The Daily Telegraph
November 18th 1999

Elderly patients 'dying because of bad management'

By Jenny Jarvie

ELDERLY people undergoing surgery are dying because of poor management of hospitals, according to the findings of a confidential inquiry published yesterday.

Shortages of staff and facilities are resulting in some elderly patients waiting three days for operations that should be carried out within 24 hours. Extremes of Age, which examined deaths of patients over 90 after surgery, found as many as two out of 10 patients experienced a delay for non-medical reasons.

More than half of hospitals did not have a high-dependency unit, which experts say should be available to any hospital carrying out major surgery. Ian Martin, clinical co-ordinator of the report, said: "Often the physical status of the elderly is not adequately taken into consideration. This is to be deeply regretted. If elderly people are submitted for operations, they should receive a sufficient standard of care."

Elderly people are at greater risk of complications after an operation. About 80 per cent of elderly patients had severe diseases other than those they were admitted for. The report found that these most vulnerable patients were often designated to the least experienced members of ward teams.

Mr Martin said: "There does not seem to be a tailoring of medical staff according to the severity of patients. The experience of surgeons and anaesthetists needs to be matched to the physical status of patients as well as to the technical demands of the operation."

The management of fluid balance around the time of the operation, usually a responsibility of junior and inexperienced staff, was judged "deficient" with many patients dying because of excessive fluids in their bodies. The report recommends fluid management be given higher priority and accorded the same status as drug prescription.

John Williams, chairman of the National Confidential Enquiry into Perioperative Deaths, which published the report, said: "We have to develop skills to deal with the increasing elderly population. There is not a lack of will, but a lack of people trained in high dependency."

Lord Hunt, health minister, said: "We accept that there are still areas of care and service delivery that can be improved. Some of this has already happened. We are working to improve the availability of high dependency beds in the NHS. The latest estimates are that there were 765 available in September 1999 compared with 718 in March."

Prof George Alberti, president of the Royal College of Physicians, said: "We hope the report helps stop the ageist approach to care of the elderly." The report also examined deaths of children after surgery, finding an improvement in many aspects of care.