If you’re an older person in hospital right now waiting for social care to help get you home, then you’re in trouble. A recent Guardian survey found that in some parts of the country one in three beds are occupied by people who are trapped there waiting for care to be arranged.
Many older people are stuck in a grim cycle of despair because the longer they remain in hospital, the less chance they have of living independently at home. There’s an oft-quoted saying that 10 days in a hospital bed leads to 10 years’ worth of loss of muscle mass in the over-80s.
However, the problem of the physical and mental condition of older people deteriorating in hospital is not solely caused by a lack of social care provision. It has been made worse by the NHS itself. Until relatively recently, hospital wards had day rooms where people ate their meals and socialised. Patients were expected to be dressed in their normal clothes and at mealtimes they would be expected to walk, or be helped to walk, to the day room as part of their rehabilitation. Patients benefited from mutual emotional support and encouragement and the social setting improved their eating habits. The ward would be full of the sound of people talking together. Sadly no more. Today’s hospital patients are fed in or beside their beds.
Earlier this year my own elderly mother was in hospital. After a spell in acute medical wards, she spent four weeks on a rehabilitation ward in her own room, with nothing to do except stare at the brick wall outside the window. No shared mealtimes, no trips to any day rooms, nothing. Unlike other wards at least this one had an activity coordinator who did her best with her isolated patients. By the end of her stay my mother had lost her mobility and was utterly miserable.
Why doesn’t the NHS care about this? It’s tempting to say that the current nursing crisis is a factor but the reality is that shared mealtimes and socialisation in day rooms disappeared in times when staff shortages were much less of an issue.
One important factor is nursing practices. Wards are easier to manage if patients are contained in bed or at the bedside. This means nurses are not as proactive as they could be in working towards rehabilitation goals set by occupational therapists and physiotherapists. Therapists provide vital support and advice to older people, helping them regain their function and prevent deterioration. This is absolutely essential if older people are to regain their function and mobility and live independently at home again.
Another factor is that keeping people apart in hospital reduces the risk of infection. Every hospital has a high-profile infection prevention team that prioritises this over everything else. Covid has reinforced this mindset but in fact, the benefits of socialising and mobilising for patients far outweigh any infection risks.
One big problem is that the NHS simply does not value its occupational therapists and physiotherapists. NHS boards, which run local hospitals, always have a medical director, representing doctors, and a director of nursing (or chief nurse), representing the nurses. There is never a therapy director. Who will speak up for a culture of round-the-clock rehabilitation and the benefits of communal mealtimes at a board meeting if their voices are absent from the conversation?
Doctors and nurses are of course vital but the relationship between them and patients is one-sided. Doctors fix patients and nurses care for patients. Occupational therapists and physiotherapists, on the other hand, form a therapeutic relationship where people are equal partners in their own recovery. During my career in the NHS I worked with an inspirational senior manager who had been an occupational therapist and who rejected the word “patient” as it implied an unequal relationship. Instead she always referred to “people”.
In 1947 Dr Richard Asher wrote a famous article in the British Medical Journal entitled “The dangers of going to bed” in which he argued that hospitals needed to change their approach and get people out of bed and moving every day, for the good of their physical and mental health. He wrote: “Too often a sister puts all her patients back to bed as a housewife puts all her plates back in the plate-rack – to make a generally tidy appearance.” Sadly when it comes to maintaining the independence and mental health of people in hospital, the NHS today shows every sign of being stuck right back in 1947.
David Lee is a former NHS manager
