Health Minister Ivan Lewis made a futile attempt to seize the moral high ground this week by highlighting the plight of elderly patients starving in NHS hospitals.
He said "A single scoop of mashed potato, lonely in the middle of the plate. It's not an appetising meal. Yet for some elderly patients in hospital, this masquerades as lunch every day. Plastic cutlery has its place at a summer picnic, but not for everyday use. Yet some older people are still being served their dinners with plastic cutlery, even though they have suffered a paralysing stroke which making it impossible for them to eat properly. Some have a tray placed on the end of the bed, tantalising with hot food. It may be just an inch out of reach but it might as well be a mile. To a bedridden pensioner, it must seem like torture."
Speaking to a local newspaper in Birmingham he added "We wouldn't put up with this happening to our children, so why should we find it acceptable for our older people?"
He plans to enforce a rule that all patients must be regularly weighed to ensure that they are not dying of starvation.
There's no doubt that, in terms of fact, he is right. The NHS pays for more than 300 million meals a year, spending an average of £2.65 on each, but hospitals throw away more than 37,000 untouched meals every day. The cost of the failures to the NHS is estimated at more than £7.3billion a year. Poorly-fed patients stay in hospital longer, have a higher death rate and are three times more likely to develop complications during surgery.
Predictably the situation in care homes is even more dire. Figures from official inspectors published in December 2005 showed that more than 2,000 care homes for the elderly failed to meet minimum nutrition requirements. Yet it is precisely these people - who are most at risk of becoming ill - who need the highest standards of nutrition.
But Ivan Lewis's sudden attack of conscience and compassion hasn't impressed everyone. Help the Aged said "This is an issue we have been lobbying over for a long time and something the Government has known about for years," and the charity Independent Age said "The Government has now finally realised, after years of campaigning, that it has a problem."
And it's absolutely typical of this government - indeed, of all governments - that their solution to the problem is just another layer of targets and forms and procedures, all of which will require even more hospital administrators to organise. Why, for God's sake, don't they just make sure someone feeds the old dears? Plate of food, patient's mouth - how hard is that? It's not exactly rocket science, is it? And it doesn't need an administrator to administer it - just someone with a spoon.
Mind you, it might take one or two prosecutions to get the idea into people's heads. After all, if starving someone to death isn't a "cruel and unusual punishment", what is?
First nurse: "Has she had any dinner yet?"
Second nurse: "Sorry, I'm too busy looking at this piece of paper"
And this problem isn't confined to England. The same thing is reported in Scotland and in the USA, while in Queensland they reckon as many as 1 in 4 elderly patients could be starving. A report by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment paints a "bleak picture for the elderly in European nursing residential homes, where one in five to three is malnourished".
But according to the Guardian the situation may not be confined to hospitals and care homes. Old people may be starving in their own houses. Earlier this month Professor Jean-Pierre Baeyens wrote "More than 2 million people in the UK are malnourished today. Not in the last century, not during the war, but now, when we pride ourselves on having such a high standard of living and one of the best health and social care systems in the world.
Malnutrition is endemic in Europe's elderly population, in hospitals and care homes, and will rise across the EU in line with an ageing population, unless urgent action is taken by governments and healthcare professionals.
It is hard to believe that a startling 40% of patients now admitted to hospital - of all ages - are malnourished. And, this figure increases by the time they leave, partly due to the poor standard of hospital food and partly because hospital staff often don't regard food or nutrition as an important part of the healing process.
Another shocking figure: one in six people over 65 is malnourished. Older people tend to eat less, and the ageing process means they absorb calories less efficiently. Older people are at greater risk because, with the disappearance of the corner shop, they may find it more difficult to get to the supermarket and carry heavy bags back home. Many are isolated and don't have anyone to help or transport them. If they are old and lonely they may lose the motivation or ability to prepare food for themselves and even eating may cause problems - badly fitted dentures, sore mouths and changes in taste and appetite as they get older all contribute to the problem.
Older people are often vulnerable to depression and lose interest in caring for themselves. The characteristic frailty and lack of energy, which come with malnutrition, are too often dismissed as symptoms of old age. Some old people are, literally, slowly starving to death."
Pretty bad, eh?
But wait - there's more. The Telegraph reports that "Elderly patients are dying because of an unspoken policy of "involuntary euthanasia" designed to relieve pressure on the National Health Service, a senior consultant claims. Police are investigating 60 cases involving pensioners who died after allegedly being deprived of food and water by hospital staff. The inquiries follow complaints from families, NHS staff and pressure groups that elderly patients are being denied appropriate treatment and care.
Families appear to be rejecting the NHS complaints procedure in favour of making criminal allegations to the police. SOS NHS Patients in Danger, a pressure group formed by concerned relatives, is considering taking to the European Court of Human Rights 50 examples of elderly patients who have died.
Dr Adrian Treloar, consultant and senior lecturer in geriatrics at Greenwich Hospital and Guy's, King's and St Thomas's medical schools, London, alleges that "involuntary euthanasia" is going on in NHS hospitals.
He said: "There are severe pressures on beds and in order to relieve this there may be a tendency to limit care inappropriately where you feel doubtful about the outcome. Are the elderly being served properly? No, they are not getting what they deserve and I think they are being sold short. I think that is becoming clearer and clearer. If old people start to resist early discharge they are seen as an encumbrance."
Dr Treloar said he had heard many allegations from families of relatives being denied treatment and being left to die in NHS wards. He said: "When you are asked to talk through this with a distressed relative you find that some of the time there has been a lack of communication. But some of the time it feels very much as though they do have a case. Involuntary euthanasia is not too strong a word for it."
Recent British Medical Association guidelines say doctors should be allowed to authorise withdrawal of nutrition and hydration by tube for stroke victims and the confused elderly, even when the patient is not terminally ill.
"The only safeguard is that you get a colleague to say it's a good idea, which is about as flimsy as you can get," said Dr Treloar. "If the medical profession is going to move, as they have done, to a position where they accept the deliberate withdrawal of food and fluid from patients, then it's very difficult for patients to trust the doctors."
Sir John Grimley Evans, professor of clinical geratology at Oxford University, has written to the NHS pleading for more open data on age discrimination by health authorities. "There is secrecy," he said. "Our difficulty is getting our hands on the relevant information."
Evidence of pervading ageism is manifested in attitudes of staff, cases of neglect and allegations that elderly people are dying unnecessarily by being left untreated and uncared for in geriatric wards across the country. There is also statistical evidence that in the treatment of cancer, heart disease, strokes and mental health, elderly people are not receiving equal treatment. Help the Aged has, since last January, been highlighting the severe failings in the treatment of the elderly. The charity has received thousands of letters in response.
In many of the cases the hospital trusts involved have openly admitted failures in care. Some blame lack of funding, some talk of the need to "prioritise" and some admit that hospitals simply "cannot do everything for everybody as we would ideally like to be able to do".
The GOS says: Well, there you have it. It's not being grumpy that kills you, it's nurses who are too highly-specialised to actually have anything to do with their patients. My sister-in-law works in a hospital and she says it's almost impossible these days to get nurses to move away from the nurses' station because they're too busy being important.
And as for "Trust me, I'm a doctor …"
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