My second image of later life looks at the other end of the health care system. The acute sector of the NHS looks after us very well throughout our childhood and our working adult life. At its heart, the doctors and nurses do a good job of getting us better when we really need them, which is why they have been held in such high regard since the NHS was formed on the 5 July 1948 (63 years ago today!).
So what has gone wrong for the elderly? :-
- The numbers of elderly people are increasing faster than NHS resources.
- More things can be done to keep people alive for longer – e.g. hip replacement, recovery from heart conditions, etc.
- The elderly are living longer so acquire more chronic conditions – e.g. arthritis, diabetes, etc.
- Their condition is often complex and needs input from more than one specialist.
- They take longer to recover so don’t fit easily with the new fast track NHS; rather they end up being seen as bedblockers.
- Finally dementia/confusion is a feature of many older people’s condition which adds significantly to the caring work load.
Elderly people are a problem for NHS hospitals from start to finish and we should recognise that and adjust the approach to acute care of the elderly. Acute hospitals still need to be there for acute conditions and surgical interventions, but many elderly admissions are for preliminary assessment which would be better done in less extensive and technological diagnostic environment, with less specialist consultants. A bit like a cottage hospital but to give it a new name, lets call it a “Health Improvement Centre”. Many elderly people may then never need to move on acute hospital care. Equally after acute treatment, elderly people could be moved to this less expensive provision to be allowed to recover more slowly than young patients. So what does this new facility look like?
Well the first thing is it’s not a hospital at all. It is a virtual care environment where you stay where you are and the doctors and nurses come to you. Equipped with more sophisticated diagnostic tools and backed up by properly trained specialist nurses for the elderly. Available in your own home for a time limited period and paid for by your private health insurance. Yes it is more expensive than at present but its better quality. The health outcomes will need to be proven to be better and recovery times will also need to improve. The good news is that there is far less risk of cross infection (MRSA, Norovirus and C.Difficile). There is also better opportunity for family support.
People who cannot stay in their own home may need a short stay at the Health Improvement Centre for initial observation and assessment. Equally after recovery from acute treatment in hospital, they may need to convalesce or receive high quality rehabilitation in the Health Improvement Centre. This would obviously cost rather more that care in your own home and should be funded out of a re-allocated NHS budget.