Simon Read Phd Student Cardiff University of Social Sciences
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The Cultural Representation of Older People: Ageism and the National Health Service PhD Thesis 2015 Sociology Simon Read PhD Student Cardiff University of Social Sciences Acknowledgements The supervisory team of Doctor Luke Sloan and Professor Adam Hedgecoe provided a perfect blend of criticism and motivation, for which I owe a deep debt of gratitude. Before them, however, was Doctor Win Tadd, without whom my interest in the topic, and my self-belief, would be so much the lesser. I also wish to thank my family, Kadesha and my peers across different backgrounds for their moral support, well wishing and listening. iii Abstract The care of older people in the hospital setting has been the subject of increasing scrutiny from policymakers, researchers, philosophers and age campaigners over the last twenty years. However, in spite of continued attention in organisational training, dignity campaigns and government policy, reports of undignified care continue to surface through notable incidents such as the Mid Staffordshire Public Inquiry. This study examined the role that the cultural representation of older people may have on the attitudes of National Health Service (NHS) staff towards them, hypothesising that this influence can be as meaningful as that gathered in the work or social settings. The research adopted a mixed methods approach incorporating a national survey of NHS staff cultural consumption habits, multi-modal discourse analysis of cultural texts typically consumed by that population, and semi-structured interviews with NHS staff. The findings show that older people are generally underrepresented from large swathes of culture, and when represented there is a tendency towards either negative or positive stereotypes. Market trends and operational processes within the cultural industries help to explain the variation of representation on offer, with audience segmentation being a key factor in cases where older people were absent or negatively stereotyped. These representations were found to inform the interviewees’ perceptions of the older population, although this was also mediated by experiences gathered on the job, in training or through social engagement. While efforts are ongoing to foster intergenerational understanding in NHS organisational culture and local communities, the unique position of the cultural industries makes similar interventions in this field more challenging. iv Contents Abstract...............................................................................................................................................................ii List of Tables and Figures............................................................................................................................vi Chapter 1: Introduction.................................................................................................................................1 Chapter 2: Older People Dignity and Healthcare..................................................................................9 Chapter 3: Cultural Representation and Ageing ................................................................................ 22 Chapter 4: Methodology ............................................................................................................................. 46 Chapter 5: NHS Staff Survey Results....................................................................................................... 71 Chapter 6: Introduction to the Findings ............................................................................................... 92 Chapter 7: ‘Positive’ Representations of Older People..................................................................115 Chapter 8: ‘Negative’ Representations of Older People.................................................................143 Chapter 9: Older People, Culture and Healthcare ...........................................................................182 Chapter 10: Conclusion.............................................................................................................................217 References ....................................................................................................................................................224 Appendix A: Media Consumption Survey ...........................................................................................254 Appendix B: Discourse Analysis Templates ......................................................................................264 Appendix C: Semi-Structured Interview Schedules ........................................................................269 v List of Tables and Figures Table 1: EQ-5D Dimensions, By Age and Sex - Aged 65 years and over only..............................4 Table 2: Welsh Health Boards and NHS Trusts................................................................................... 12 Table 3: Sample of Cultural Texts for Discourse Analysis .............................................................. 58 Figure 1: Media Consumption and NHS Staff Survey responses by age...................................... 72 Figure 2: Media Consumption and NHS Staff Survey responses by sex...................................... 73 Figure 3: Media Consumption and NHS Staff Survey responses by occupation ...................... 74 Table 4: Media Consumption and NHS Staff Survey responses by ethnicity ............................ 76 Figure 4: Amount of television Watched by volume of respondents........................................... 77 Table 5: Media Consumption survey results on television shoWs Watched most often ....... 78 Table 6: Media Consumption survey results on television shoWs for Which time Was set aside to Watch................................................................................................................................................ 79 Figure 5: Level of neWspaper readership by volume of respondents ........................................ 80 Table 7: Media Consumption survey results on neWspaper read most often.......................... 81 Figure 6: Magazine readership by volume of respondents............................................................ 82 Table 8: Media Consumption survey results on magazines purchased ..................................... 83 Table 9: Media Consumption survey results on magazines read................................................. 83 Figure 7: Radio listening by volume of respondents........................................................................ 85 Table 10: Media Consumption survey results on radio stations listened to............................ 86 Figure 8: Time radio is most likely to be listened to by volume of response........................... 87 Figure 9: Internet usage by volume of respondents......................................................................... 88 Table 11: Media Consumption survey results on Internet neWs sites visited ......................... 89 Table 12: Media Consumption survey results on Internet entertainment sites visited....... 90 Table 13: National Readership Survey Social Grades (NRS, 2015a) ........................................... 97 vi Chapter 1: Introduction This study builds upon a range of academic research and public interest into the dignified care of older people in the United Kingdom. The first major push for improvement in this area came through Martin Bright’s 1997 series of articles for The Observer and an associated Dignity On The Ward campaign (Bright, 2001). This served as a call to arms to many relatives, carers and older people who also spoke of their own negative experiences within the healthcare setting. In response to this, the government commissioned an independent report from the Health Advisory Service (HAS) entitled Not Because They Are Old (HAS, 1998). This highlighted a severe lack of dignity and general poor quality of care on acute wards. Subsequent reports from Help The Aged (1999) and the Standing Nursing and Midwifery Advisory Committee (2001) evidenced recurring problems in both how care was provided and how patients felt they were treated. Since this initial work was carried out, nearly 20 years ago, numerous policy drives, dignity campaigns, training initiatives and corporate policy directives have been implemented to address the issue. However, the recent work of Tadd et al (2011a; 2011b), Hillman et al (2013) and Calnan et al (2013) has helped to highlight the ongoing deficiencies within the healthcare sector, most clearly evidenced by the Mid Staffordshire Inquiry into the abuse and neglect of older people within that particular NHS Trust (The Mid Staffordshire Foundation Trust Public Inquiry, 2013). The emergent picture, then, is of persistent infringements to the dignified care of older people in the hospital setting, set against almost two decades of effort to reverse the issue. Generally, this effort has explored the behaviours and practices of healthcare practitioners, as well as occupational and organisational factors that may influence them, such as corporate culture and staff training. This study expands this focus to incorporate long-established research strands such as dignity theory, organisational sociology and health research alongside theories on the cultural representation of marginalised groups. In doing so, it addresses what some have perceived as an underlying institutional and cultural ageism (see Edgar, 2004; Oliver, 2010; and Tadd et al, 2011a; 2011b). 1 This introductory chapter will