Thursday 13 October 2011

Why is NHS care so inhumane if you're old?

I had to share James Naughtie’s astonishment at the responses of the Sandwell NHS Trust chair this morning.  As if somehow more training and new systems were really an adequate response to the appalling news about care of older people in the NHS.

It really is extraordinary that the care is now so bad in a fifth of all UK hospitals that they are breaking the law – not feeding patients, not helping them go to the loo, and a range of other abuses.

We need some kind of working explanation for the complete disappearance of the public service ethos. Geriatric care has never been good, and there have been very dark corners even recently, but this ubiquitous disdain bordering on cruelty needs some explanation.

Baroness Neuberger’s excellent book Not Dead Yet provides a fascinating insight into why some institutions feel human and some don’t, and – at least in the NHS – it doesn’t have anything to do with money.

In her book about older people, she described with horror how her uncle was neglected in three of the four hospitals in which he lived his final weeks. She explained that the one exception was also the hospital which was most cash-strapped:

“When my uncle eventually died, in the hospital which really understood and respected his needs and treated him like a human being, there were volunteers everywhere. In contrast, there was barely a volunteer to be seen in the hospital which treated him like an object, although it was very well staffed. At a time when public services are becoming more technocratic, where the crucial relationships at the heart of their objective are increasingly discounted, volunteers can and do make all the difference.”

What she suggests is that volunteers are the antidote to this disdain. In wards where older patients might otherwise be mistreated or ignored, she says, “the mere presence of older volunteers are the eyes and ears that we need.” Human beings provide that kind of alchemy, however target-driven the institution is around them.

It isn’t quite clear why this is. Is it because the presence of outsiders is a reminder to staff of what is important and how to behave? Is it because it stops them getting too inward-looking, or prevents that brutal contempt for customers that – as we have seen – can emerge in organisations, public and private?

I don’t know. But there is a new frontier opening up in this debate about how human beings make things work, which suggests that it is not just about having other people there. The volunteers have an effect because they are working alongside staff. It is because the boundaries are blurring between the world inside the organisation and the world outside.

I don’t know whether it would work the same way if the volunteers were just there observing, but I suspect that would just cause resentment. No, this is because they are equals. It isn’t just because outsiders are watching staff at work, it is because they are sharing the work that it is so humanising. It works because this is co-production.
That is one way out, but don’t let’s pretend that it is really such a mystery why such modern institutions, targeted and standardised to within an inch of their lives, have become so inhumane.

It is because the past ten years of centralised targets, standards and auditing has sucked the human element out of these and other institutions. They have been treated like assembly lines and now that is what they have become.

If we are going to rescue our public services, we are going to have to inject the human element back in again.  Find out how in my new book!

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