Today's post is from Alliance Director ,my Friend and Mentor Irene Oldfather @ireneoldfather
Irene and I have been friends since 2011 and have worked together since. 2012
Has the Time Come for Scotland to have a Commissioner for Older People?
It is with some dismay that I read Healthcare Improvement Scotland’s Audit of Care of Older People in Acute hospitals over a period of some 8 months. (HIS Care for Older People in Acute Hospitals Healthcare Improvement Scotland Audit Aug 2012-April 2013. Published July 2013).
While there was some recorded good practice which identified 25 specific areas of strength across 8 inspections carried out, there wereregrettably 87 areas identified for “improvement”, including issues such as “staff not always using appropriate and respectful language when referring to older people in hospital.”
In three hospitals, inspection staff found alack of meaningful stimulation and activity for patients and across all hospitals inspected, staff were not completing food and fluid balance charts accurately or consistently.
This inspection audit comes some five years after the Scottish Parliament Cross Party Group on Alzheimer’s, which I chaired, produced a report with recommendations on how we can improve the hospital experience of older people with Dementia.
The report recognised that with simple measures, we can save lives – minimising hospital moves, ensuring good hydration and nutrition, understanding the importance of exercise and stimulation.
We know that increased mortality rates, higher re admission rates and functional decline are all associated with this vulnerable patient group who are particularly subject to adverse incidents in hospital. The Report was launched in 2009 and was accepted in full by the Scottish Government. It should be operational in every Health Board in Scotland. So why do we still read of so many system failures?
Older and Wiser, Pressure for Change, Starved of Care, Remember I’m Still Me – previous Inspection Reports from the Care and Mental Welfare Commissions - all make for distressing reading. Regrettably despite a highly developed Policy Structure which includes, - the National Dementia Strategy, the Charter of Rights and the Dementia Standards, we still see Inspection Reports containing damning information about our older people in hospital and in care.
The Dementia Carer Voices project located within the Health and Social Care Alliance regularly receives reports of less than satisfactory care that falls far short of what would be expected in terms of the policy landscape. Clearly we are not talking about “one off” situations and the gap between policy and implementation is wide. So how do we narrow it?
Raising awareness, destigmatising dementia and valuing our old people is only a first step. It is time to face up to the system failures and to put in place adequate measures to deal with them.
People with Alzheimer’s and Dementia are at particular risk because of their communication difficulties. This makes it difficult for them to articulate how they are being treated. We rightly accept the importance of protecting children in our society – indeed we have an independent Commissioner for Children and Young People to protect their rights and give them a voice. We have yet to place the same value on people with Dementia and frail older people.
Wales has for some years had an Older Person’s Commissioner, Sara Rochira. She was a keynote speaker at the Alliance annual conference this year and challenged us to ask the questions – what constitutes abuse - lack of nutrition, hydration, inappropriate restraint - and why are there so few prosecutions for elder abuse?
If we are not completing nutrition and hydration charts, how do we know how well someone has eaten across changes in staff shifts?
If we used inappropriate and disrespectful language towards ethnic minorities, we would rightly be branded racist. We have created a culture where such behaviour would not be tolerated and yet for older people this is identified as “an inspection area for improvement”.
A clear message about the parameters of prosecution for inappropriate and inadequate care and treatment of older people in Scotland is overdue. Maybe its time to look to the Welsh Commissioner’s Office for a solution.
Former MSP and Convenor of Scottish Parliament Cross Party Group on Alzheimer’s. Now Programme Director with the Health and Social Care Alliance.