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Large numbers of older patients experience lack of dignity in hospital

More than a third do not receive enough help at mealtimes and over a fifth experience poor standards of dignity

Ingrid Torjesen

Wednesday, 15 July 2015

Older hospital patients in England face a “widespread and systematic” pattern of inadequate care, according to a detailed statistical analysis of inpatient experience data in NHS hospitals in England.

The analysis* by Drs Polly Vizard and Tania Burchardt of the Centre for Analysis of Social Exclusion at the London School of Economics uses data from the Adult Inpatient Survey for 2012-13 to give a detailed picture of older people’s reported experiences during hospital stays.

The results showed that experiences of poor or inconsistent standards of dignity and help with eating were too high in the “vast majority” of NHS trusts. Over a fifth of older people (23%) reported experiencing poor or inconsistent standards of dignity and respect and more than one in three patients who needed help with eating did not receive enough assistance.

Poor or inconsistent care was more likely to be experienced by women, those aged over 80 and those with a long-standing illness or disability such as deafness of blindness. The likelihood of poor or inconsistent care was particularly high for patients whose hospital stay had been long or if they had stayed on three or more wards.

The authors highlighted that there had been “remarkably little change” in the percentage of individuals reporting inconsistent and poor standards of care over a substantial period time. They called for sustained efforts to ensure improvement in standards of dignity and support with eating for hospital patients – the majority of whom are aged 60 and over, and often frail and suffering from multiple conditions

A new and improved approach for identifying hospitals where poor quality care is a cause for concern, they said, for example, separate monitoring of the care provided to older disabled women. They also recommended better use of patient experience data to identify hospitals where care is a cause for concern, with hospitals judged on their absolute levels of poor or inconsistent care (a “minimum threshold approach”).

Polly Vizard of the LSE’s Centre for Analysis of Social Exclusion said: “It’s the first time we have analysed an NHS patient survey in such detail and the findings are very disturbing. What really stands out is not just the large number of patients who say they aren’t always being cared for in a dignified way or helped to eat - but also that there has been remarkably little change in the percentage of individuals reporting inconsistent and poor standards of care over a substantial period time.

The Francis Inquiry into deaths at the Mid-Staffordshire NHS Foundation Trust recommended “better use” of patient experience data, she added. “Treatment with dignity and respect, and help with eating for those who need it, are key markers of quality of care. Our analysis across NHS hospitals suggests that experiences of poor or inconsistent standards of dignity and help with eating during hospital stays are endemic across the vast majority of trusts.”

Caroline Abrahams, Age UK’s Charity Director said: “It must be recognised that the data this research is based on is two years old now and that the newest figures suggest some welcome improvement, especially as regards older people's experiences of dignity, but this sobering report certainly shows that hospitals need to redouble their efforts.

“Above all it is really worrying, if perhaps not altogether surprising, that the more vulnerable an older person is, the greater their risk of not being treated as we would all wish for ourselves or our loved ones. Turning this situation around ought to be a top priority and no hospital can afford to be complacent."


* Vizard, P, and Burchardt, T. Older people’s experiences of dignity and nutrition during hospital stays: Secondary data analysis using the Adult Inpatient Survey. CASEreport 91. London: Centre for Analysis of Social Exclusion, London School of Economics, 2015.

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