"NHS Nursing Neglect"

In March 2008 my 89 year old mother was admitted to Cranmer Ward, St Martin's Hospital, Canterbury, as a voluntary patient, suffering from severe depression with features of psychosis. She had suffered similarly several years ago and had tried to take her own life. Following hospital treatment, and a spell in a residential home, a period of relative stability ensued, and, she was able to live independently, and remained, physically, very fit, despite a diagnosis of diabetes. Unfortunately, the depression recurred and she stopped eating, and as the depression worsened the psychosis returned. Initially she came to stay with us and received nursing care from me, with daily checks of her pressure areas and weight, and close monitoring of her food and fluids, which she took reluctantly but reasonably well with much persuasion. She needed help with personal hygiene. She continued to deteriorate mentally, though she was still able (though not very willing) to accompany me on dog walks of a mile or so over the fields. As she deteriorated, her GP arranged a psychiatric home assessment and admission ensued.

Despite our best efforts, on admission to Cranmer Ward she was very frail, malnourished and very depressed. We made this very clear to the nursing staff, and we expected basic nursing assessments to be performed (Waterlow, MUST etc). As far as we know they were not. Indeed, she was not even weighed on admission. Medication was not helpful, the nursing care she received was terrible and within days she had developed bleeding sacral sores (despite the fact that she was at no time confined to her bed). These sores were not noticed by the nursing staff, but found by me on one of my daily visits, when I noticed blood on her chair. At around the same time we noticed she had developed a foot drop, but despite pointing it out nothing was done about it. She continued to eat and drink poorly and lose weight. The staff appeared to put little or no effort into encouraging her to eat or drink, and their lack of care was reported to us by other patients. Food and drink would be put in front of her and taken away when it hadn't been consumed. The bulk of the care of patients was devolved to nursing assistants, whilst the trained staff spent the majority of their time in the office. It was only on my suggestion that she was given Resource drinks to supplement her poor food intake.

Concern regarding dehydration from the medical staff led to mum being sent by taxi (!) to the Kent & Canterbury Hospital A&E, we were told for intravenous fluid therapy. After assessment by the elderly care team, we were told this was not necessary and another taxi was arranged to take my dehydrated malnourished mum back to Cranmer Ward. This was on the same day that I had discovered the pressure sore, and she was laid on a hard A&E trolley with no pillow for several hours.

I became so worried about her malnutrition and care that I was given special dispensation to visit during protected meal times and coerce mum to eat. With one to one persuasion she ate full meals and drank more,

Her deterioration continued, culminating in a Mental Health Act Section, so the she could be treated with ECT. The standard of nursing care remained poor, at times mum appeared dirty and dishevelled with faeces staining her legs and feet. No-one seemed to take responsibility for her basic nursing care and hygiene.

My husband and I are both healthcare professionals, and our attempts at pointing out our concerns were met with variable responses, ranging from apathy to outright hostility. On one occasion a staff nurse told us that she was not happy to discuss our concerns as we had been dissatisfied with mum's care from the moment she arrived, and if we were that concerned we could take her home (despite the fact that she was by then about to be sectioned under the Mental Health Act).

ECT is provided at the Arundel Unit, William Harvey Hospital, Ashford. Patients are usually transferred to Winslow Ward on the Arundel unit for the duration of their ECT treatment, but the ward was closed due to an outbreak of "gastroenteritis" so mum was taken twice a week by taxi from Canterbury to Ashford, having been nil by mouth overnight, given a general anaesthetic and ECT treatment, and then woken up to to be taken by taxi back to Canterbury. Is this any way to treat a severely depressed 89 year old? After 3 or 4 weeks of this she was transferred to Winslow Ward for the remainder of her ECT, but despite more than 12 treatments with ECT she was still not improving.

From the moment she arrived at Winslow Ward, the difference in staff attitude was palpable. Still the trained staff spent the bulk of their time in the office, but the healthcare assistants, housekeeper and even the cleaning staff were friendly , helpful, and willing to spend time caring for mum, cajoling her to eat and drink, and not simply placing food/drink in front of her to remove it later, untouched. She was kept clean and coiffed.

Sadly, mum still didn't improve. 2 weeks ago I pointed out to the psychiatrist that mum had been on Lithium following her previous episode of depression (having repeatedly told medical and nursing staff the same information from admission onwards), and he started her on it. Since then she has changed from being very withdrawn, to becoming almost a chatterbox, though sadly she dwells on her guilt at her perceived past misdemeanours, and continues to exhibit delusional and disordered thinking. 2 days ago the psychiatrist felt that she would be ready for discharge next week. Nothing had previously been done about her foot drop, but now, a week from proposed discharge, she has been referred to a physiotherapist. Likewise, she has seen a psychologist once, following referral some weeks ago, but if she leaves the unit cannot see her again. She is certainly not fit to go home and live independently, even with a full care package, and an OT visit yesterday, with mum, proved to me that I wouldn't be able to cope with 24 hour care. Because we live out of the catchment area of the Arundel Unit, we are now faced with the prospect that mum will be sent back to Cranmer Ward in Canterbury, and who knows what her fate would then be?

We are extremely concerned that mum's treatment has become a Post Code lottery, and dread her having to return to Cranmer Ward. We have always understood that criticism should be taken in a constructive manner and used to improve patient care. It is clear to us that many of the staff on Cranmer Ward take criticism personally, and are unable to co-operate with us in providing proper care, which in turn leads us to avoid interaction with them, until pushed too far.

What are we to do? Time is of the essence. Does my mother have no human rights?