Bed-Blockers: Does The NHS Truly ‘Care’ About Its Elderly Patients?

In December, as preparations for a no-deal Brexit threatened to derail urgently needed reforms to health and social care, a drama aired on BBC 1 which reminded its audience of problems beyond borders and backstops. Care, written by Jimmy McGovern and Gillian Juckes, offered a shocking, unflinching portrayal of the failings of modern care provision. Alison Steadman gave a convincing performance as the lively, capable grandmother Mary plunged into the ordeal of dementia, whose story became a vehicle for delivering hard truths about the state of contemporary healthcare. The way in which Care handled NHS failings was uncompromising and polemical, as Mary’s suffering brutally exposed the lack of empathy that can characterise the treatment of vulnerable elderly patients.

Following a stroke, Mary’s only remaining means of expressing herself is a stream of incomprehensible mumblings, and her consultants and carers often act as if she were an object: voiceless and passive, rather than a human being. The drama bristles with fury at this shortfall in carer compassion, and the viewer is never allowed to forget that what they are watching reflects a real-life crisis. There may have been room for greater nuance, and a more generous acknowledgement of the remarkable, life-saving work of NHS employees, but the problems Care presents are all too real.

Sheridan Smith and Alison Steadman in Care | © BBC
Sheridan Smith and Alison Steadman in Care | © BBC

An unrelenting squeeze on NHS resources, exacerbated by an ageing population, and lack of proper integration between health and social care, has led to the kind of drastic conditions which Care dramatises in a personal, heart-wrenching story. It is a predicament captured by the thousands of aged patients waiting in hospital beds to be transferred to more appropriate care homes, whose loss of dignity is compounded by the designation ‘bed-blocker’. Care ruthlessly exploits the symbolism of their plight when Mary’s daughters are told by an NHS administrator their distressed, suffering mother will be discharged because the hospital ‘needs her bed’. This family’s struggles show how, in the hands of contemporary care provision, the elderly are frequently reduced to the status of an inefficient use of space.

This is not a new problem. Ever since the emergence of ‘modern medicine’ during the nineteenth century, western society has struggled to preserve the humanity of the frail and sick. Dramatic improvements in our ability to cure disease and prolong life have come at a cost. French philosopher Michel Foucault describes this turn to new medicine as the moment clinicians were freed to treat a ‘disease’, instead of a ‘person’. In his seminal work The Birth of the Clinic (1963), Foucault hailed the arrival of the modern clinic as the point at which unhelpful distractions like doctor-patient relationships were finally removed, with the cool precision of scientific rationality taking their place. It is easy to see how this shift in approach set the course for the medical strategies which Care critiques, as a path was cleared for the emotional, personal qualities of a patient to be dismissed as irrelevant. From the moment Mary enters the system, she becomes a set of symptoms, rather than a unique individual: an anonymous, voiceless body defined by its flaws. The nineteenth century ‘mutation’ Foucault celebrated was the birth of a medical modus operandi which legitimised, and even encouraged, this dehumanising way of treating those most in need of help.

Alison Steadman in Care | © BBC
Alison Steadman in Care | © BBC

It was not until the 1970s, with the arrival of Cicely Saunders’s hospice movement, that the problems of ‘modern medicine’ began to be addressed. Saunders, and other pioneering figures such as the German psychiatrist Elisabeth Kübler-Ross, began to try to return clinicians’ attention to the human, emotional dimensions of their patients. Their aim was not to denigrate the astonishing breakthroughs in science and technology which the new medicine brought. Instead, they wanted to temper hard science with warm humanity.

The work initiated by Saunders, Kübler-Ross and others is still ongoing, and Care is not the first example of the artistic community lending its support to their cause. 25 years before McGovern and Juckes’s drama, Tony Harrison’s film poetry was raising the same issues. Harrison’s Black Daisies for the Bride (1993), is a potent blend of imagery, verse and music, which brings to life the stories of three elderly women with Alzheimer’s in High Roads psychiatric hospital, Yorkshire. Like Care, it restores the complexity and humanity of the characters it portrays, using metre and melody to remind the audience of what has been lost.

In preparation for filming, Harrison spent time in the ward with director Peter Symes, getting to know each resident’s unique character and life story. The result was a poetic docu-drama focused on three female patients, exploring forgotten memories of their wedding days. Using a visceral, vibrant blend of visuals, verse and song, each woman is transformed into a bride recounting her special day, recovering the depth and breadth of life experience behind the frail, confused figures we see. This not only reanimates cherished memories, it also gives the women a voice.

Black Daisies uses artistic licence to make unseen details of character and experience unavoidably present, provoking recognition of what has been trapped within locked wards and failing minds. As Care also captures, patients who have lost command of language are allowed all too easily to become unheard and unnoticed. While Care uses subtitles to translate Mary’s garbled inaccuracies into comprehensible phrases, Harrison uses personal, impassioned solo songs in Black Daisies to give the voiceless a chance to tell their story. The poet’s time on the ward revealed that music was often able to reach the victims of Alzheimer’s, even when words no longer could. His film succeeded where modern care systems often fail, finding a common language through which those silenced by Alzheimer’s or dementia could be heard.

In the 25 years between Black Daisies and Care, little has changed. Harrison’s film has lost none of its relevance. When a recent retrospective of Harrison’s film poetry, held at the Edinburgh Film House, brought the work back into the public consciousness, the audience was quick to express its dismay that the issues raised by Black Daisies are still so pertinent. The compassionate, imaginative quality of attention the film pays to its elderly subjects still reminds the viewer of the care which NHS employees wish they could provide, but rarely can. Harrison – who is my grandfather – has often spoken to me about his frustration at the way in which the problems posed by an ageing population are consistently ignored or downplayed. The conditions which first motivated him to produce Black Daisies have not improved.

Prior to its recent revival, Black Daisies had been allowed to drift into relative obscurity, despite the impact it made on first release. Given the lack of progress since, it is tempting to wonder whether Harrison’s work has been neglected because it shines far too bright a light on problems which persist to this day. The persuasive power, and lyrical sensitivity with which it handles those trapped in a world of bewildering suffering is painful to watch. The image of a young woman in bridal regalia striding confidently through hospital corridors is hauntingly evocative, especially when contrasted with the horribly familiar sight of confused, anxious patients spilling out of wards onto makeshift beds in these same corridors. Black Daisies reminds us that those cast as bed-blocking, as unwanted obstructions by modern medical practice are also people, who have been loved as wives, husbands, family members and friends.

The only false note Care struck was its ending, which consoled the viewer with a blue-sky, birdsong and smiles dénouement that distracted from the unresolved nature of the issues it raised. Watching Black Daisies will quickly disabuse anyone of the notion that this is an area in which substantial, satisfactory progress is being made. Its poetic, passionate challenge to a care culture that treats elderly patients as an inconvenient waste of resources remains difficult to watch, as it forces its audience to recognise that the very humanity of those who enter these systems of care is still at risk.