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Wednesday, 16 September 2015

Inspector warns of compassion fatigue in care of seriously ill

Written by The Press Association

Seriously and terminally ill patients are suffering from a lack of around-the-clock expertise and staff with compassion fatigue, some of Britain's top medical professionals have told an influential Parliamentary committee.

Only about one-in-five hospitals is offering a seven-day specialist palliative care service, meaning some patients are being deprived of medical help at weekends and through the night.

Professor Sir Mike Richards, chief inspector of hospitals with the Care Quality Commission, said urgent specialist care was sometimes found wanting, while under-pressure staff on some wards didn't have the time to show the level of compassion that seriously ill patients required.

He told the Public Administration and Constitutional Affairs Committee, meeting to discuss the Parliamentary and Health Service Ombudsman's recent Dying Without Dignity report: "People need to be seen within a matter of minutes, or very few hours, not waiting 11 hours or more as in the report.

"We need these services available seven days a week and access to experts out of hours so that people can get the advice as well."

Asked what is destroying some staff's ability to show compassion to patients, Sir Mike replied: "If they are overstretched to the point where they are running around unable to deliver proper care, they can lose their compassion.

"In general, the levels of care and compassion are very high. Where that breaks down, it is almost exclusively where individual wards are understaffed where the staff are stretched so thin they lose compassion. It's often just an individual ward that's just understaffed. It is not an excuse, it is an explanation."

But he warned committee chairman Bernard Jenkin MP the fatigue was often "only temporary".

The report included evidence of poor care from some of the country's hospitals treating people with serious illnesses.

In one case, an 89-year-old deaf woman was sent a letter asking to attend a meeting at which point she would be told she was dying of cancer. But the patient failed to respond, and medical staff failed to follow it up.

In another case, a 29-year-old terminally ill man experienced unnecessary pain and distress for more than 11 hours because the on-call doctors did not respond to his sister's request to review his pain medication. The issue was never escalated to senior staff.

Professor Irene Higginson, director of the Cicely Saunders Institute at King's College London, told the committee: "What comes out in this report is hugely tragic.

"There is a chronic underinvestment in the training of palliative care and the provision of services."

She said some of the challenges for palliative care were "attitudinal, not financial", but added: "We need 24-hour care in the community and in hospitals.

"The issue is the staffing of it and the resourcing of it. Members of the Association of Palliative Medicine are already often providing this but there isn't enough of them so what they're doing is covering very large geographical areas or many multiple hospitals in order to do a rota that's possible."

Committee chairman Mr Jenkin, the Tory MP for Harwich and North Essex, said: "We need to spend more time thinking about the human factors, the behavioural issues and the leadership issues because if they were addressed more directly, maybe it would be easier to get the policy and to distribute the resources more effectively."

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