It’s not sensational enough to make the news. No emaciated ribs, he wasn’t found face-down, drowned in the gutter. It’s just a story telling us something about the Britain we have chosen to live in. It’s a story of institutionalised neglect. About how someone, just like you or me, becomes a mere statistic.
A man of ninety-six, never been ill in his life. Slim and temperate, until last Summer, he was a regular walker. That’s why he was so fit. For years, he’d exercised his huskies in the forest twice daily. But when the last one died, he decided it might be wise not to replace her: he was getting less steady on his legs. So he walked alone in the forest, every day. He was a man who had never been inside a hospital. Didn’t drink, smoke or gamble. Since he retired at sixty, gave away half his monthly pension to various charities. No family. No close friends. Just a man living happily on his own in pre-Covid Britain, in 2019.
Then he got an ulcerated leg. It was difficult to get a doctor’s appointment and then it took some time for the doctor to organise nurses to come in and dress the ulcer twice a week: a pity, since the ulcer put an end to those healthy daily walks. For three months, the ulcer just didn’t heal. Perhaps the doctor should have called in to see how the man was, see if the nursing strategy might need modification? That’s what doctors used to do.
But doctors no longer do that sort of thing in Britain in 2019 because they have such huge caseloads. Maybe the doctor, who has an enormous caseload because he works in Britain, not Germany or France, didn’t realise that his patient who had always been fit was now spending all his days housebound, getting no exercise with an ulcer that wasn’t healing? But the man was cheerful and self-reliant still. He got Budgens to deliver his shopping each Friday and did the washing and the ironing and the cooking still. Not bad for a man of ninety-six. He wasn’t complaining.
Then he suffered a very minor stroke. Was that anything to do with being stuck at home for weeks, not getting any exercise, losing his appetite and therefore eating less healthy food, no fresh air? Who knows? A neighbour noticed a slight distortion to the left of the Man’s face. The Man could still speak, but his memory was shaky. He was still himself, he could walk (slowly because of the ulcerated leg) but it seemed wise to call in the paramedics, just to check him out. This was 2019 so the doctor who knew him was no longer available for home visits. The earliest appointment available at the surgery would have been a week later. “Better safe than sorry,” the neighbour thought.
The overworked paramedics were prompt and caring. They decided it would be prudent for a man in such circumstances, as described in the protocol, for they didn’t know the Man personally, to be taken into hospital overnight for observation. Sadly, the local community hospital had been shut, it was so inefficient. Much more efficient to send the man to the big hospital twenty miles away. The Man packed a case and said goodbye to his neighbour. The hospital was an hour’s drive in the ambulance.
The hospital reported back to the neighbour: they’d decided to keep the Man in, just for observation for a day or two as there was no transport available to take him home and of course he would need some social care: it wasn’t something they could arrange quickly these days, even though, they admitted, very similar situations occurred every day.
No, they didn’t have that kind of capacity, to organise appropriate social care promptly, and no, the hospital didn’t have a social care unit. It was fine, nothing to worry about: the neighbour could go on holiday as planned. The Man was in a specialist stroke unit, there were several similar men in there though two of them didn’t need to be in hospital either. Not in a specialist stroke unit. But the community hospital had been shut; it wasn’t efficient.
When the neighbour got back from holiday and visited the Man, three weeks later, he had become a Different Man. Whether this was because he had suffered more minor strokes or because he’d fallen over a few times, nobody seemed to know. Nobody seemed to know whether it was once or three times The Man had fallen over, nurses have so many forms to fill in these days on their computers, are so busy at their screens, nurses are for ever looking at their screens to see what they’re supposed to care about, they can’t be expected to watch old men liable to fall the whole time.
Or maybe it was because he’d been spending all day, every day in a room without windows, without a radio or any kind of stimulation, nurses being far too busy looking at their screens to talk to their patients, without any intervention from the dementia team and fed a poor hospital diet, no fresh vegetables, just crisps and white bread and processed cheese, nobody could say. The Man certainly was dramatically worse as a result of staying in that big hospital: he’d lost a lot of weight, over twenty per cent and he was always slim, so much worse that obviously he couldn’t go home ever again because he’d deteriorated beyond that stage. “Sadly, we missed that window,” Dr Robert said. The Man needed a place in a nursing home. He could never go home.
Here’s a blameless man of ninety-six who was an air gunner in the War, who for the last twenty years has given half his money to charity, who shouldn’t be in hospital at all but has been there for two months, who went there just for an overnight observation, who’s become institutionalised, a mere statistic, a bed blocker. A man denied living in his own home ever again.
The neighbour was advised to find the man a bed in a nursing home. One catering for people with dementia.
The neighbour was puzzled. How did you go about finding a nursing home? Didn’t the State do that? Surely the hospital should have a nursing home for people like the Man? Or perhaps the man’s doctor should send him to the surgery’s nursing home? It seemed that wasn’t what hospitals and surgeries did. Perhaps the Man should have a social worker? The neighbour knew nothing about nursing homes. How many people know anything about nursing homes? Do you?
Eventually the neighbour was able to catch a social worker who, although he was far too busy to stop and talk, was very helpful: he gave the neighbour a list of nursing homes. He’d been too busy (like the doctor, he was working in Britain and so he had an enormous and growing caseload because of the cuts) far too busy to visit any of the homes himself and, sadly, none of them were where the man wanted to live, in his own town.
And of course, even if he had visited them, the social worker wasn’t allowed to tell the neighbour which homes were good, which were dreadful because they were commercial nursing homes, operated for profit, not for the national good. And you must never pass judgement upon commercial organisations if you’re a lowly social worker. What do social workers know about anything? They rarely understand what’s meant by value for money.
It seemed a very odd situation: that the person who should know about nursing homes wasn’t allowed to tell someone who didn’t know anything about nursing homes, which were good nursing homes and which were dreadful. Surely people needed nursing homes every day? Why should it come as a surprise that a man of ninety-six kept two months in hospital would need to be discharged into a nursing home? That what was needed was a good one rather than a dreadful one?
Surely, the neighbour reasoned, the State has first-class nursing homes for people who are ninety-six and have suffered a minor stroke? Surely the hospital which has lots of men and women like this man every year to deal with has recovery units in the community, near a person’s home, where people can go and be cared for well when it becomes necessary? Surely it’s not left to money-making companies to provide minimal care for the vulnerable, to see nursing as a profit-making opportunity?
Imagine the kinds of nursing homes you’d get if that were the case!
Would they be well staffed by qualified nurses who had time to sit and talk to their patients? Would the accommodation be welcoming, homely, a dignified place in which to spend one’s final years rather than some dreadful place resembling a seedy boarding house where the television blared out all day to a ring of old folk with their Zimmer frames looking bored out of their skulls because if you dumped them all in front of mindless daytime television all day long, you needed only one nurse on duty? Like two men looking after a herd of cattle? A very British euthanasia: a slow and undignified death by a thousand units of daytime television. Surely places run for profit would be cramped, overcrowded, serve up cheap processed food, be located where property was cheap and unlovely, be dedicated to doing everything on the cheap?
Well, it depends what you mean by cheap. The places available to the Man charged about £1000 a week so his house would have to be sold because his assets were worth more than £20,000. The neighbour visited a few homes and decided that if that was what awaited him when if was ninety-six, he’d better book a trip to the clinic in Switzerland now. It wasn’t a question of choosing the best, just of trying to decide which of the available handful was the least awful.
They were mostly dingy, smelly, scruffy, furnished with chipped melamine chipboard cupboards with wonky drawers: everyone knows what a seedy bed and breakfast is like. That’s what many of Britain’s nursing homes are like in 2019: not places you or I would want to end up in. The Man is still in hospital, lonely and waiting to die. You can visit him: he’s one of thousands.
Perpetually Tory Britain will be, we are told, one of the most prosperous countries in the world. With an aging population, a large population of the very old. And nearly everyone will get old. Old people are just young people who have lived a bit. They are exactly like you and me: teachers, bricklayers, designers, you name it, they’re old people. Contrary to appearances, old people think and feel very much the way they did when they weren’t old people. White hair and being brain dead, insensitive, ignorant, useless and uncomplaining do not go together.
When we say Britain is a very rich country do we simply mean that if you are very rich you will be OK? Because if you consider the life experiences that most people can look forward to when they retire, the way most people will spend at least twenty years of their lives, especially the last two or three years, it does not look like a very rich country, more like a third world horror show.
We need, urgently, a national debate. Either we live in a country which believes in the Welfare State, in looking after people well when they need to be looked after, by taking money from that tiny percentage of the very rich and investing it for the benefit of the vast majority who cannot possibly afford private education, private health care and comfortable nursing homes or we do not. It’s not rocket science.
Do we treat old people as people or as mere statistics? We could create an integrated health and social care system, a universal, free sure-start to university education system that would be the envy of the world if we raised income tax a little and remorselessly pursued all those individuals and companies presently evading taxes. Simply make it a criminal offence with stiff penalties to attempt deliberately to avoid paying tax. No ifs, no buts. All the present government wants to do is cut the Welfare State so rich people pay less tax and multinational companies can continue to pay very little tax at all.
“Why the silence? Why aren’t more people concerned about what will happen to them if they really cannot be bothered to think about what happens to people in Britain when they are old? Because everyone will be old sooner than they expect. The circle of Zimmer frames in the television lounge, with the hideous floral carpet and the plastic daffodils reeking of air freshener, has a space waiting for every one of us.