Mr Kent’s.
Douglas was left with an unsupported broken hip when in bed, his bed was wet from urine on at least a couple of occasions when his family visited him, his mouth was not hydrated, medication was apparently left half dissolved on his tongue with a second tablet on the floor, and his family felt that they were not kept informed about what was happening to him or about the care that he was receiving. Now, his family are struggling with their loss and with the knowledge that the care that he received in the final stages of his life was not acceptable.
The experience of the local health service for the two patients and their families was not only very sad, but perplexing given that there has been a large increase in the number of nurses working in the NHS. The Government intended ward housekeepers to take responsibility for the quality of the cleaning and food on the wards, thus freeing up nurses’ time to enable them to focus on patient care. The Government introduced that initiative in 2000, with £50,000 start-up costs for each trust, and I assume that the Epsom and St. Helier University Hospitals NHS Trust was a beneficiary of that sum. At the time of the launch, the Government set a target whereby half of all trusts would have housekeeping services in place by 2004.
The document, “A First Guide to New, Modern and Dependable Ward Housekeeping Services in the NHS”, was published in 2001. Describing the role of ward housekeeper, it says:
“A ward housekeeper’s main tasks will focus on cleaning services, food services and maintaining the environment… Ward housekeepers will work together with the ward sister to ‘get the basics right’, so that: patients feel...cared for; patients’ individual needs are met; hospital wards are clean; food is enjoyable”.
The guide also says:
“There must be commitment from trust management”
to make it work. Such care was exactly what Douglas and Mr. Kent needed but did not receive.
The trust is abolishing the existing housekeeper posts. Their abolition is the most concrete example of a measure that will, inevitably, impact on patient care. In the trust’s proposal for removing the housekeeping service, it specifically says in its conclusion:
“There is a risk that the standard of support services, and the ability to respond to immediate requirements of the ward, will reduce, but”—
it goes on to say—
“be consistent with other wards in the Trust.”
The conclusion implies that the trust is reducing services to the lowest common denominator. The higher standards that applied to the wards with housekeepers will no longer apply; standards will simply be consistent with those that apply to the trust’s other wards, because housekeepers have not been available on all its wards. I could cite other examples, such as the freeze on staff vacancies, which will have an impact on patient care.
Like my hon. Friend the Member for Sutton and Cheam, I hope that the better healthcare closer to home project will continue to proceed smoothly. We have debated it many times in this place and it could facilitate the rebuilding of St Helier hospital. However, it is not the subject of today’s debate. In the meantime, I urge the trust not to lose sight of the necessity to provide patients with standards of care that we would all feel comfortable with were they applied to our own families.
I congratulate my hon. Friend the Member for Carshalton and Wallington (Tom Brake) on securing today’s debate, which is one in a series of debates that we have had about the future of St. Helier hospital and the Epsom and St. Helier University Hospitals NHS Trust. Over the past 18 months or more, many people in my constituency have rallied to the flag to give their full-hearted support to St. Helier, through protest marches, petition signing and letter writing. However, amid the publicity, the expressions of support for the trust and the high-profile campaigning to secure its future, people have also said, “I cannot support St. Helier, because of the experience that I and my family have had there.” I acknowledge, as my hon. Friend did, that they are probably a minority of those who have experienced care in the hospital. The vast bulk of people who have been cared for there do not write to me as a Member of Parliament, because they have had a good experience. However, that should not be an excuse for ignoring those who do not have a good experience.
I should like to a refer to one particular case and to a conversation that I had recently with the Sutton Association for the Blind, which has drawn together a compendium of evidence relating to its concerns about the experience of blind or partially sighted people at the trust.
The case that I want to cite is that of my constituent Mr. Bedford, which was drawn to my attention by his daughter Mrs. Eaton. He was admitted to St. Helier hospital in September 2006. During five weeks in the Barrington Brooke ward he went from being a mobile individual, able to potter around the ward, as my constituent put it, to one who was bedridden, incontinent and unable to feed himself. He suffers from Parkinson’s disease and appears also to have had a change in prescription of the drugs used to manage his condition, which has produced some violent reactions and a change in his condition generally. My constituent also tells me that Mr. Bedford had not been bathed for 10 weeks and that when he was transferred to St. George’s hospital, it was discovered that his hair was dirty and matted, evidence of a lack of attention to personal hygiene on the ward.
Mrs. Eaton felt that the decision making about her father’s care was more about managing the work pressures of the staff than about choosing the appropriate level of care for the individual. She cites the fact that it appeared to have been decided to treat him as though he were incontinent rather than providing a bedpan, to put him on a drip rather than providing him with fluids orally, and to leave him wet in a bed until lunch was served rather than changing him before then. It was only when the family’s lobbying and my contribution to it led to a transfer to St. George’s that things got a little better. Indeed, some of the comments and reactions at St. George’s that Mrs. Eaton passed to me were disturbing in themselves. I mention that case because it is one of a number of examples that constituents have raised with me recently.
Sutton Association for the Blind has cited three repeated concerns of visually impaired constituents of mine and my hon. Friend’s, which go to the heart of the initiatives that the Minister is likely to tell us about in a minute. First, there is a concern about the lack of awareness and sensitivity on the part of staff about feeding, particularly of people with disabilities or a visual impairment. Placing food in front of someone who is blind, but then not guiding them to the knife and fork or the plate, is a sure-fire way of not providing them with a nutritious meal. Secondly, there is a concern about medication not being properly provided in a capsule that can be readily accessed and about patients not being talked through the process. As a consequence, patients on wards have taken the wrong combination of medication or incorrect quantities.
The third concern, which is almost always at the centre of the cases that constituents bring to me, is about communication. That includes communication with the relatives, at what is often the most emotionally charged point in the care of their loved ones, when they need staff who are most able to communicate effectively and understand their needs, communication between staff, the effective handover between teams and effective record keeping. The lack of audit in all those respects is a concern.
That is why I agree with my hon. Friend that what is required is a fresh start. We do need that new hospital that he talked about. But, well before that, we need the kind of cultural change in the organisation that the Government want to see in the NHS and which is essential if the care that relatives and patients need is to be delivered in the right way.
It is always a pleasure to serve under your chairmanship, Mr. Taylor. I congratulate the hon. Member for Carshalton and Wallington (Tom Brake) on securing this Adjournment debate. It is perhaps important that we as parliamentarians occasionally bring individual real-life stories to this surreal world of ours. I congratulate him on bringing to our attention some of those cases, which I shall deal with, as much as I can directly, in a moment.
I am also delighted that my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) has joined us in this debate. She more than anybody has been passionate in her support for St. Helier hospital and in making the case, privately and publicly, for the site to remain a district general hospital, serving the local community. There has been a tremendous all-party commitment to that campaign, which we welcome, although it is interesting to note that no Conservative Members at all, either Front Benchers or Back Benchers, have been present during this debate. I do not quite know what that says about their interest in the health service or some of the issues locally.
The hon. Gentleman recently brought Mrs. Donoghue, one of his constituents, and the organisation Headway to see me, to talk about the impact of her husband’s condition on her and her family’s life. She is a remarkable woman, of tremendous courage and insight, and she gave a most powerful presentation. The hon. Gentleman will be pleased to know that we are having a summit tomorrow on the specific issue of long-term neurological conditions. As promised, we will begin that summit with a presentation on Mr. Donoghue’s case given by Jean Donoghue. Talking about the real-life impact that those debilitating and challenging conditions can have on people is an innovative and important way to begin such a meeting, so I thank the hon. Gentleman for giving me the opportunity of meeting Mrs. Donoghue. We shall be using her and her husband’s personal experience tomorrow to influence, I hope, the development of some of our policy on neurological conditions.
The hon. Gentleman referred to two cases: that of Mr. Leonard Kent and that of Mr. Douglas. The first thing that I would say, through the hon. Gentleman, to the families of those individuals is that we cannot underestimate the reality, which they have articulated, of their experiences of the health care that they have received. It is important to send them the clear message today that not only do we have empathy and sympathy with their experiences, but we redouble our efforts to ensure that every day we minimise the number of people who have a negative experience of the national health service. We would never want to belittle or devalue the experiences that people have had. I should like in particular to extend my condolences to the family of Mr. Douglas, who tragically passed away, having, from his family’s point of view, not received the kind of care that they would have wanted and had a right to expect.
It is also important to say, however, that the vast majority of people, when asked about their experiences of acute national health service care, speak about it incredibly positively, whether at St. Helier or in different national health service organisations up and down the country. There is a great disparity between the way the NHS is reported and people’s general or abstract sense of optimism about the state of the NHS, as well as the real-life experiences of those who access NHS services day in, day out.
It is important to make that point, and not only for political reasons—clearly the Government are very proud of the additional investment, nearly tripled by next year, that has been put into the NHS. We are also proud of the fact that by the end of 2008 we shall have achieved the historic target of a maximum wait of 18 weeks from the point a patient visits their GP to reaching the door of the operating theatre, for the vast majority of conditions. That is a remarkable story for waiting times in the NHS, compared with 10, 15 or 20 years ago.
It is important to make the point that the extra investment has made a difference and that waiting times are coming down. However, the point is also important for the morale of the people who work on the front line of the service—the doctors, the nurses, the support staff and the ancillary staff. On the whole they do a tremendous job, not always in the easiest circumstances, to ensure that patients and their families get access to the highest-quality treatment. However, health services are about not only treatment but emotional support and understanding what emotional impact a serious illness can have on a patient and their family. On the whole, those health care professionals are still passionate and idealistic about working in the national health service and still, by and large, do their best to be as professional as possible. In debates such as this we must always pay tribute to those front-line workers.
However, we must also make it clear that dignity and respect in how we treat patients, particularly older people, have to be at the heart of the health care that we provide. About a year ago, not long into this job, I launched a national campaign to place dignity and respect at the heart of services for older people—whether delivered in hospitals or nursing and residential care settings, or as part of day care services or of the support that people receive at home. We launched the campaign because people and their families told us time and again about some of their unsatisfactory experiences. Those were not so much to do with surgery or medical attention, but were about the sense that becoming a patient should not mean ceasing to be a human being. When we become more frail and dependent and lose control of many elements of our personal needs, perhaps for the first time, we want to hang on to our dignity and respect more than ever. It is crucial that the health care system—indeed, the social care system—should place dignity and respect at the heart of everything that they do.
The hon. Member for Sutton and Cheam (Mr. Burstow) mentioned the experiences of the Sutton Association for the Blind and his constituent Mr. Bedford. I say to Mr. Bedford’s family that obviously I regret some of the experiences that they appear to have had. It is not for me to make judgments; there is a formal and proper complaints process that families and patients have the right to use. However, I obviously regret that Mr. Bedford and his family feel that they were let down.
The Sutton Association for the Blind raises issues that are right at the heart of our national dignity and respect campaign. First, at a basic level, if somebody does not eat properly when they have a health problem, that will undermine their capacity to recover and will affect their general well-being. Too often, we hear from patients and relatives stories of food being left in places clearly inaccessible to the person who wants to eat. The direct impact will be that the person will not have the balanced, nutritious diet that they require and that will have a direct impact on their health care. A major part of our dignity and respect campaign is the question of nutrition. Often an assumption is made that somebody’s deterioration is due to their condition, when it may well be because they are not getting the balanced and appropriate diet that they require.
There are other factors. My hon. Friend the Member for Don Valley (Caroline Flint), the Minister with responsibility for public health, may not thank me for saying this on the record, but if an older person of 85 or 90 is used to eating steak and kidney pudding, trying to persuade them to eat salads regularly is a little pointless. There is also the question of appropriate food, listening to people’s definitions of a balanced diet and offering them a choice so that the food is as attractive as possible.
There are also cultural and faith-based sensitivities about food. That applies particularly to older people. For most of their lives, they have been in control, have made choices, and have been proud of their independence and clear about what they want. Suddenly, because of a health issue, they find themselves dependent on others in a way that they would not have chosen. Even in such circumstances, it is crucial that we respect their right to retain maximum control.
Will the Minister confirm that one of our concerns should be about how staff are sometimes too informal in how they address people, particularly seniors? Sometimes staff drop patients’ titles and use first names very familiarly. Should there not be further encouragement to staff to respect the patients’ wishes and use the name that the patient wants?
I can think of occasions on which we Members of Parliament would like to be called names different from those that are used.
Of course what the hon. Gentleman mentions is an issue. Some time ago, the Daily Mail attacked me for making that point and asked whether that was the only problem that existed in the system and whether it really mattered. However, it is a person’s fundamental right to be addressed in the way that they feel comfortable with. We should not take that for granted. Sometimes first names are used when older people would prefer more formality; on the other hand, some older people will feel more comfortable and relaxed if addressed by their first name. The issue is about establishing what the person feels is appropriate and respectful and what makes them feel as comfortable as possible. It is not about launching some ideological politically correct campaign, but about the rights of individuals to be treated with respect.
Does the Minister agree that in most cases, constituents’ letters in MPs’ postbags are not about waiting times or people being on trolleys at the weekend or overnight, but about care? They are rarely about brain surgery, but often about the human care that people get. Do we need to consider how we train nurses, and the qualifications that they require?
My hon. Friend makes an important point. All the evidence is that personalisation, individual attention and treating each person differently according to their needs, experiences and preferences are the future challenges that face the health service and all public services in this country. That is why the reform of public services is important and giving maximum control as well as choice to those who use services really matters. Of course there are implications for the nature of the training experience—initial and entry training and also continuing professional development—in respect of the things that we focus on.
I also have a strong view on the role of senior managers in the health service. To inform their management decisions about what matters in their organisation, they should be on the front line, regularly engaging with staff and patients. I do not believe that that happens anything like enough. Chief executives and senior managers should spend time and be visible on the wards to experience for themselves the everyday realities for staff and patients.
It is not for me to second-guess decisions, trust by trust and hospital by hospital; such judgments and decisions are for others. However, it is true that when we consider the responsibilities and priorities of a modern health care system, the personal, emotional and practical needs of the patient and family are incredibly important. They should not be given Cinderella status in comparison to other aspects of the health care provided—particularly, although not exclusively, when we are talking about older people. Recently, we have heard pretty horrendous stories about how people with learning disabilities have been treated by the mainstream health care system. Frankly, that is unacceptable in a modern society.
To conclude, I again congratulate the hon. Member for Carshalton and Wallington on raising some really important issues on behalf of individual constituents. The vast majority of people speak positively about the NHS and the vast majority of staff do an excellent job. However, we have to reflect and listen when people tell us, from their everyday experience, that the service is not as good as it needs to be.