What additional needs assessment is required?
In addition to feedback from people, there is a range of evidence from inspections and audits relating to care and support of older people.
In 2011, the Care Quality Commission (CQC) carried out 100 spot inspections of hospitals in England and reported: ‘time and time again, we found cases where patients were treated by staff in a way that stripped them of their dignity and respect’ and that people were ‘not given assistance to do the basics of life – to eat, drink, or go to the toilet’. The language and issues described are almost identical to those identified in a Health Advisory Service report called Not Because They Are Old, published in 1998. In its write-up of the report, the BBC explained that some NHS staff were overtly ageist and lacked respect for older people and that ‘many [older people] were not given enough to eat or drink’.
The fundamental question of why older people cannot expect to be treated with dignity remains unaddressed.
The CQC inspections found that one in five of the hospitals visited were not meeting the very minimum standards of care for older people with respect to dignity and nutrition.29 In February 2011, the Health Service Ombudsman published a report, Care and Compassion?, concluding that
the cases it described ‘present a picture of NHS provision that is failing to respond to the needs of older people with care and compassion and to provide even the most basic standards of care’.
The National Audit of Dementia, published at the end of 2011, hints at one of the reasons for such failures. It found that only 5 per cent of hospitals had mandatory training in awareness of dementia for all staff. This is despite estimates that people with dementia over 65 years are using up to one-quarter of hospital beds at any one time.
The CQC report “The state of health care and adult social care in England 2014/15” highlighted “Our challenge to all health and social care services, and the sector overall, is therefore to continue to put quality of care at the centre of change, and not fall into the trap of seeing innovation as only driven by the need to save money. Alongside this, we encourage all partners in adult social care to come together and set out a common vision and plan for how to address the current fragility and uncertainty in the adult social care market, and ensure they can continue to provide good care. People deserve high-quality care. It is therefore our duty to the people who use services to be open and transparent about the quality of care that we see, and not lower our expectations of quality in the challenging times ahead”.