NHS slated for failing to preserve patients' dignity

Published on Saturday 21 November 2009 20:00

SCOTLAND's official NHS watchdog has castigated health boards for failing to treat a growing number of patients with the dignity they deserve.

Jim Martin, the Scottish Public Services Ombudsman, said he was speaking out because he was seeing "too many" cases in which patients, many of them elderly and vulnerable, were not receiving adequate care.

He made his comments after upholding complaints made by a Tayside family about the shocking lack of care given to 86-year-old William Burnett in Dundee's Ninewells Hospital.

Terminally-ill Burnett, who was suffering from pancreatic cancer, was left lying with his genitals exposed and covered in his own excrement in his hospital room. He was then transferred to a hospice without the paperwork required to ensure he had the right painkillers during his final moments. He died 12 hours later.

Martin has issued a series of other judgments this year about the inadequate care of seriously ill or dying patients in Scottish hospitals, where their dignity has not been preserved. And he revealed that, last week, he had met the chief executives of all health boards in Scotland to make clear his concerns about the trend.

Martin, speaking with the permission of Burnett's family, who wanted his case to be publicised, said: "Mr Burnett received an inappropriate level of care – nursing care and professional care – and not just once but over a period of time. Hygiene standards were just not kept. But the biggest thing for me was the lack of dignity that was accorded to him. I see too many cases where people do not get treated with the dignity they need.

"I raised this issue with the chief executives of all the health authorities last week. It is absolutely vital that the health service is patient-centred and that its first principle is dignity."

Martin upheld all three complaints made by Burnett's family. The retired joiner was admitted to Ninewells in June last year with a cancer that had spread from his pancreas to his liver and his lungs. His prognosis was never good and doctors quickly realised he would not survive.

His wife Isobel, 83, and daughter Wilma, 53, were deeply disturbed by the way Burnett was treated after he was diagnosed as terminally ill and moved to a side room off Ward 3 at Ninewells. He was often, they said, left lying among urine bottles and his own excrement.

His daughter said: "One day, we came in to find that he had faeces on his hands. We pointed this out to a doctor who said to Dad, 'Oh dear, I think we need a manicure.' A nurse came and started cleaning him. We went out. When we came back, he still had faeces under his fingernails.

"He was left dirty for hours. At one point, the consultant said my father wasn't eating. My dad said he could not eat, his hands were dirty. It was quite distressing to see that."

Burnett had difficult swallowing, his family say, so his food was often left untouched by his bedside, with no effort made by staff to feed him "We were shocked," his daughter said. "I spent hours trying to drip-feed food, jelly, juice into him. He was like a little bird."

There were also concerns about a lack of suitable clothing. Wilma said: "They didn't give him trousers for his pyjamas or a nightgown. One time, a nurse came in to check his urine bottle, whipped off the sheet and left him exposed. At the end of it, we thought, if this happens to him, what is happening to people who don't have folk who are so attentive?"

Martin's team deemed her father's care to be inappropriate. Their investigation also revealed considerable confusion over his regime of pain relief.

Burnett was transferred out of Ninewells after a week. He was sent to a local hospice but arrived, his family says, without the right documentation for the high-powered painkillers he needed. He died 12 hours later.

The ombudsman cited his medical adviser, who "noted in conclusion that the sense of an overall lack of care and compassion gained by the family, the mishandled transfer to the hospice and the patient's continuing pain and distress and possible side-effects of his analgesia were all indicative of poor care and treatment by staff."

Martin also upheld a family complaint that their original complaint to NHS Tayside had been badly handled. Senior executives at the authority have since apologised to the family.

NHS Tayside's director of nursing, Margaret Simpson, wrote to Burnett's family. She talked of "how ashamed" she felt of the service given to both Burnett and his relatives. "You have my unreserved apology for this and my absolute assurance that we are working hard to improve standards of care in Ward 3," she added.

NHS Tayside is enacting an action plan to ensure such mistakes are not repeated. It said all recommendations made by the ombudsman would be fully implemented.

Margaret Watt, chairwoman of the Scottish Patients Association, said most of the complaints it received were about issues of respect, dignity and human rights.

She said: "We have really ill people in filth, with faeces on their sheets from previous patients, and with toilets you wouldn't let your dog use."

Woman, 88, died in ward with no curtains

The Scottish Public Service Ombudsman has issued numerous reports criticising NHS hospitals for failing to respect the dignity of dying and seriously ill patients.

Earlier this year, in a written finding, Jim Martin heavily criticised the care of Grace Settle, who died shortly after last Christmas in Glasgow's Victoria Infirmary. The active 88-year-old had been hospitalised with a broken hip but developed an infection and then caught a dose of the winter vomiting bug.

She passed away in an open ward with no curtains and amid, her family claimed, people singing carols.

Martin, who anonymises his cases, calls Settle "Mrs A". He wrote: "She and her family deserved greater care and respect. There was very little recognition and support from staff at such a difficult time, which left Mrs A's family feeling isolated, and there was a lack of dignity afforded to Mrs A in her final hours."

Martin also raised serious concerns about the care of a 79-year-old Ayrshire man whose family said his bed sores were so infected staff had to use insect repellent to keep flies away from his bed.

Martin's medical adviser said the pressure sores on the body of Lachie Turner, who was treated at Glasgow's Southern General, were the worst he had seen. One was the size of a saucer.