IT’S amazing what you learn when you spend three hours waiting in an A&E department. I had occasion to visit our local hospital last week with my daughter, Lizzie, who had banged her wrist at school.
As we sat there in the paediatric waiting room, I fell into conversation with several other women. One lady was anxious because she had been obliged to come out of work to bring her son, who had a bump on his head. Time was ticking by. She huffed and puffed and kept looking at the clock.
“Don’t blame the doctors,” said a young woman beside her. “At this time there will be only two on. And that is for the whole A&E department.” It turned out that this young woman worked in a care home for the elderly when she wasn’t accompanying her little sister to casualty with a suspected broken arm.
In this, she was well-placed to pass comment on the failings of NHS care. She had been to A&E more times than she could remember, accompanying senior citizens to hospital. She knew there was no point complaining. The doctors were prioritising. A waiting room full of children with nothing too seriously wrong with them would not be top of their list.
Her comments would have been welcomed by the Care Quality Commission (CQC), which has released its annual assessment of care in England. The respected watchdog warns that A&E departments are buckling under the pressure of a social care system which is reaching its “tipping point”.
Margaret Willcox, vice-president of the Association of Directors of Adult Social Services, says there will be serious consequences for care providers, carers, the NHS, and elderly and vulnerable adults and their families unless the Government addresses the under-funding of this sector.
Three out of five hospital trusts have been told they need to make improvements, especially in acute care such as emergency and medical services. However, one insurmountable problem presents itself. It is happening far away from the frontline of the A&E departments, but it impacts directly on the entire operation of efficient emergency medicine.
Adult social care is simply failing to meet the needs of an ageing population. This means that too many elderly people are suffering from illnesses and serious health issues which should be tackled before they require emergency treatment.
Dehydration. Breathing difficulties. The common cold. All conditions which can be given effective early intervention by proper first-hand care and a readily available general practitioner. The problem is too many elderly and vulnerable people simply do not have access to such security. This puts pressure both on frontline resources and beds on hospital wards. When older patients have been treated in hospital and discharged, the care they return to may not meet their needs. A vicious circle develops, with confused, unwell and vulnerable elderly people at the centre.
I’ll give you an example. A friend of my father’s, aged in his 80s, had to undergo an operation on his eye. Less than two hours after the procedure had finished, he was back out into the hospital car park and on his way home, with the instruction to return the next morning at 8.30am for a check-up.
He wasn’t regarded as an urgent case, so securing a bed for him would not be a priority. Yet this was at a hospital more than 10 miles from his home address. If he didn’t have a son willing to drive him, what would his chances of recovery be? At least this chap can be looked after by his family. What of those who are too ill or too isolated to be supported in such a way? Their lives could literally, be in peril.
The CQC says that despite a 33 per cent in the number of people aged 85 and over in the last decade, the proportion of people receiving local authority care has actually declined. The provision of nursing homes is not increasing in line with demand. More worryingly still, it is reported that care home providers are pulling out of local authority contracts because the funding available cannot cover the necessary costs.
It stands to reason that when care is not efficient and sufficient, something has to take the strain. And this, as we all know and the CQC report confirms, is too often the A&E department of the local hospital.
It is clear that there is only one solution. And that is a sharp injection of cash. Caroline Abrahams, charity director at Age UK, raises a flag. She points out that next month’s Autumn Statement is an opportunity for the Government to give social care the priority it deserves in terms of public spending. Will the Health Secretary listen to her plea? If previous form is anything to go by, it seems unlikely.
Lizzie’s wrist turned out not to be broken. This is more than can be said about the NHS itself. Jeremy Hunt should look beyond the platitudes and promises he makes, and come and experience what the public must endure.