Live webchat with Paul Burstow, Minister of State for Care Services, with Townswomen's Guilds on 1 March 12.30-1.30pm

I'd like to know why my friend's husband's GP refused to visit him in his care home, saying, 'I don't visit the over 90s.' Apparently this is not the first time it has happened. Is there a cut off point for GP care?

That is disgusting! What HAS the medical profession come to? It makes me ashamed to be associated with it!

Paul - it is an incredibly common experience for older people in hospital to ring their bell and ask for help to go to the toilet and be fobbed off repeatedly. I have seen this with my own eyes and my mother in law, who has been in hospital a few times recently has just confirmed how common it is. Once I found her shaking with pain because she had been forgotten after a request and her call button left out of reach.
There seems to be little priority put on this for some mysterious reason. Also it is so much easier to pop someone onto a commode next to the bed than take five minutes helping them to walk to the toilet. If you do this for a few days an elderly disabled person quickly gets "off their legs" - unable to walk at all. If you point this out the nurses say they will refer to physiotherapy, a if it is not their problem or concern.
Then the patients have to be admitted to a rehab ward for specialist physio to try to get their independence back. Result: more expense to the NHS. They would not "block beds" if they could get themselves to the loo.
I guess my diagnosis of the problem is that those in charge of wards do not adequately manage their nursing assistants and make it clear to them that help in this area is a very high priority. My mother in law used to be a ward sister in a London teaching hospital in the 1950s and she agrees that she would never have allowed such a thing to happen on her ward!

Have you got any suggestions as to how this basic but vital issue can be addressed?

Paul - I can confirm what JessM is saying, having spent several months in hospital at the age of 56, and being treated like that myself. As a seriously ill patient I was placed directly opposite the nursing station with other very ill elderly patients and watched them being disrespected, ignored, and left without food and access to a commode or toilet. One elderly woman wet her bed several times. and it was only when a pool of urine reached the desk that they leapt up and realised what had happened, despite her light being on to summon help when they didn't bring the commode.

As each of their relatives visited, I would report what I had witnessed and they arranged to come in at mealtimes, and for the morning doctors ward round to express their concerns. Nothing changed. I was kept in hospital until I could show I could get up a flight of stairs to the toilet, but wasn't helped to make progress to do that - it was easier to plonk a commode by my bed than take me to the toilet at the end of the ward, easier to give me morphine until the day of discharge than help me be alert, get up and move about to distract me from pain, and easier to tell me the physio would sort me out than check I was getting the help I needed - the physio came twice in two months.

The ward manager was a waste of space - unhappy she hadn't been promoted, and spent at least two hours every shift talking to her children on the phone, and checking the internet for house exchanges as she wanted to move house. She even put a bid it at a set time, so the drug round she was doing was delayed! Poor morale and staff who don't feel they are valued.

If things continue like this, I will take my chances at home. I understand why so many people fear going into hospital and claim you will die if you do. They do indeed, and now we have statistics that tell us this is a real risk at weekends. What are you doing about it??

Hey and Carol was only 56, not a wobbly 76 or 86.

Definitely wobbly!!

Hey I'm only67 and definitely wobbly. That's why I have 3stitches in my head!

Is there now a 'one stop shop' in the UK to help the long distance carer?

A few years ago I was a long distance carer [200 miles distance] and found it so hard to piece all the little bits of information together which would help me provide a suitable care package for my parent [I eventually wrote a booklet myself!] At the time agencies such as banks and the DWP did not seem to understand the problems of long distance caring and medical staff were hidebound by confidentiality rules which made life incredibly - and needlessly - stressful.

We are still being encouraged to support 'care in the community' but just a few years back it was extremely difficult to establish and maintain suitable care from afar. It would be good to know that long distance carers are at last being recognised and supported by useful advice from an organisation with experience.

Do you know how many health workers are leaving this country to work abroad because of the dire state of the NHS? I ask because my daughter and her husband, both senior level nurses, are emigrating to New Zealand where they will be working in a hospital Auckland.

I have recently spent 3 weeks visiting hospital as my 78 year old father in Law had pneumonia.

I witnessed 1st hand patients being left on a bed pan for an age, or waiting forever until it was too late to be taken to the w.c/commode.

I also found it very distressing patients meals and drinks placed on the tray in front of them, but out of reach resulting in the patient missing meals, they only managed to eat when a family member was present.

The staff appeared to spend great amounts of time chatting at the nursing station but ignoring the calls from patients.

The caring side to Nursing has disappeared and need to be re-addressed and in doing so the length of time patients spend in hospital will be reduced and the NHS will save money.

Shouldn't training for all medical staff, especially nurses, include a focused section on care of the elderly? Many older people have other conditions besides the one that has caused them to be admitted to hospital. Arthritis in the hands, for example, may prevent someone undoing the plastic wrapping in which sandwiches are delivered, but if no one is aware of such constraints, the patient will go hungry. Some elderly people have difficulty in hearing and so can easily become confused when a nurse or doctor rattles off some comment that they can catch only odd bits of. When a commode or visit to the toilet is requested, it can often be an urgent need for an older person. Any of us who have looked after elderly relatives know these sorts of things. Surely those who look after them in hospital – and not just in care of the elderly wards – should be aware of them too.

I think many of us will be concerned about the negative impact of the new Health bill on the elderly and the vulnerable. How will the government ensure that a market-led Health Service gives due consideration to the care of older people? What safeguards will be put in place to ensure that older people continue to benefit from a truly National Health Service?

Many years ago I was struck by the fact that most surgery is performed on older people? Do you know what percentage of beds is occupied by those over 70? (And if you don't know this - why not?)

I recently heard an apologist for the proposed NHS reforms say that competition has been found to improve efficiency; but no-one seems to be addressing the fact that "efficiency" from a managerial or financial point of view can be the opposite of effective caring and healing.
For example, the most cost-effective kind of hospital would be one where every patient on arrival dropped down dead! That patient would no longer be a cost to the system!
How do you propose to address the tension between care and "efficiency"?

Findings by the Royal College of Nursing highlight that the skilled staff-to-patient ratio on hospital wards is actually much lower for the elderly than it is for general adults and children. You have to admit that the skilled staffing numbers simply don’t add up, especially given the complex care needs of many elderly people. In fact, it's shocking. My question to Paul, is that based on these proven and reported figures, why does the government clearly seem to place more value on the care of children and general adults over that of the elderly? (Townswomen's Guilds member and supporter of the Hear My Voice campaign)

In the days where sisters and matrons ruled the hospital roost things seemed to work so much better in terms of patient care. Now everything seems to be target driven and people so busy watching the bottom line that the patients come way down the list of priorities. Surely bringing back the nursing hierarchy is an obvious thing to do - would you ever consider it?

Do you agree that wards that run well have good leadership?

My in-laws both recently died - one in a super efficient ward in Bradford Royal Infirmary, where she was nursed personally and with great care; the other in a chaotic ward in Airedale General Hospital where he developed terrible bedsores, patients were to be found wandering and weeping, where nurses at the nurses station ignored us and it was impossible ever to locate anyone who could speak with authority.

Given the skills required to run a ward well, do you accept that ward sisters are underpaid - especially compared to doctors and nurse consultants? - and that paying them more and giving the job back status and clout would do a lot to mitigate the problems outlined on this thread and elsewhere on Gransnet?

Would the coalition Government consider dealing with the iniquitous charging system in hospital car parks? Patients need to have visitors who, in many cases, need to park their cars. Out patients often have to use their cars to access the hospital. It really doesn't seem fair to charge people who have no option but to use their own transport because they have limited access to public transport. To some extent this has been tackled in Scotland, though hospitals built and managed under PFI are still able to charge.

Parking charges made for disabled people unless you park in a disabled bay. I took my mother to hospital yesterday for an assessment as she is having replacement knee(s) surgery. There were no disabled bays available so we had to pay £4.50 for a two hour stay. Public Transport is not appropriate - to far to the bus stop each end of the journey.

Yes, Pennysue, a very good example. See what I mean, Paul?

I'd like to ask a question about the NHS bill - did you really come into politics to give the private sector more opportunity to make a profit at the expense of the NHS?

It may just be our miserable media taking a slant, but too often PR is simply turned into news so I have to wonder at the priority focus of today's latest trumpeted 'initiative'.

When is anyone at the top going to stop tip-toeing around tinkering on 'isms like calling a patient 'Dearie', vs. addressing actual service delivery that is competent and works, oversight that is not designed merely to conceal, and accountability with actual teeth to reward those who are genuine positives to the caring profession, while properly dealing with the deadweights that are sucking it, our parents' and future generations down into a box-ticking abyss of public sector delivery delusion?

ps: 'lessons are being learned' will not be greeted with much favour. I have had that for two years, and counting, from ever-more senior, and more venal, overpaid officials from the NHS, DMHoP, CGC, PHSO, LGO up, down and sideways, and it is getting a mite tired.

Do you think its really necessary to legislate against nurses calling older patients 'old dears'?