[A-List] Scotland: private affluence, public squalor

["Michael Keaney" <michael.keaney@xxxxxx>]

Elderly hospital patients 'going hungry'
LUCY ADAMS and MARTIN WILLIAMS
The Herald, September 14 2004

ELDERLY people are malnourished in hospitals across Scotland, according to
charities and human rights groups.

Lawyers have now warned that health boards could be taken to court for
failing to help frail patients eat.

All the Scottish boards are expected to receive a letter from the Scottish
Human Rights Centre warning that not ensuring that patients are fed properly
is a breach of the human rights of the elderly.

The centre is also calling for an urgent investigation into the problem by
the parliamentary health committee.

Relatives and charities have contacted the centre to say that some older
patients have become dangerously malnourished because of the type of food
they are offered and a lack of staff to help those too weak to feed
themselves.

Age Concern Scotland has been contacted with similar fears. Relatives and
friends said they have to travel to hospital themselves to ensure patients
receive enough food and liquids.

The revelation comes three years after ministers said they would solve the
problem of malnourished elderly patients and is a further blow for the
health service, already in crisis over cutbacks and hospital closures.

In 2001, a report commissioned by Scottish Executive found that
approximately one in five elderly patients in hospitals and care homes were
undernourished. Ministers said they would deal with the problem and
implement the 50 recommendations of the report, including ensuring staffing
levels on long-term wards are adequate at mealtimes.

However, experts and relatives say not enough resources have been put in to
make this work.

Jean Turner, the independent MSP, who was a doctor for 25 years, experienced
at first hand how frail elderly people go unfed at the hand of nurses and
yesterday called for improved resources in hospitals.

Ms Turner had to tend to a frail 83-year-old relative recovering from a
broken shoulder, hip and arm in Gartnavel General Hospital recently after
she was left to feed herself.

She said: "They just put a pudding in a plastic container in front of her
and she was too weak to feed herself. There was so much food on her and
around her but not in her.

"It is not the nurses to blame if there are not enough nurses. Nurses are
working very hard and on the ward she was in they were working hard and
doing their best.
"But they don't necessarily have time to do what they used to do - and that
is sit down and feed someone who is a little bit frail."

The SHRC is now writing to health boards to warn they may be breaching
Article 2.

Rosemarie McIlwhan, director of the centre, believes the boards must take
responsibility for feeding patients. She said the failure to fed elderly
patients breaches this article of the European Convention on Human Rights -
the right to life. "It is essential that a member of NHS staff within each
hospital or ward takes responsibility to ensure all patients' welfare,
including all aspects of their nutrition and meals."

Malnutrition has been identified as a major public health problem, with
between 15% and 40% of hospital admissions affected, and more than two
million adults affected in Britain.

Experts say that being malnourished reduces people's ability to fight
infection, shrug off illness and their mobility.

Age Concern Scotland is also worried about the levels of malnutrition among
elderly patients. A spokesman said: "The importance of good nutrition to a
person's mental health and wellbeing as well as to their physical health
cannot be underestimated. This is especially critical in hospital."

Roseanna Cunningham, the SNP MSP expected to become convener of the health
committee next week, said: "I find these allegations absolutely horrifying.
"The way we treat vulnerable people is a mark of a civilised society. If
these reports prove to be true, then it is nothing short of a disgrace."

An spokeswoman for the executive said: "The Scottish Executive has made it
clear that food, fluid and nutritional care must be viewed as an essential
clinical service and given priority.

"NHS boards should aim to incorporate nutritional care into clinical and
other planning responsibilities and ensure that providing good standards of
nutritional care receives appropriate priority at every level."

David Davidson, the Tory health spokesman, said there should be an inquiry
into this and that evidence go before Malcolm Chisholm, the health minister.

Professor Debbie Tolson, Scotland's only professor of gerontological
nursing, based at Glasgow Caledonian University, was a key member of a
steering group that produced an NHS best practice document aimed at nurses
two years ago in an attempt to get an improvement in nutrition for frail
elderly patients.

Professor Tolson said yester-day: "We recognise that there are budget
constraints. But we really need to look at this aspect of care for older
people and take forward a positive model that values the complexity of care
needs. It is a fundamental aspect of nursing care."

-----

Ill-feeling over builders of NHS future
CALUM MACDONALD and DEBORAH SUMMERS
The Herald, September 14 2004

CONCERNS have been raised about the composition and remit of the special
advisory group set up by Malcolm Chisholm, the health minister, to plan the
future structuring of the NHS in Scotland. This comes amid claims the
group's brief is vague and it is stacked with medical professionals in
favour of centralising services.

The Advisory Group on Service Change in NHS Scotland was established last
April to examine how the NHS can plan and deliver better healthcare in
Scotland over the long-term future.

The group, chaired by David Kerr, a Glaswegian and Oxford University
professor, is largely made up of medical experts and NHS managers. They are
expected to make a final report to the health minister next year.

However, both the make-up of the body and its agenda have been roundly
criticised by those opposing the health service cuts proposed by NHS boards
across Scotland.

Dr George Venters, a former public health consultant until last year and now
the leader of the National Health Campaigns Network, accused the group of
having no credibility and questioned exactly what it is supposed to achieve.

The Scottish Executive claims the body will "develop a national framework
for service change", but Dr Venters dismissed the brief as "flimflam".

He said: "I was involved in health planning for 30 years and I can't
understand what that is supposed to mean. They have a responsibility to
explain exactly what they are doing in words that the man or woman on the
street can understand. At present it's just flimflam."

Dr Venters demanded that the group be scrapped and called for it to publish
minutes of its discussions and its working papers in order that the public
can follow the course of its deliberations.

Dr Jean Turner, who was elected to the Scottish Parliament last year as an
independent anti-hospital closure candidate, called on the group to examine
the proposals being put forward by health boards that have prompted
unprecedented public protests across Scotland.

At the moment the advisory body does not have the power to decide on current
or imminent major service reviews by health boards.

The doctor said: "I think the group has to consider the current proposals
because you have to look at what is happening now if you want to plan for
the future.
"The group must be concerned by why all these people in Scotland are
campaigning at the moment."

A spokesman for the executive insisted the group's remit would not be
widened and rejected the accusations of any centralising or academic bias.

He confirmed that the members were appointed by the health minister on the
advice of civil servants.

The spokesman said: "The advisory group's remit is to look at the long term,
and the minister has already said he would not be rushing wider change ahead
of next spring when the group reports. He also said he would not approve
anything which is inconsistent with the direction of the national work.

"The group will be involving the public and looking at things that are
ongoing at present," he added.

Mr Chisholm is expected to come under renewed pressure today to find a
national solution to Scotland's health service crisis when he meets Labour
MPs in London.

As the battle to stop further hospital closures gathers pace, Westminster
MPs will urge Mr Chisholm to resist health board plans to centralise
hospital service and remove frontline services from communities.

David Cairns, Labour MP for Greenock and Inverclyde, is expected to tell the
health minister it would be "daft" to take a decision on the Argyll and
Clyde board's plans to downgrade Inverclyde Royal Hospital now, when a
national solution will be ready in March. Mr Cairns will urge the health
minister to postpone any decision on the future of the hospital.

"It would be madness to take an irreversible decision about Argyll and Clyde
health board's plans to downgrade Inverclyde Royal Hospital when a national
policy framework report, commissioned by Mr Chisholm, is due to be published
in March," he said. "At the very least we are looking for him to say he
would not give the green light to Argyll and Clyde. We need to solve the
national problem on a national basis."

Advisory group members
Professor David Kerr, Rhodes professor of cancer therapeutics and clinical
pharmacology at Oxford University; Professor Graham Teasdale, president of
the Royal College of Physicians and Surgeons of Glasgow; Dr Charles
Swainson, medical director, NHS Lothian; James Kennedy, chair of the
Scottish Partnership Forum; Peter Bates, chair, NHS Tayside; Roger Gibbins,
chief executive, NHS Highland; Professor Nora Kearney, professor of cancer
care, Stirling University; Dr Lesley Holdsworth, clinical co-ordinator, NHS
Forth Valley.

Professor Jillian Morrison, professor of general practice, Glasgow
University; Professor Gillian Needham, postgraduate medical dean, north-east
Scotland; Irene Sweeney, chair, Scottish Pensioners' Forum; Jae Ferguson,
chair, Mid-Argyll Maternity Service Users Forum; Alexis Jay, director of
social work, West Dunbartonshire Council; Lesley Summerhill, director of
nursing, NHS Tayside.