It’s a problem that wastes hundreds of millions of pounds every year while causing untold damage to the health of frail older people admitted to hospital for treatment for an infection or a fall - and then trapped there because they are unable to be discharged. Ending this appalling failure of care will be complex and require innovation - as I found, when I investigated the issue for an article that appeared in the Daily Mail this week, http://dailym.ai/1FqTjyP.
1. Therapists need to work 7/7
Hospitals pay medical and nursing staff over the weekend - but they can choose whether to fund occupational therapists and physiotherapist seven days a week. That’s not because therapists themselves are unwilling to work weekends. ‘We’re happy to help + fully support well managed 7 day working’, tweeted Lorraine Bridges of the College of OTs in response to my piece. Let negotiations begin.
2. Keep the old and frail out of hospital
Several readers described how their relatives had been trapped in hospital after being admitted for relatively minor conditions - especially out of hours when, as Prof David Oliver, President of the British Geriatric Society point out: ‘A&E is the only place where the lights are on’. Once pulled out of their routine, it’s more difficult for frail older people to maintain their health and independence. What’s more, as well as being trapped in hospital, they’re also more at risk of being sent home too early (http://dailym.ai/13Cw17u). Keeping the lights on in general practice has to be normal.
3. Focus on discharge from the moment patients are admitted
Personalised care is the future of compassionate, effective medicine. For frail older people, that means ‘only keeping them in for as long as hospital is the best place for their needs to be met’, says Prof Oliver. The whole team, perhaps led by occupational therapists, should prioritise planning for care and support after patients are discharged from hospital.
4. Coordinate with practitioners in the community
‘What’s the point of having OTs available at weekends to discharge patients when their opposite numbers in the community aren’t available,’ ask OT readers of the Mail. True - but by prioritising the patient’s journey from essential admission to hospital and back to their place of residence, it has to be possible to get the right people at the end of the right phone at the right time. Decide who should take responsibility for making this happen.
5. Convalescence matters
Convalescent homes may be part of history but people still need to take it easy for days or weeks following surgery or acute illness - and for those living alone or with multiple chronic problems, that’s not straightforward. Care homes that offer convalescent beds could be one answer; another could be ‘Home from Hospital’ programmes involving ‘collaborative relationship’s between hospitals and community care services that provide daily support for people in their own homes. That means hospital discharge managers taking a pro-active role in setting up these relationships instead of ignoring invitations to get involved - as so often happens, according to Angela Gifford, director of Able Community Care.
6. Home helps - a case for renationalisation?
The Home Help service was privatised in 1990 with hundreds of profit-based organisations set up over the last 25 years, many, sadly, providing inadequate care. In its first ever guidance on social care issued this week (September 23 2015), Nice has criticised five-minute visits that are the norm. And not a moment too soon: this is a social issue with a direct impact on cost-effective and efficient health care. With the question of renationalisation of services back on the political agenda and the need for home care greater than ever, is it time to consider the renationalisation of this crucial and previously well-run local authority service.
7. Use words carefully
If you want to stop ‘bed-blocking’, stop using the term, says Prof Oliver - and he may be right. It’s a phrase that appears to express a big problem in a couple of words and therefore widely used in the press as well as by charities and even the NHS. But the College of Occupational Therapists ‘firmly rejects the term’ - something the rest of us should be aware of. Also avoid talking about: ‘the elderly’ for the same reason you wouldn't use a single word for people with epilepsy or diabetes.
My view on what counts in healthcare
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A way forward for quality peer review
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Blind faith that the publication of medical research in peer reviewed journals elevates a study to the status of “the evidence,” and therefore “the truth,” may be on the wane among those in the know. But for the public, and a vast number of doctors, this “naïve and misplaced” credulousness persists.
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