Hospitals and care homes face spot checks over care of elderly

Health Secretary Andrew Lansley announced the drive following a report by the Care Quality Commission (CQC) that raised serious concerns about the treatment of elderly patients.

The latest wave of inspections will cover 50 hospitals, 150 centres housing people with learning disabilities, and 500 elderly care homes.

Mr Lansley’s call came as a CQC report yesterday raised concerns about standards at York Hospital after inspectors found doctors were failing to comply with guidelines on patient consent to care and treatment, particularly the use of Do Not Attempt Resuscitation (DNAR) requirements on patient records.

It also follows a highly critical report by MPs last month which found the CQC carried out 70 per cent fewer inspections in hospitals and care homes in the six months to March as it focused on other areas.

In a speech, Mr Lansley insisted NHS organisations “owe it to their local communities” to improve performance.

“Too often, we deny the experience of patients and their family members who have been at the sharp end of appalling treatment,” he said.

“Where there is great care, we will celebrate it. But wherever there are pockets of poor performance, we will root it out.”

Michelle Mitchell, of Age UK, welcomed the move.

She said: “Dignity and nutrition are essential standards of care and not optional extras and the fact that one in five of the 100 hospitals spot checked in the last round were breaking the law shows shocking complacency on the part of the hospitals.

“It is vital that we have a clearer picture of the standards of care in all hospitals and care homes, not a select few.”

The CQC inspection noted good standards of care across much of the York NHS trust.

But it said documentation relating to whether a patient should be resuscitated was not being completed correctly. It meant some patients could have had an instruction in place which was out of date, incorrect or no longer in their best interests.

There was no evidence that relatives had been consulted where appropriate, there had been no second opinion in some instances and no specific date when the decision should be reviewed.

CQC regional director Jo Dent said: “We found DNAR forms which had been completed by a doctor but that there was no evidence to say that patients had been involved in the decision, or evidence that relatives, even where they were taking an active role in the patient’s progress, had been consulted.

“Doctors we spoke to agreed it was best practice to discuss these decisions with the family or next of kin and the patient themselves where possible. But one doctor also told us that it was a difficult topic to raise with relatives and patients and that these decisions were often made when relatives were not around.

“The trust’s own policies are in place and make it clear how these decisions are to be reached, who to consult and how it should be recorded to make sure the right decision is made. The records seen by us did not follow these guidelines.”

Other problems uncovered at the inspection included one ward where vulnerable patients were not receiving the nutritional support they needed and lack of proper auditing of medication.

York trust chief executive Patrick Crowley said it was disappointing to find some areas of concern but the CQC also highlighted many examples of good practice.

“All professionals within our organisation recognise the importance and sensitivity of discussions with patients and their families regarding DNAR decisions,” he said. “It is important to recognise that a new system was introduced not long before the CQC’s visit and we are in the process of rolling it out across the organisation. This robust new policy reinforces the importance of documenting how and when these discussions happen.”