Where the NHS is getting care wrong for elderly patients

The NHS is being criticised for failing to provide the most basic care to elderly patients.

The Care Quality Commission looked at whether nutrition and dignity standards were being adhered to at 100 hospitals by spending a day on two wards at each site.

Concerns were identified in 55 cases.

Two of the worst performers were the James Paget Hospital in Great Yarmouth and Sandwell General in West Bromwich.

The scale of the problems identified in these hospitals were on a greater scale than many others, but the type of issues were typical of what the inspectors said were bedevilling the wards of the NHS.

James Paget Hospital, Great Yarmouth

Not only was James Paget criticised for its performance, the hospital failed to act sufficiently on the warnings, inspectors said.

They first visited the 544-bed hospital in April and judged it to be failing on both dignity and nutrition.

Even after being warned about poor performance, James Paget failed to act sufficiently, inspectors said

The report revealed numerous examples of what were said to be "moderate" breaches of patient dignity.

These included two female patients who were left partially exposed when theatre staff came to collect them and failed to pull the curtain completely around their bed. On another occasion a person sitting on a commode was visible to inspectors.

On nutrition, where the concerns were also judged to be moderate, some patients complained they had not been offered the opportunity to wash their hands before eating. One patient even told them they had brought in their own hand wipes.

Another person with an allergy was unable to find out from staff whether they could eat the meals so they just ended up leaving any food which may have contained something they could not have.

But one of the most worrying aspects about this case was that even though the problems were flagged up to hospital bosses they had not been rectified by the time inspectors carried out a follow-up visit.

The hospital has now been given a warning notice, meaning if an immediate improvement is not seen James Paget could face prosecution or the closure of services.

Sandwell General Hospital, West Bromwich

Sandwell General effectively got a red card for its approach to nutrition as there were judged to be "major" concerns about the issue at the 470-bed centre.

The inspectors said the systems used to identify which patients needed support to eat and drink was simply not working. But even when patients did not slip through the net, it was not clear to inspectors whether there were enough staff to help them anyway.

Nutrition standards were criticised at Sandwell General

As one staff member said: "Sometimes I am the only [one] to feed on the ward. How can I feed all these people? Sometimes by the time I get to the last bay either the food is cold or it has been taken away."

Concerns were also expressed about the measures in place to monitor dehydration among patients, while the interruptions and noise during meal times were judged to be unnecessary.

There was also no provision of food between 5pm and 8am except for biscuits and toast.

The hospital did little better with dignity. The concerns were said to be moderate with patients telling staff that they were "not really listened to". One patient said: "Some staff just seem to do their own thing regardless of what I say." Another said they seem "gruff and miserable".

The criticisms prompted the hospital to close the ward where most of the problems were identified.