Care, or just repair?

There is an alarming article in this week's Catholic Herald by Simon Caldwell headed Death by Starvation about the increase in death's in hospitals due to malnutrition. It reminds me of a comment made by Alan Bennett in his diaries Untold Stories when he recounts the descent of his mother into dementia. She was sustained by a strong and healthy appetite (and someone to feed her) which certainly kept her alive for much longer than others in the same nursing home. Caldwell draws the clear conclusion that nutritional care of the elderly is not given the attention it should be, and that while food may be brought to patients, there is no one to ensure that they eat, nor indeed is there anyone to sit with them and feed them.

Caldwell suggests that this is a kind of creeping euthanasia, devaluing the elderly and effectively encouraging them to starve to death. It may be so. After all if the patient were a young victim of a motor accident, and immobilised, someone would certainly ensure that he or she were fed.

However, as one who frequently visits hospitals and nursing homes, as well as seeing people in their own homes, I tend to think that this is less conscious policy than a simple distortion of priorities. Let me explain.

We all know that the technological advances of health care are extra-ordinary, and that treatments are possible now that were inconceivable previously. Surgery can be performed more easily and more effectively. Drug treatments can address conditions that may have been untreatable in the past. Major operations, such as heart bypasses and joint replacements are now routine. Hi-tech equipment is a feature of the modern hospital and other places of treatment.

From our own lives we know the consequences. Hospital stays are very much shorter than they used to be. When I was born in the late 1950s, my mother spent a fortnight in hospital after the birth, and most of that in bed. When I had a hernia operation in 1990 I stayed in for 10 days. But when my father has a heart bypass much more recently, he stayed in hospital just four days. My daughter had a baby a few weeks ago and was discharged only a few hours later.

Much of this is good. If we can be at home, most of us would prefer to be. But there is another side to this. The human body is being treated like another piece of technology in need of repair, and nursing has become focussed on the technical process.

So there is very little actual nursing taking place. Treatment is usually an intensive process to ensure the technical aspects of care are all undertaken. The human contact, the time spent talking to the parient, the befriending and empathising - no it hasn't gone, because the nurses are caring human beings - but it is no longer seen as what is really important. We could blame the 'managers', I suppose, but that is too simple. I think it is a general drift in what is and what is not health care.

And this doesn't just affect the care of the elderly. There have been concerns at the lack of support new mothers are now given after birth, frequently - like my daughter - being sent home within 6 hours of the birth. In Stoke-on-Trent there have been stories of a baby lost after a first-time mother in labour was sent home and the horrendous situation at Stafford hospital.

Of course there are outstanding exceptions. The care shown in hospices is a shining example of what nursing, caring for the whole person is really all about. Chaplaincy teams (when they are not sidelined or devalued by hospital management) also provide care well beyond those of their own religious groups. And those who do the nursing are often, usually, highly motivated and compassionate people. Yet until all involved in managing, planning and carrying out health care realise that the body is far more than just a machine, but is the manifestation of a person, then stories like this will continue to come.