Old, vulnerable and hungry – the shocking view from inside the NHS

I am leaving London soon, coming to the end of my time as a voluntary hospital visitor working from a chaplaincy in a London teaching hospital. I have been roaming around a variety of wards for the last three years, only one day a week, but in those few hours I have seen quite a lot. The most disturbing things have been the poor quality food, which cannot aid anyone’s recovery, and the neglect of the very old and vulnerable, the patients rather ominously labelled ‘bed blockers’.

On my last visit, the Anglican chaplain was not in the hospital, so instead of attending a morning service with him in the hospital chapel, I went up onto the wards early, at breakfast time. In one ward there is a neighbour of mine, an old man I’ve known for years. At first I didn’t recognise him as he has become so thin. He was asleep and his meal, two large pieces of thick, uncut, unbuttered white toast, lay untouched on a tray near his bed. If he’d been awake he wouldn’t have been able to reach it, and if he’d been able to reach it, he couldn’t have chewed it, I happened to know, because his dentures had been left at home. Gumming his way through those big leathery slices wasn’t going to work.

As his tea was also sitting in a mug going cold, I woke the old man and encouraged him to drink — just to get something into his wasted body. He said that all he really wanted was some soup, so I went off to the kitchen to see if I could find some. It seemed like it must be quite a normal request in a big hospital: isn’t soup the food of invalids, let alone toothless ones, worldwide?

On my way to the kitchen a young Spanish-speaking supervisor suddenly appeared at the end of the ward. He became very agitated when I asked him for soup, quite excited as if it was something quite extraordinary. He began to agree with me emphatically: yes, build-up soup was what was needed, so off we set in search of it. Our mission met a dead end in the large but largely unused hospital kitchen. The catering assistant seemed decidedly affronted that I’d asked for soup for a patient at that time of day. The Spanish supervisor scuttled off, muttering about ‘build up soup’, but he didn’t reappear.

Hospital kitchens are as shiny as operating theatres but largely empty until the ready meals are brought in and loaded into microwaves. They contain tea bags, coffee machines, and lots of cupboards. I had the idea that there might be some simple, dried packet soup in one of the cupboards up there, so hell-bent on getting my friend something to eat I tried to have a look. A Chinese woman in a white coat was doing something in the corner of the kitchen. She said there was indeed some powdered soup in a cupboard, but unfortunately it was in a very large container which couldn’t be opened for one person. She didn’t seem inclined to help, so I returned to the ward without anything.

By then my ancient neighbour had also admitted defeat and gone back to sleep. It’s probably against some rule or other but I gave one of his unwanted toast doorstops to a little old man opposite who was senile and unable to speak. He’d finished a very small, shallow bowl of porridge and was still looking hungry. I buttered the toast and cut it up into small pieces as best I could with the blunt knife, and he ate it hungrily. As I walked away he smiled at me with such gratitude and delight, not just for the bits of toast, but also because I’d been attentive to him.

I worry about that little old man now. Because he couldn’t speak, or ask for anything, he relied on there being workers on his ward able and willing to observe his needs. I thought of being someone unable to speak, and feeling hungry. I’ve seen many patients go hungry just because they can’t eat without assistance. Food is banged down, left, then taken away untouched while the patient watches helpless and hungry.

Most of us can envisage what that would be like, but I am not sure that the NHS staff I met can or do. After three years of observation I seriously doubt whether any nurses or their more ubiquitous assistants on that ward ever butter any toast or even cut it up so that the older ones can eat it. As I left the ward, the woman I took to be a catering assistant came up to me and said very aggressively, ‘He says he wants the soup later.’ Her point was not about the patient, but that I had interfered unnecessarily. Lord knows whether he ever got his soup. Neither she nor the catering supervisor seemed interested in his immediate needs or really motivated to help him.

In my experience, looking after old people, or rather ‘bed blockers’, in NHS hospitals seems to be about finding the cheapest way to do the bare minimum: white bread, take it or leave it.

Nothing has changed since I first saw an old lady being left without food three years ago. When I consider my years on the ward I’m left wondering, and not quite knowing, whether the poor treatment I’ve witnessed is just a product of an underfunded and overworked hospital, or whether perhaps I have been witnessing deliberate, organised neglect.