This is not directly on-topic because it is related to the demanded "efficiency savings" in the NHS, rather than to privatisation. I put it here because the topics are related.
http://www.guardian.co.uk/society/2011/dec...eatment-elderlyThe article is about a report on a "waste of resources" within the NHS. According to the authors a lot of money is being wasted because some people stay in hospital longer than is necessary and a great many of them are elderly. We see the by now familiar fig leaf of apparent concern for people's welfare. As people who are out of work for more than a fortnight lose the will to work, so people who are in hospital for more than a fortnight apparently become depressed and/or lose their independence. It is quite interesting how a fortnight is a watershed for all sorts of long term changes arising from use of government services, such that people's whole outlook is affected. Or it might be nonsense: you decide.
What this report is mainly talking about is the care of people who are elderly and who are admitted to hospital as emergencies because they have pneumonia or have broken a hip, or things like that. The authors consider that a stay of more than 2 days is seldom necessary and they say that it costs the health service a lot of money. Planned admissions do not take up unnecessary bed space, but the emergency ones do, and this has to change if hospitals are to meet the "efficiency savings" demanded of them. I suppose it is inevitable that each service will focus on its own financing because that is how things are structured: but it is completely at odds with any notion of integrated service.
You may not be aware, but the issue of "bed blocking" by the elderly has been a problem forever. It is one of those issues which comes up from time to time in the press and in politics and we hear just such arguments as are again contained in this report. I am aware of it because of my work: when the hospital wishes to discharge someone they pass responsibility to the social work department for services: we have regular fights about this because the SWD has no more resource than the NHS and hospitals have been rather odd in their ideas about what is reasonable: I have often had calls from NHS staff demanding a full package of care for a vulnerable elderly person who is to be discharged that afternoon. That has improved in recent years becaue there has been a slightly better mutual understanding of the different pressures NHS and social care staff are facing: but this report ignores all that, and talks of discharge within two days if a person has broken a hip.
If someone is to be discharged from a hospital you have to know what they need in terms of care, including equipment. An occupational therapist has to assess the need at the point of discharge and then has to make equipment available if the person is to go home: such things as aids to allow them to get into the bath so they can wash or special chairs so they can get up if they are mobile enough to do that. It is not all rocket science: but it is essential. And OT's are in heavy demand and their budgets are such that if you happen to need equipment between January and April there is likely to be a problem. Alongside that assessment there has to be a package of care which suits the need and that needs to be assessed too. And then someone has to be identified to do the tasks required. And the money to pay those people has to be applied for and agreed. These things take time to do properly: two days is laughable.
Think about that for a moment. A frail elderly person with a broken hip is to be discharged from hospital in two days, they say. Now it is perfectly true that once that hip is set, and assuming no other health problems come to light on admission, the person does not really need health care as such. So on the face of it they need no be in hospital. Hospital care is, as they say, expensive. Adequate care of any kind for such a person is expensive, as it happens. The relative costs of out of hospital care are lower, as the article says: but as we have seen that is because the payments to residential homes are inadequate to meet the costs: so homes are closing. It is perfectly true that this is in part an artefact of the privatisation of those services becaue much of the cost comes from the need to pay rent to related companies and the associated profit. It doesn't matter. This report is not concerned with what should happen at a wider political level: it is about money. There are not enough beds in residential care homes and there is concern that there are likely to be fewer in the future because the costs will have to rise if the current arrangement of buying care from private firms continues: and there is no suggestion it will not. This government is not going to nationalise care: you can take that to the bank. So for very many people there will be no bed available in a care home.
Even if that were not true, you have to consider the effect of discharge to a care home for people who are depressed by hospital care and by "long" stays. If it is the case that they are concerned about a loss of independence then a move from hospital to residential care will not alleviate such fears. Quite apart from the disruption such a move entails many people understand and trust that a stay in hospital is temporary, and expect to go home when they are well. That is not how they see residential care, however. For many people they see a move to residential care as permanent. That would change if there were more short stays of the sort we are discussing: but so long as the report chooses to tell us how people react to the decisions taken about their care, then my experience of that is valid: and that is how many people see it. This is at least as depressing as a fortnight in hospital: but it does not suit the authors of the report to focus on people's reactions when it is not in support of their money driven agenda: so they don't. At least if they do it is not evident in this article.
It is said that most people prefer to be at home. If home is a safe and comfortable place where your needs are met, that is probably true for most. It is not true for everyone even when they are healthy: it is true for fewer when they have a broken hip. That is because you are not mobile if you have a broken hip. You are not really well placed to make a cup of tea or use the toilet, or get up and dressed. If you live alone ( as very many elderly people do) it is quite scary to be ill and alone and dependent on carers. Leaving aside the recent findings on inadequate home care through callousness or lack of training or neglect, home care is underfunded and not readily available. It has also been privatised, very largely.
What that means is that home carers do not have time to do what they are required to do properly: and they don't. In practice what happens is that they go in maybe three times a day: half an hour in the morning to wash, dress and prepare a meal for the person: 15 minutes at lunch time for another meal: and half an hour at night to put the person to bed. I say at night: you need to be aware that the constraints of staff etc often mean that folk are put to bed early: by early I mean 8 pm. For folk with a broken hip that means they are stuck in bed from then till the carers arrive the next morning. It is unfortunate than many elderly people don't sleep well: it is a long and lonely night when you can't sleep: are in pain perhaps; can't get up to make a cup of tea or whatever: and can't use the toilet. Did I mention that elderly people often need the toilet through the night?
Some people have a good social network which can supplement this level of care: they have friends or family or a church or whatever: and many people don't. If you are 85 many of your friends will be dead, or themselves unfit. Family might live hundreds of miles away; or may not exist. Many elderly people are quite isolated and have no links with church. Clubs and activities they may have previously participated in will sometimes generate social support: but by 85 you are not likely to be still bowling or playing golf or whatever you used to do. Those links also diminish as you age, for most people at least.
In the past it was part of a social worker's role to visit people who were at home or in temporary residential care: we used to have some time to do that and so would be aware of problems with the care package: that is much less possible now. We are now "care managers" and what that means is we commission services from private companies, mostly. We have no time to visit and talk to the people concerned in the way we used to. That is the model for "community care" and it leads to vulnerability for the elderly as much as any group. Their safety is dependent on the regulator, and we have already seen how effective that is.
But we must make "efficiency savings" and so none of this matters. The costs are to be transferred from one inadequately funded service to another inadequately funded service on grounds of cost: and all that matters is the bottom line.
