How We Treat the Sick
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How We Treat the Sick : Neglect and Abuse in Our Health Services

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No official statistics are kept for the number of hospital patients, in particular older people, who are subjected to neglect and abuse. That is, left malnourished and dehydrated, in pain, allowed to develop agonising and fatal pressure sores, not taken to the toilet, left to lie in their own bodily waste, cared for in a filthy environment and at risk of infection, ignored, allowed to fall over repeatedly, not spoken to, left naked or dressed in other patients' clothes - and discharged from hospital prematurely. This book bears witness to all these practices and more.

Setting out a wealth of evidence not previously brought together, Michael Mandelstam shows beyond question that neglectful care is a systemic blight, rather than mere local blemish, within our health services. He analyses the causes and factors involved, reveals the widespread denial and lack of accountability on the part of those responsible - and spells out the political, moral, professional and legal implications of this failure to care for the most vulnerable of patients with humanity and compassion. Most important, Mandelstam points to the main obstacles to a solution - and to how they can be removed and change be accomplished.

This book should be read by anyone concerned with the state of our health services, including National Health Service users, government policy makers and planners, public health practitioners and academics and researchers.
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Product details

  • Paperback | 384 pages
  • 156 x 228 x 26mm | 564g
  • London, United Kingdom
  • English
  • 1849051607
  • 9781849051606
  • 2,126,103

Table of contents

Foreword. Preface. 1. Introduction. 2. Assessing the Evidence for Neglectful and Abusive Health Care. 3. Health Services: Public and Private. 4. Systemic Nature of Neglect and Abuse Within Health Care. 5. Dignity in Care: All the Good Guidance. 6. Dignity in Care: All the Bad Practice. 7. Getting to the Toilet and Management of Continence. 8. Keeping the Environment Clean and Managing Infection. 9. Helping People Eat and Drink. 10. Pressure Sores and Falls. 11. Hospital Beds, Admissions, Stays and Discharges. 12. Older People: the Unwanted. 13. Patient Voices, Consumers and Markets. 14. Staffing Levels, Competence and Attitude. 15. Priorities, Targets, Fear and Bullying. 16. Misinformation, Concealment and Spin. 17. Muted Voices: Clinical and Professional Integrity. 18. Denial, Accountability and Blame. 19. Legal Implications of Neglect and Abuse. 20. Human Rights. 21. Criminal Offences of Ill Treatment or Wilful Neglect. 22. Manslaughter. 23. Health and Safety at Work Legislation. 24. Regulation of Health Care Providers and of Health Care Staff. 25. No Secrets: the Policy of Safeguarding Vulnerable Adults. 26. Negligence. Concluding Postscript. Index.
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Review quote

This sobering account of the deterioration of care for elderly patients in this country makes a strong case about the systemic nature of this failure... Above all this book makes a bold address for action at every level of the NHS and indeed society, to find good solutions to this snowballing epidemic. -- Stephanie Watts, Assistant Psychologist, Bagnor University * Signpost * Caring for people is extremely challenging and expecting anyone to do so in adverse, under-staffed conditions, with little or no emotional support, is asking for trouble, as the people given a voice in this book bear witness. -- The Psychiatrist. A searing condemnation of neglect and abuse of older people in our health services, this is a must-read volume to spur us to action. We tolerate the appalling treatment of older people in some of our institutions (by no means all) because, as a society, we don't think they matter. If we visited more, challenged more, took ownership more seriously, and gave care staff, often pressurised and underpaid, more respect, things might get better. Michael Mandelstam is to be congratulated for drawing this to our attention. Now it is up to us to find the solution - and that lies partly in valuing those who care for our older people better, paying them better, and regarding care as a serious career choice. -- Baroness Julia Neuberger Amidst the striking advances in modern medicine stands the starkly contrasting deterioration in the day to day care of vulnerable patients. Neglect and abuse of elderly and incapacitated patients in our hospitals and nursing homes is not a rare or occasional scandal picked out by the media. The picture painted in this timely book strongly points to a much wider spread of failures of acceptable standards of care. Despite any number of published inquiries little seems to have changed in the last few years. This excellent book now demands action not words from the professions and Government. -- Lord Leslie Turnberg How we treat the Sick' is a call for action. NHS staff have been smothered and de-motivated by countless targets and controls. Focused regulation and more autonomy for front line staff could transform the experience of patients. -- Baroness Molly Meacher Michael Mandelstam has provided a devastating account of some of the more horrifying aspects of the care provided by the National Health Service. As he points out this is not necessarily typical of all care provided, even by those institutions mentioned in the book. It is however a sufficiently alarming book that should be read by everyone concerned with health care in Britain, and demands attention both from the organisations concerned and from those responsible for the management and reorganisation of the NHS. -- Tim Yeo MP Going forward we can, and must, do much more to improve, firstly the health and social care of vulnerable people who cannot speak for themselves and secondly, the training and morale of those whose job it is to care for them. A good place to start would be immediately to begin the process of vigorously consigning to history the bad practices so clearly highlighted in this important book. -- Baroness Sally Greengross OBE Successive reports on catastrophic failures in the nursing care of desperately sick people in our hospitals have had little effect. They have failed to see the systemic nature of the problem and, worse, have proposed box-ticking solutions to what is often the abandonment of common humanity. Michael Mandelstam's documentation of a continuing scandal that touches on all of us is worth a thousand expensive inquiries. This brilliant and impassioned book should be mandatory reading for policymakers and all of those who care for vulnerable people. -- Raymond Tallis FRCP FMedSci, Emeritus Professor of Geriatric Medicine and author of Hippocratic Oaths: Medicine and its Discontents. In some ways it is the voice of the neglected and abused elderly and their relatives pleading for change... The balance between running a financially viable organization and providing high-quality individualized care needs to be pivoted on the fulcrum of dignity and respect. To help redress that balance, someone should send a copy of this book to every chief executive, finance director and chief nurse in the NHS. -- The Tablet Terrible in its message and merciless in its delivery, it is quite unlike anything I have read from JKP. It is certainly their most daring and significant publication ever. But be prepared: I had to take a break halfway through, exhausted and trembling as I tried to live with the pace and intensity of the writing... Every argument and observation is backed up by a series of facts annotated with sound references. Michael Mandelstam shares with many healthcare litigants a deep sense of wrong and loss. Loss of the healthcare system he and I and most of you have believed to be ours: good, and never-to-be hurt or transfigured into something soiled, tarnished, perverted... It should be read by everyone with a serious concern for the health, welfare and pride of this country and others. It could be the Old Testament from which a New Testament can emerge. -- Dementia UK Yet again Michael Mandelstam has applied his precise yet passionate analysis to "neglect and abuse in our health services". Mandelstam is a brilliant and committed writer. We should all read this book alongside the report of the inquiry into the management of the Mid Staffs Foundation Trust (if it ever gets published). -- Caring Times Michael Mandelstam... outlines and provides evidence for what he sees as the decline in care, especially of older people in the NHS and the independent sector.

His book is filled with shocking detail from public inquiries, coroners' reports, court judgements and statements from patients and their relatives... Every assertion is supported with clear evidence... This book should be required reading for everyone with any influence over health care, from the prime minister and health secretary to care workers. -- Nursing Standard For social workers, this book raises challenges. How far should social workers challenge and confront poor standards of health care? Should social workers challenge other professionals who speak coarsely and harshly to and about those in their care? The answer should, of course, be "yes".

This book gives material to ponder the consequences of silence. Recommended for students, those working in adult safeguarding and adult services. -- PSW In How we treat the sick, Mandelstam combines his detailed legal understanding with his commitment to "skilled, compassionate, dignified inpatient nursing, genuine rehabilitation and palliative care" (dedication, to the memory of the staff at the Walnuttree Hospital in Sudbury, Suffolk)... Michael Mandelstam's work on Community Care law has been so thorough, accurate, and useful for practitioners so it was a pleasure to review this book. -- Community Care, "Mad World" blog This is very important book for all to consider carefully, because, whatever health problems we encounter, we do hope, at least, to be treated with compassion and professional care. -- The Sign Students and practitioners reading the book should appreciate and learn from the material provided and gain a deeper understanding of the range of issues involved. This is a useful book that will be of interest to the range of individuals and organisations working in the area of adult services, including but not exclusively, adult safeguarding. -- Journal of Adult Protection This very readable book presents an enlightening read for all involved in health care, from senior politicians and policy-makers to individual practitioners and students. -- British Journal of Occupational Therapy
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About Michael Mandelstam

Michael Mandelstam has worked independently for thirteen years providing legal training, advice and consultancy to local authorities, the NHS and voluntary organisations. Prior to this, he worked at the Disabled Living Foundation, a national voluntary organisation, before moving to the Social Services Inspectorate at the Department of Health. He holds postgraduate qualifications in law, information studies and the history of science and medicine.
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