Thursday, 5 July 2012

Western Morning News Column - 2 July 2012

Six weeks ago I fell over in the street hurrying between meetings at work. Within 32 hours I was recovering from surgery to pin my broken hip. Within 96 hours I was on my way home.

I shared my ward with five other ladies who were all over 75 years old. While I believe we all received excellent care from the NHS, they were destined to spend considerably longer in hospital recovering from similar injuries. While there are undoubtedly medical reasons for this, there were also undoubtedly others.

Anyone who has spent time in a hospital ward knows that you don't have to try to over hear conversations between clinicians, their patients and family members.

What I heard were a series of pleas to go home that were thwarted by the care system. Despite the best efforts of staff, the divide between the care the NHS provides and what people, families and in some cases the local council provides creates confusion, bureaucracy and delay.

No one should be made to stay in hospital longer than necessary. This is important to all of us, because our elderly family members are important. Delaying people from returning home from hospital costs hospitals a great deal. The Department of Health has estimated that each overnight stay costs £250. It also prevents people who need to get into the hospital from doing so as beds are blocked.

What I saw is not an isolated problem. Last year the Department of Health, found that while over 75 year olds accounted for 23% of hospital admissions they also accounted for 75% of all delayed discharges. I wanted to have a better understanding of the problem and made a Freedom of Information request to all the NHS hospital trusts. From the responses I have received so far from the year ending March 2012, forty hospital trusts recorded 14,616 patients over 75 experiencing delays in their discharge from hospital. Behind the numbers will be many different reasons reflecting the lives of the patients, but I am left in no doubt that this is a significant problem.

So, what, you ask is the Government doing about this? Well, they agree there is a problem. They agree that more needs to be done to try and get councils and the NHS working more closely together.

Despite the extraordinarily difficult financial situation the government inherited, the NHS budget has not been cut and by 2014-15 £2 billion will have been diverted into council adult social care budgets. More money has been given for other support to enable people to make the move home with, for example, home adaptations.

So what more needs to be done? Firstly we need to do all we can to enable elderly people to live healthy and fulfilling lives in their communities. To do this we need to focus on preventing elderly people ending up in hospital for reasons that could have been prevented, for example by the improved management of long term health conditions, or preventing isolation and loneliness ,or by making home adaptations to prevent falls and broken bones. 

So, more care needs to be provided in communities. Last week at their annual conference the Local Government Association highlighted their concerns about the pressure on local services that care for older people.

Love it or loathe it,  the Health and Social Care Bill makes a big step forward in tackling this, by enabling Councils to have a key role in integrating and improving local services that focus on promoting health and wellbeing in the community. Health and Wellbeing Boards bring together patients and councillors, as well as health and care professionals to shape services in their communities. They provide the opportunity of integrating NHS, social care and housing budgets to provide improved joined-up services for all older people. Integration secures a better deal not just for patients, but for the taxpayer also. Some say for every £1 spent on social care £2.65 is saved for the NHS.

For six more weeks I am due to be on crutches and during that time Parliament will consider a draft bill on reforming social care as well as an update on the cross party talks on finding a solution to the question of who should pay for social care and how much. Quality of care and fairness need to be at the heart of the reforms. I will be working hard to make this a reality before I return my crutches to the hospital.

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