19 February 2011

week 8.11 22.2.11

Tendring Topics…….on line

You are old Father William, the young man said,
And your hair has become very white…….
Yet nobody cares when you’re ill and in bed
I really don’t think that is right!’

The first two of the lines of verse above are Lewis Carroll’s and can be found in Alice in Wonderland. The other two were inspired by the Health Service Ombudsman’s recent report on the treatment of some old people in NHS Hospitals. It was a report that made those who, like me, have left both youth and middle age behind them, and who are becoming aware of increasing physical (and possibly mental) disability, feel a tremor of apprehension at the possibility of needing hospital treatment at some time in the future.

Some elderly patients had been left unattended, in pain and with open wounds. Some had been unwashed and had no opportunity for a bath or shower. Some, unable to feed themselves or attend to their own toilet needs, had pleaded in vain for help. These were, of course, only ‘a minority’ of elderly patients but the fact that they were a substantial minority should be a cause for shame.

I listened with interest as an ‘authority’ on the subject explained on tv that the problem was one of lack of communication. Nurses and other carers need to listen to their patients and discuss their problems with them. I began to wonder if that ‘authority’ lived in the same world as I do!

It was seven years ago, when she was just eighty, that my late wife Heather, having had a broken hip repaired in Colchester General Hospital, found herself, for rehabilitation, in the Kate Grant Ward of the Clacton Hospital. Heather had had a wider-then-most experience of hospitals. Illness led to her spending time in several London hospitals in her childhood. At the age of 24 (when we had been married for just two years) she spent two years in a Sanatorium with pulmonary and laryngeal TB, including two months in Papworth Hospital undergoing major surgery. In middle age she spent two brief periods in the Essex County Hospital for minor gynaecological surgery.

Visiting Heather at what was then the British Legion Sanatorium at Nayland. It had been taken over by the newly created NHS. Heather had to put on a stone in weight before having major surgery at Papworth Hospital near Cambridge which, at that time, specialised in the treatment of pulmonary tuberculosis

She was not a complainer. She had never liked being in hospital, but she was always cheerful and optimistic and prepared to make the best of it. She made friends with the nurses and other patients, and helped where she could. In the Sanatorium she made friends with whom she corresponded for the rest of her life.

It was only in Clacton’s Kate Grant Ward that she was desperately unhappy and keen to get out and come home at any price. It was not that the nurses or other members of the staff were unkind, uncaring or incompetent. There were simply not enough of them. One or two nurses or nursing assistants may well be adequate for a ward in which a good proportion of the patients are able to get into and out of bed, put on their dressing gowns and attend to their toilet needs and their meals. One or two nurses are not enough to cope with a ward of ageing or elderly women, the overwhelming majority of whom are unable to walk unaided.

Added to this is the (new?) rule that no nurse or nursing assistant may ever attempt to lift a patient on her own. This is an operation for which two helpers are always required. Then again, nurses disappear from time to time ‘for their breaks’ and at weekends regular nurses disappear and are temporarily replaced with ‘supply’ staff who know nothing of the patients. Is it surprising that getting the patients out of bed and dressed and back into bed again at night are operations that can take hours? Is it surprising that bells are unanswered; cries of distress unheard, and patients become incontinent for the first time in their lives? I wouldn’t for one moment suggest that any nurse should do lifting beyond his or her capacity, or be denied a break or a weekend off, but there should be enough nurses and/or other staff to cope with the special circumstances that exist in a ward of this kind. When that is done the nurses may well have the time and energy to ‘communicate’ better with their charges and discuss their problems. Perhaps, in the past seven years, things have changed in the Kate Grant Ward. I hope so – but I hope that I never personally find out!

For a week I arrived at the hospital before 8.00 am so that I could get Heather out of bed, washed and dressed. I spent most of the day there and I was always there in the evening to get her undressed and into bed again. I did this to impress on the Nursing Sister in charge of the ward that I was well able to be my wife’s carer. There was no need therefore to delay her discharge until a ‘care package’ could be organised. I soon realized though that by doing this I was also providing a real support for the hard-pressed nurses; a foretaste of David Cameron’s Big Society perhaps?

My most vivid, and most painful, memories of the time that Heather spent in Clacton Hospital were her distress when I parted from her every evening, and her joy ‘I thought you were never coming’ when I turned up in the morning. Until then I hadn’t fully appreciated the sense of loneliness and desolation that can overwhelm patients when they are alone with their thoughts in what they feel to be an uncaring atmosphere.

The late John Betjeman caught a glimpse of it in his poem Five O’clock Shadow, the time of the day when the visitors have departed. Here are the first and third verses:

This is the time of the day when we in the men’s ward
Say ‘one more surge of the pain and I give up the fight’.
When those who struggle for breath can struggle less strongly.
This is the time of the day that is worse than the night.

Below the windows, lots of loving relations
Rev up in the car park, changing gear at the bend.
Going home to a nice big tea and an evening of telly.
‘Ah well, we’ve done what we can. It can’t be long till the end’

‘Concentrate on something else – and it won’t hurt so much’

That’s the kind of advice that dentists used to give their patients before getting to work with their drills. Perhaps they still do.

Something similar seems to have motivated both politicians and newspaper editors in recent weeks. In Britain, government cuts threaten public services on which we have relied for many years. The number of unemployed is steadily increasing. Folk who had imagined they were ‘home owners’, when they were really only ‘home buyers’, are threatened with homelessness when they find themselves unable to continue their mortgage payments. Young people leaving universities with degrees are unable to find employment but are burdened with a lifetime of debt that, the government tells them ‘reassuringly’, they may never clear! Inflation has risen steadily. It is now at 4 percent (double the government’s ‘target’) and experts forecast a rise to 5 percent. Meanwhile incomes remain static or actually fall. In the Middle East, the ‘west’s’ policy of selling arms to, and supporting corrupt and tyrannical regimes. is rapidly falling apart. Worldwide, natural disasters make clear the reality of Climate Change, but national governments decline to take effective action to counter it.

It might have been thought that these circumstances provided both politicians and the popular press with plenty of material to arouse their fear and anger. But those haven’t been the issues that have aroused most ire. They have preferred to concentrate on the trivial and the irrelevant. Take, for instance, the case of the army’s redundant warrant officers. Twenty, one actually serving in Afghanistan, were sent their redundancy notices by email. All the indignation has been vented on the email. It should surely have been concentrated on the redundancy, no matter how those concerned were informed of it. Does it make sense to discharge 20 experienced professional soldiers, still in their forties, while a war of attrition is being waged in Afghanistan – and while millions of pounds are being spent on nuclear submarines armed with Trident missiles purposelessly prowling the oceans?

Then there are the two rulings of the European Court of Human Rights – that most prisoners in Britain’s gaols should have the right to vote, and that after fifteen years, sex offenders should have the right to appeal against their names being retained on the register of offenders. From the outrage in press and parliament you’d have thought that an invading army had landed on our shores! We would be better engaged in persuading a majority of those of us who are not in prison, to vote, rather than making sure that prisoners can’t. It would surprise me if many prisoners want to vote anyway. I reckon though that most of them would welcome with enthusiasm the possibility of cash compensation for having been refused that right!

As for sex offenders; they have been punished for their crime. Surely it isn’t unreasonable to consider the possibility that those who have lived an unblemished life for fifteen years since their discharge from prison may have permanently changed their ways. The right to appeal doesn’t mean an automatic right to have their names removed. In many cases it well be decided that they should remain on the register.

Ah well – these issues gave us all something about which to think and vent our indignation. For a few days they successfully diverted us from the real threats to our world and our civilisation.

A part-time job?

A short while ago Colchester Borough Council approached Tendring District Council with the idea of ‘sharing’ an expensive Chief Executive – in effect ‘Two for the price of one!’ They were rebuffed, but have now reached agreement to share a Chief Executive with Braintree Council. Colchester’s Chief Executive is currently paid £117,107 and Braintree’s £119,000. It is claimed that the agreement will save Colchester £150,000 a year, and we must surely assume that Braintree is hoping to achieve a similar saving. Mathematics was never my strongest subject at school but I can’t quite follow the arithmetic there.

I believe that Tendring Council’s outgoing Chief Executive enjoyed a salary comparable with those of both Colchester and Braintree. He also had two Assistant Chief Executives each on a salary higher than that of any other Council employee.
Colchester and Braintree are by no means unique nowadays in sharing a Chief Executive. Tendring Councillors must surely be wondering if they have been paying three very substantial salaries for what now appears to be regarded as a part-time job!

























































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