I think overcoming this one - 'Or even worse, current financial constraints mean that it may be in their interests to introduce delays in order to delay spending' - is likely to be a serious challenge.
Fundamental problem is we all work in silos and compartmentalise the care. Too many leaders working in too many organisations and care is fragmented. social services do not work 7 days and our NHS also doesn't work 7 days.
Hopefully 7 days NHS, Vanguard and Devomanc will give us fantastic opportunity to get this right. NHS must stop over treatment, under treatment and wrong treatment and for that we need good medical leaders with good values and excellent staff engagement and governance right.
Out main problem at present is difficulty in recruiting elderly care consultants due to national shortage and this is something Royal College has to address. Sad reality is when there is shortage of doctors quality comes down and cost increases and patients suffer.
In my view the problem is simply down to funding. When I consider the excellent care for hip fracture management for all the elderly, it simply comes down to rewards being attached to good care.
What is now needed first is for funding to be attached to excellent elderly care. Everyone caring for our elderly understands how to make things better but often the resources and systems are not adequately in place.
Legislation has to be put in place to ensure that funding follows the elderly and everything will automatically line up.
Trusts will be rewarded for excellent Care for the Elderly
Social Services will be financially incentivised to provide high quality services.
The private sector will become interested in the provision of care.
At that point we can look at how to make the care efficient. Until we reach there it only be words and no action!
THERE IS NO POLITICAL VOICE FOR THE ELDERLY!
Well explained why is it more difficult than ever for older people to leave hospital. informative and concise.
I am currently working in an integrated role between social services and hospital teams to facilitate discharges with complex and stranded patients.
There are many issues that block discharges, namely lack of domiciliary packages and residential beds in the private sector, families not understanding that you cannot just place a person in residential care and prevent them going home because they don’t agree and they won’t support them, ward therapists not being aware of specialist equipment available in the community or being risk averse, requesting double handed care packages which cannot be sourced.
In addition, NHS funded pathways are timely to put in place (CHC and Fast Track) which in my opinion is a political tactic- managers protecting their budgets and spends, health and social care budgets should be joint, this would save a lot of time and money.
Some patients and families use hospital beds as a way of accessing free care, others are frustrated at the bureaucracy when they try and get people home and are blocked by staff afraid to manage risks.
To compound the issue a local rehabilitation hospital that specialised in geriatric medicine was closed, land sold to private developers and is now a housing estate, this was replaced by 1 ward in the acute hospital. Meaning that patients that required recuperation and time to organise a more complex discharge are in an acute bed in a general hospital as the rehab ward is full.
Social Care Occupational Therapists are highly successful in preventing hospital admissions in the first instance which is largely not documented or audited to demonstrate this. More social care occupational therapists working jointly with health staff will facilitate safer and more timely discharges, as we are able to follow the person back out into the community and mitigate risks with primary care support - GP’s, community based nurses and care providers.
Without a collaborative approach from central government, NHS policy makers and local government to implement change this will only continue.