The provision of care in the UK is in need of a co-ordinated approach.

This article looks at the challenges faced by the NHS when it comes to elderly care and hospital discharge; social services in supporting vulnerable older people; and families seeking care at a stressful time.

There is an increasing need for care at home given the ageing population and the increased pressure on the National Health Service. There is plenty of evidence to suggest that the NHS can struggle to send patients home because the lack of care available. Currently, on any given week, over one hundred patients – medically ready to go home – are awaiting a care package in each hospital in Cheshire. The longer they remain in hospital, the more they are at risk of their underlying conditions deteriorating. This means they may need more care to re-establish independence when they do return home.

Discharge Teams work tirelessly to improve the flow of patients through their hospital. If those who are ready to leave cannot, then that simply means someone awaiting a hospital bed is lying around in A&E. In turn, that leads to those needing emergency care being treated in hospital corridors or other inappropriate locations. And that leads to ambulance crews being unable to discharge those they have brought to hospital – and they sit about awaiting hand-over to the Emergency Teams. Ambulances ‘stuck’ at hospital means they cannot attend emergencies in a timely manner. Anything that is not an emergency is then shunted to the back of the queue. Thus an older person who has fallen at home – and needs medical attention – can face excruciatingly long waits for help. It is a vicious spiral – in a large part due to the inattention successive Governments give to social care. It most certainly isn’t a co-ordinated approach to care for our loved ones.

Families Under Stress

This in turn brings about huge pressures on the families of older people. My own experience of waiting with my father after a fall in his home bears testament to the above. I only live 2 minutes away, but I had to drop work and family commitments to rush to his side. He was hurt too severely for me to attempt to get him upright and into bed. Although my Mum was there to keep him company, it took two of us to attend to Dad’s personal needs whilst he waited 8 hours for the ambulance crew (and I know we were lucky the wait was that short).

For others, this is an impossible situation – whether due to time constraints or distance from their loved ones. People are often isolated from family and friends, and may not have a network of readily available neighbours and volunteers to help when somebody needs care. In the past families weren’t so geographically dispersed and therefore more in touch with each other. An aunt, cousin, niece or nephew could step in – but those days are generally long gone. As a result we are increasingly reliant on agencies to step in and provide care workers to support our nearest and dearest. The agency model of care can serve us well. Other models of care may rely on friends and family stepping in or perhaps a ‘friend of a friend’ will provide a private arrangement of care. The last resort is a care home. However, research tells us that 69% of over 75s do not wish to go into a care institution when it comes to old age and frailty.

Many families turn to their Local Council and their Social Workers. However, due to their caseloads, only the most vulnerable and needy clients are dealt with swiftly. This is not the individual social worker’s fault but it leaves many families having to work out the care situation for themselves, with little understanding of the system. This is especially true where the client has sufficient financial assets to fund the care themselves. Knowing what level of care is needed to be put in place to allow a safe hospital discharge – and where to find that when under pressure (and possibly hundreds of miles away) – is very stressful. An independent social worker may help in this instance – giving that co-ordinated approach to care by guiding families through ‘the system’ – talking with their loved ones to understand what is needed and the right agency work with.

Some Solutions

Hospital across Cheshire are also working with charities and social prescribing providers to help ease the backlog of bed-blockers. Sometimes care cannot be provided because the home is not in a suitable state. Working with volunteers, the home can be spruced up and made safe. With adaptions directed by the Occupational Therapy Team, a person can return home safely. At other times, a package of care may not be needed at all. So long as the person can take part in activities and have companionship locally, then they can return to health and independence. This is social prescribing – and Cheshire works with a number of different organisations to deliver this much more co-ordinated approach to care.

Discharge Teams, Social Workers and other professionals can also explore new models of care – such as live-in care – to speed up hospital discharge. With live-in care, a carer resides at a client’s home so they are present around the clock to give care and companionship. This is a wonderful alternative to a care home, and may be more readily available than timed hourly-care – especially in very rural parts of the county.

Ultimately, hospitals, socials services, charities, social prescribers and care agencies will have to work together to deliver this co-ordinated approach to care in Cheshire. Families need to be sign-posted to the right services and agencies for them and their loved one – and be given far more understanding of what is needed to allow them to regain independence. The sooner all the stakeholders the NHS and Local Authorities work together with charities and private care businesses to deliver a more seamless service the quicker the curse of delayed discharges can be solved.