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12 March 2015, 07:15
Elderly people are not being provided with fundamental standards of care in many hospitals, a new report from nurses' leaders has warned.
The Royal College of Nursing is now demanding the Scottish Government commit long-term funding and investment so that "older people can be assured that their care will be effective, safe and person-centred''.
The nurses' union analysed 35 reports, each looking at the care senior citizens are given, that have been published by inspectors at Healthcare Improvement Scotland between February 2012 and October last year.
The new report stated: "It is clear from the inspection reports that fundamental standards of care are not being met for older people in many hospitals.''
It said that inspectors had "often found examples of warm, caring and meaningful interactions between staff and patients'' in hospitals across the country.
But its analysis showed that 31 out of 35 inspections found hospitals did not appropriately screen and assess older people for cognitive impairment while 27 hospitals needed to improve nutritional screening of older people.
Meanwhile, 19 out of 35 inspections identified improvements were needed in the assessment of pressure ulcers and 18 out of 35 found hospitals could do better in the way they implemented adults with incapacity legislation.
The report said that inspections "frequently identified issues around patient flow'', including delayed discharge and boarding - where shortages of beds can mean a patient is cared for in a ward that is not best-suited to their needs.
It stated: "If hospitals do not have the staff, beds and resources needed to manage the flow of patients coming through their doors, it is hard for them to provide the best care for their patients.
"Critically, the management of patient flow can put the safety, care and dignity of patients at risk. It can also be a barrier to getting people out of hospital and back to their own home or into a homely setting as soon as possible.''
About two-thirds of hospitals inspected - 23 out of 35 - in 11 different health board areas were identified as needing to improve some aspect of patient flow, boarding or discharge procedures, according to the report.
In addition, five hospitals in five different areas needed to "ensure that the management of patient flow does not compromise patient safety, care and dignity''.
The report said it was "clear that there are examples of good practice in older people's care across Scotland'' but also stated it was "obvious'' from many of the inspection reports and others that ``there are still significant concerns around the care of older people in many of our hospitals''.
RCN Scotland director Theresa Fyffe said: "When older people come into hospital, they are often acutely unwell.
"If our hospitals don't have enough staff or enough beds and resources to manage the flow of patients coming through their doors, it is hard for them to provide the best possible care for their patients.''
She added: "Based on what we found from our analysis, many of our hospitals just don't have the right systems in place.
"They're struggling to manage, with inspectors reporting that two-thirds of the hospitals inspected needed to improve the flow of patients through the hospital, with older people being moved from bed to bed, not being cared for or treated on the right ward for their condition, or not being able to be discharged and so taking up desperately-needed beds.''
Ms Fyffe concluded: "Scotland has a growing population of older people, who are living longer, often with multiple and complex health conditions, and with the number of people aged over 75 predicted to rise substantially over the next 25 years the pressures that this will put across the whole system are only set to increase.
"We know that providing quality care for older people takes time, resources and support.
"Yet HIS's improvement programme that helps NHS boards improve the quality of care for older people in hospital is only guaranteed funding until March next year.
"The Government must commit to long-term funding and invest in sustainable services so our older people can be assured that their care will be effective, safe and person-centred.''
Liberal Democrat health spokesman Jim Hume claimed the report showed that "the complacency of SNP ministers on the future of Scotland's NHS is setting Scotland's hospitals up to fail older patients''.
He added: "Time and time again, clinical experts have warned the Scottish Government that NHS boards do not have the resources or flexibility they need to tackle bed-blocking.
"The SNP has taken its eye off the ball, and as a result nearly three-quarters of bed days occupied by delayed discharges are by patients aged 75 or over. This isn't good for our hospitals and it isn't good for older people.
"The SNP's backwards approach of cutting beds before putting appropriate social-care provision in place will only serve to worsen this situation.''
Angiolina Foster CBE, Chief Executive of Healthcare Improvement Scotland, said: "We recognise the support of RCN to continually drive improvements in the care of older people In Scotland. In November 2014 we produced our own overview report of the care of older people in acute hospitals.
"We are seeing improvements being made across Scotland. The report identified a number of areas of good practice including an increased awareness by staff of the issues facing older people in NHS Scotland hospitals and patients being consistently treated with dignity and respect.
"However, we also identified areas for improvement including the flow of patients in acute hospitals and the practice of boarding (when patients are moved from one ward to another to meet the needs of the service and not because of the patient's clinical needs).''
He added: "We will continue to work with all healthcare providers to ensure that all older people receive the best care possible.''
Health Secretary Shona Robison said: ``We're committed to driving up standards in the care of older people in hospitals, which is exactly why this Government introduced these inspections.
"These inspections are already reviewed regularly by Healthcare Improvement Scotland, whose most recent review already identified the points raised by the RCN and action is underway to address them.
"Through the inspection process HIS also found that 'on average, 99% of patients said the quality of care they received was good.'
"We've also provided an extra #2.5m to HIS to continue their improvement work across the NHS, which will also impact positively on improvements to the care older people receive.
"I have also asked Chairs of NHS boards to proactively look at their individual services, including for older people, and report back to the Chief Nursing Officer who is overseeing this work.
"We know our NHS is facing challenges which is why this Government has protected the budget of the NHS despite massive cuts from Westminster. This is supporting the record staffing levels that we have currently in NHS Scotland.''
Scottish Labour health spokeswoman Jenny Marra said: "This report from Scotland's nurses saying that the care of the elderly is under pressure is extremely worrying.
"The SNP government can't wait until this amber warning turns to red to act. We have known for many years that our population is ageing and this is more challenging to our NHS.
"The SNP health secretary has said that it is her biggest priority to get older people out of hospital, but today she needs to look carefully at how her government is giving staff the resources to care for elderly people while they are in hospital. Poor inspections and poor screening of our older people is not good enough.''