BBC radio 4 Today’s programme for 13/05/2015 http://www.bbc.co.uk/programmes/b05tllvh
picked up on two of the big themes that will be central to concerns in Health
and Care for the foreseeable future.
The first is a cry for help from care staff working for a
private sector care company. Staff have drawn attention to the fact that they
are being expected to “clip” the times on Home visits, to make it possible for
them to travel to their next appointment, and have on occasions been told to
leave a patient who has fallen, where they are, on the floor, with the door
open for the emergency services to come in. I suspect that we will see much
more of the same. The interview then went on to talk with Andrea Sutcliffe from
the CQC. John Humphrys from BBC Today characteristically
went down the path of blaming the individual care providers and demanding that
they should be penalised. I think he is missing the point.
The second is that the Academy of medical royal colleges is
asking GPs and the public to avoid asking for unnecessary interventions. The
£22bn cost savings that the NHS has agreed to make, in order to get the £8bn
injection of cash from the government (from a source that is not yet specified)
will mean that the health service has to stop doing things. The interview with Dame
Sue Bailey of Aomrc shows that Aomrc
advocates working closely with patients to help them understand when
interventions may be of limited value.
http://www.bbc.co.uk/news/health-32703632
Both of these items show the financial pressures on our
health and care systems are huge, and show that meeting the growing needs of
the next few decades is going to be pretty challenging.
From the view point of Stafford it is clear that the
problems in our acute NHS, both at the time of the exhaustively documented local
problems in 2006/7 and now, is that there are many people within the hospital
system who would be better off being “somewhere
else” if the “somewhere else” exists.
Successive governments (and perhaps also voters) for the
last two decades or more have dodged the questions of where should frail
elderly be cared for, by whom, and how should we pay for it.
There is broad acceptance that the only way the NHS can be
made to cope is by much closer integration with the social care services. The
details of what that should look like are in many cases still to be worked out.
So far it seems that the only people who have fully grasped
the implications of the fact that to cope acute hospitals must discourage
unnecessary admissions, and must discharge patients more quickly, are the entrepreneurs
offering private sector care schemes. The result of that is that we are seeing the
growth of a whole range of social care providers, with care staff, often on
minimum wages, being forced to travel some distance between one “customer” and
the next. Even if these schemes sincerely wish to provide excellent services,
the cards are stacked against them.
We need to understand what integration really means, and we
need to think carefully about realistic ways of delivering an integrated
service.
Private sector care providers have a simple objective. They
need to get into homes for the time specified by the person paying for the
care, and deliver the specified service. What an integrated service needs is
for the care providers to be a key part of the whole business of monitoring the
health of the individual, calling in additional help when required and doing
what is necessary to help prevent the individual from having to go into acute
care. An integrated service also requires that if an individual is discharged
from hospital they can receive the additional help they will need during a
period of rehabilitation.
Do the private sector companies that exist now have the
necessary skills and motivation to play this role?
To me this seems to be a key moment. The Health service is changing
and the care service must change too. Do we know what we want to see? How can
it be made to work for both the individual “customers- patients” (I don’t even
know what words we should be using) and for the individual carers providing
these services.
As care shifts from hospitals into people’s homes, there
will be a constant stream of stories about people left after a fall, without
food, without company, without access to WCs. We know this will happen. What
are our views on this? Is there a better alternative?
It is a depressing picture, but we have to find our way
through this. For me there are at least
some pioneering projects pointing us in
better directions. I would strongly
advise that people should read Atul Gawande Being Mortal http://atulgawande.com/book/being-mortal/
This matters because it looks at the distressing
effects of unnecessary treatments, and looks at different ways of providing the
essential social care that we must provide.
I would also advise looking at the Buurtzorg model http://www.kingsfund.org.uk/sites/files/kf/media/jos-de-blok-buurtzorg-home-healthcare-nov13.pdf
This very local approach is where I would wish to start in the process of
building integrated care that works.
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