By Gabrielle Silver
Over the last week there have been significant developments around the management of the coronavirus with a lot of advice directed towards older people who may be at risk.
On Tuesday (17 March) in a letter sent to the NHS, Sir Simon Stevens asked for a range of measures to be implemented to help the NHS cope though the coronavirus pandemic. One of these was that the NHS cancel routine elective operations and another that they urgently discharge any patients medically fit to leave. At a session with the Health Select Committee he said:
“Community health providers must take immediate full responsibility for urgent discharge of all eligible patients identified by acute providers on a discharge list. For those needing social care, emergency legislation before Parliament this week will ensure that eligibility assessments do not delay discharge.
“This could potentially free up to 15,000 acute beds currently occupied by patients awaiting discharge or with lengths of stay over 21 days.”
This is an important moment. We know that older people who are medically fit to leave and remain in hospital suffer physical and mental decline. As an NHS geriatrician we talked to recently said in a blog published on our website.
As they wait for a package of care they are at increased risk of infection, all the while deconditioning, losing confidence and becoming institutionalised. And these are frail and elderly people who have a life expectancy of perhaps two or three years, but six months of that is being taken up by delays in navigating a broken system. Sadly, it is not uncommon for them not to make it out of hospital.
This comment is reflecting on the situation during a normal winter. Remaining in hospital in the current pandemic scenario they also stand to be exposed to the virus which would not only have a huge impact on their health, and possibly be fatal, but also add to the demand for care through the NHS at a time when this demand is at unprecedented levels.
Avoiding readmission into hospital is also of paramount importance and this can only be achieved through a dedicated focus on ensuring that patients are discharged with the right care package to meet their needs either at home or in the community. Where a provider is caring for someone with needs beyond their facilities and experience, they are more likely to become ill and return to A&E.
Realising capacity is an urgent matter but pace and quality do not need to be at odds. There is capacity in social care – it needs to be carefully managed. Deep local insight and knowledge is crucial to understanding where this is and what people it will suit best.
This is a particularly challenging time for families as they navigate care for loved ones in a highly anxious environment. Our teams are working in trusts across the country right now and support over 20,000 people to find care each year. We are dedicated to helping and supporting families to make choices about care and we have unrivalled knowledge of the local care sector. We have also adapted our ways of working with our teams support remotely supporting patient safety and infection control measures.
We know this is a tough time for the NHS and our teams are supporting across the country. We’re proud of the work they are doing and we stand ready to help wherever we are needed.