Military precision meets nursing care for older people
What it's like living and working at the Royal Hospital Chelsea, home to army veterans
What it's like living and working at the Royal Hospital Chelsea, home to army veterans
As a soldier, Alf Mason was involved in the closing stages of the second world war and witnessed the construction of the Berlin Wall.
Several times during his army career – mostly with the Durham Light Infantry – he was present as history was being made or was instrumental in making it.
Now, at the age of 94, the former company sergeant major is part of another impressive history – that of the Royal Hospital Chelsea, home of the Chelsea Pensioners.
He is one of around 300 people living at the hospital, which has been offering care and comradeship to veterans of the British Army since the 17th century.
‘The good thing is that all of us have been in the army,’ Mr Mason says. ‘It’s much better than going into a home with a bunch of strangers. There’s always someone to talk to – people I meet in the cafeteria and so on – but we have the freedom to do what we like.’
The history of the charity is fascinating (see the box below for some highlights and the hospital’s website for more detail), but it is also home to prime examples of modern healthcare. Indeed, according to the Royal Hospital’s director of health and well-being, Deborah Sturdy, it is leading the way in some respects, including meeting the particular needs of veterans.
‘I have spent many years of my career nursing older people, and have quite a breadth of experience,’ explains Professor Sturdy, whose CV includes a ten-year stint at the Department of Health as nursing adviser for older people. ‘What I see here is a strong sense of comradeship. There’s a positive, common identity and having shared experience brings people together. The Royal Hospital Chelsea is a unique environment and has a unique identity.’
The organisation scored highly in its latest Care Quality Commission inspection, with its care home, the Margaret Thatcher Infirmary (MTI), judged as ‘outstanding’. Inspectors singled out the caring ethos, leadership and responsiveness of staff for particular praise.
So, what makes the Royal Hospital Chelsea so special and what lessons does it have for other care settings? Professor Sturdy highlights continuity of care. ‘Generally, people come in when they are well and fit, and leading independent lives,’ she says, adding that some will then progress to the MTI. ‘There’s the opportunity for step-up or step-down care, but staff already know the residents and their individual needs.’
A ‘captain’ for every ‘company’
The multidisciplinary welfare team at the hospital is a mix of ex-military and civilian staff. When they become residents, Chelsea Pensioners are assigned to a ‘company’, each of which has a ‘captain’ who is responsible for their overall well-being. Their role involves keeping in touch with next-of-kin and ensuring that pensioners get the help and support they need.
‘There’s the opportunity to have a very active ageing experience here’
Deborah Sturdy, director of health and well-being, Royal Hospital Chelsea
Captains work with pensioners from the point when they move to the organisation’s ‘sheltered’ independent living facilities, and stick with them if they progress to the MTI care home. Professor Sturdy compares the role to that of navigators, currently being pioneered in some NHS organisations, who are responsible for an individual’s care. Captains have an extra element, however, in that they stay with the pensioner throughout his or her journey at the hospital.
‘There’s the opportunity to have a very active ageing experience here,’ explains Professor Sturdy. The hospital pays great attention to not only physical health needs but emotional elements of care, such as avoiding isolation, she says.
‘There’s a GP on site full-time, chiropody, occupational therapy, and there’s even a hydrotherapy pool. But the atmosphere is also important, and this shows itself in subtle ways. For example, there’s a choir and everyone is welcome – it’s a real mix of abilities, but everyone joins in together.’
Awareness of veterans’ needs
Nursing staff are mostly based in the MTI and have a good relationship with the rest of the multidisciplinary team, including the captains. Despite their differing professional backgrounds and cultures, the military and nursing staff on site create a harmonious team, says Professor Sturdy.
‘The captains have the utmost respect for nurses and vice versa,’ she says. ‘I have oversight of everything happening to pensioners – I bring the two worlds together, if you like – and everyone works well together.’
Professor Sturdy believes that some of the fundamental elements of care at the Royal Hospital Chelsea are transferrable to other care settings. This includes creating an environment where people can find common ground and encouraging a community feeling. Shared occupational backgrounds can help with reminiscence work, for example, though she accepts that this might not work for every profession. ‘God forbid being in a care home specifically for [retired] nurses, because they’d all want to be in charge,’ she laughs.
She also cites the organisation’s volunteering programme and its positive links with the present-day army, including regular visits from serving soldiers, and outings to see the Changing of the Guard.
She would like the organisation to do more to promote awareness of the needs of veterans in health and care services generally – and says that this has been quite a learning curve for her personally. ‘Even in ten years as a government nurse adviser, the whole veterans agenda never came to my door – shame on me for not picking up on it,’ she says. ‘I think there’s a bit more awareness now of the mental health needs of veterans, for example, but there’s a lot more still to do.’
‘This place comes fairly near the top’
The average age of residents is 83 and all are over 65. Some have reached their 100th birthday. At 94, Mr Mason is one of the older residents and is clearly pleased with his surroundings. Following a refurbishment, all residents now have a spacious bedroom, en-suite wet room and study area – and all have a large window, many with stunning views.
Mr Mason has made his room his own, with photographs on the walls – including one of the Duke of Sussex (Prince Harry) attending a Founder’s Day event at the hospital. He enjoys the view from his window, particularly the large Christmas-type tree immediately outside.
In a way Mr Mason embodies much of the British Army’s history in the mid-20th century. He joined at the end of the second world war ‘just in time to get my medal’, and recalls how he and his fellow soldiers travelled to France in a barge that was so low you could trail your hand in the water.
After the war, he was posted in Germany, based in Berlin. He casually mentions that he saw the Berlin Wall going up near his barracks, although he had no idea of the significance it would take on. ‘We were told not to go down there as you couldn’t trust the Russians,’ he says, indicating with a twinkle that he still doesn’t.
He also served in Greece, Cyprus, Aden and Korea, before leaving the army and taking up a job with the then Department of Health and Social Security, where his work included visiting care homes.
‘I saw the top and the bottom,’ he says, adding with a smile: ‘I think this place comes fairly near the top.’
War and peace: The history of the Royal Hospital Chelsea
The first pensioners moved into the Royal Hospital Chelsea in February 1692. Over the past three and a quarter centuries, it has been home to veterans of every conflict from the English Civil War through the Napoleonic Wars to the two 20th century world wars and beyond.
John Rochester, the Royal Hospital Chelsea’s heritage manager, says the hospital is now opening its doors to veterans of the first Gulf war (1990-91) as well as the Falklands conflict (1982).
‘It was always a place where people were looked after. It wasn’t a hospital in a medical sense, but a lot of people were invalids and needed a lot of care’
John Rochester. heritage manager, Royal Hospital Chelsea
After King Charles II issued a royal warrant to authorise the building of the Royal Hospital Chelsea in 1681, the famous architect Sir Christopher Wren was commissioned to design and build it at a picturesque site near the River Thames. The idea was to care for those ‘broken by age or war’ and certainly those first residents were very infirm, says Mr Rochester.
Successive wars have taken their toll on the Royal Hospital Chelsea – parts were destroyed in the first world war, for example, and, after being reconstructed in 1923, were then destroyed again by a V2 rocket in 1945.
In another attack in April 1941, the infirmary building was hit by an aerial mine, which destroyed its east wing. Four nurses were among those who died.
The evolving role of nursing
The history of nursing at the Royal Hospital Chelsea is not easy to define. Mr Rochester explains that the matrons who ran the ‘long wards’ before the 20th century took on a role that was part nursing and part housekeeping.
‘It was always a place where people were looked after,’ he says. ‘It wasn’t a hospital in a medical sense, but a lot of people were invalids and needed a lot of care.’
Nursing has played a more formal role since the turn of the last century, and the hospital has a history of training nurses. For example, from the 1960s to the 1980s, nurses from Queen Alexandra’s Royal Army Nursing Corps undertook their geriatric training there, Mr Rochester says.
The Royal Hospital Chelsea even has a connection with Florence Nightingale. ‘I don’t think she ever came here, but we had one pensioner who had worked as a hospital orderly under Florence Nightingale,’ says Mr Rochester. ‘She gave him letters of recommendation and a couple of prayer books, which we have.’