This book concerns neglect and abuse in our health care system, in particular our hospitals.It is about taking patients to the toilet when they need to go, not leaving them in soiled bedding, not them leaving naked and covered in dried faeces, helping them to eat and drink, protecting them from infection, giving adequate pain relief, managing pressure sores so that patients don't suffer and sometimes die of septicaemia, keeping patients well groomed, not discharging people prematurely from hospital - and even just talking to them. It also highlights how the health care system struggles to diagnose, treat and care for older people with complex needs, and how this leads to neglect and abuse. It is about dignity and compassion.The book sets out comprehensively and from many sources, a wealth of evidence not previously brought together, in order to demonstrate that neglectful care is a systemic blight, rather than mere local blemish. It contrasts this evidence of poor practice with the plentiful policy and good practice statements which urge precisely the opposite.It analyses the causes and factors associated with this state of affairs and points to the widespread denial and lack of accountability on the part of those responsible. It considers who is to blame, and the implications of this serious moral, political, professional and legal failure to protect the most vulnerable of patients from the most appalling of care practices. Most important, the books points to the main obstacles to a solution - and to how they can be removed and change be accomplished.
Preface. 1. Introduction. 2. Assessing the Evidence for Neglectful and Abusive Health Care. 3. Health Services: Public and Private. 4. Systemic Nature of Neglect and Abuse Within Health Care. 5. Dignity in Care: All the Good Guidance. 6. Dignity in Care: All the Bad Practice. 7. Getting to the Toilet and Management of Continence. 8. Keeping the Environment Clean and Managing Infection. 9. Helping People Eat and Drink. 10. Pressure Sores and Falls. 11. Hospital Beds, Admissions, Stays and Discharges. 12. Older People: the Unwanted. 13. Patient Voices, Consumers and Markets. 14. Staffing Levels, Competence and Attitude. 15. Priorities, Targets, Fear and Bullying. 16. Misinformation, Concealment and Spin. 17. Muted Voices: Clinical and Professional Integrity. 18. Denial, Accountability and Blame. 19. Legal Implications of Neglect and Abuse. 20. Human Rights. 21. Criminal Offences of Ill Treatment or Wilful Neglect. 22. Manslaughter. 23. Health and Safety at Work Legislation. 24. Regulation of Health Care Providers and of Health Care Staff. 25. No Secrets: the Policy of Safeguarding Vulnerable Adults. 26. Negligence. Concluding Postscript. Index.
'Successive reports on catastrophic failures in the nursing care of desperately sick people in our hospitals have had little effect. They have failed to see the systemic nature of the problem and, worse, have proposed box-ticking solutions to what is often the abandonment of common humanity. Michael Mandelstam's documentation of a continuing scandal that touches on all of us is worth a thousand expensive inquiries. This brilliant and impassioned book should be mandatory reading for policymakers and all of those who care for vulnerable people.' - Raymond Tallis FRCP FMedSci, Emeritus Professor of Geriatric Medicine and author of Hippocratic Oaths: Medicine and its Discontents. 'A searing condemnation of neglect and abuse of older people in our health services, this is a must-read volume to spur us to action. We tolerate the appalling treatment of older people in some of our institutions (by no means all) because, as a society, we don't think they matter. If we visited more, challenged more, took ownership more seriously, and gave care staff, often pressurised and underpaid, more respect, things might get better. Michael Mandelstam is to be congratulated for drawing this to our attention. Now it is up to us to find the solution - and that lies partly in valuing those who care for our older people better, paying them better, and regarding care as a serious career choice.' - Baroness Julia Neuberger
