We talk with hospitals up and down the country and most hospitals are dealing with lists of over 100 medically fit patients ready to leave hospital. It is upsetting that elderly people who are ready to leave hospital are stuck there over Christmas while people wait longer for admission.
What is adding to this picture is our unseasonal December election. Usual winter funding has not appeared across the board and with that, a kind of stasis has emerged across the NHS. The impact is felt in these headlines and sadly by the people seeking help at A&E and the older people who are unable to leave because support for their discharge is not available.
The bottom line is that once medically fit, staying in hospital is not good for older people. While they are in there, sick people who need the beds face unreasonable waits, or are sent home or placed into temporary beds in the wrong ward for them across the estate.
35% of 70-year-old patients experience functional decline during hospital admission in comparison with their pre-illness baseline; for people over 90 this increases to 65%.
NHS England Guide to reducing long hospital stays, June 2018
Helping people out of hospital takes focus and determination. At the moment we are working with many hospitals providing intensive support to help speed up discharge. Because we are a dedicated family liaison workforce with unparalleled knowledge of local care provision, we can make a big difference the minute we have boots on the ground. We can deploy within two weeks and our KPI for discharge is five days from referral. This is making a real difference to day to day operations in these hospitals.
We’ll soon have a new government and in the run up to his election we have all heard ad nauseum about how they would ‘fix the NHS’ whether that is building more hospitals, a milkshake tax, a public drug company or ending hospital parking charges. The solutions to social care were notably absent.
We need a proper grown up public debate about how we want to care for our elderly and those that need complex care. What’s missing for me in the relentless headlines is what it feels like for a patient and their family when they are faced with choosing care – the options, funding models and maze of processes and assessments. The lack of investment in social care may also be exacerbating the perception of risk from medics for older people going home. If you are caring for a patient and you lack confidence in what support is available for them in the community, you may be less inclined to send them home. There is a big challenge here but also an opportunity to build a system which is integrated and not about protecting siloed budgets.
All of this will take time. What we can do this winter is help people ready to leave out of hospital and into the right care in the right place, quickly and safely and that will make a difference immediately. Let’s get started.