Andrew Vine: A halfway house for hospitals can cut bed blocking and tackle social care crisis

Greater care in the community will help elderly people recover from hospital treatment, writes Andrew Vine. Do you agree?
Greater care in the community will help elderly people recover from hospital treatment, writes Andrew Vine. Do you agree?
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LIKE anybody else with an elderly relative who is in and out of hospital on a regular basis, I worry a little bit more about the plight of the NHS on every visit.

The staff rushed off their feet, the frequency of seeing an anxious son or daughter asking when a bed is going to become available for a parent, the buildings that are clean but have obviously seen much better days – they all speak of a service clinging on by its fingertips.

Care of the elderly is one of the country's most pressing issues.

Care of the elderly is one of the country's most pressing issues.

Tom Richmond: bed bound with a broken hip and cancer but deemed well enough to go home – my experience of social care in the UK

Hospital staff I’ve been chatting to at visiting times have told me of their relief that the winter just past was relatively mild, and hadn’t brought the overwhelming influx of elderly patients with respiratory problems that the previous year saw.

That’s a small mercy to be grateful for, but even without the additional pressures that a severe cold snap brings, things were tight on the ward where my relative, who is in her late 80s, was being assessed after falling, breaking an arm and, in the process, suffering a nasty bang on the head.

As so often with an already-frail patient, the injuries and their treatment were not straightforward, having to be judged and monitored against a background of other long-term medical problems.

And likewise, everything the hospital did for her had to be weighed against a background of the care she would need once discharged.

Washing, dressing and making something to eat were all going to be problematical, and the psychological effect of that on someone who prizes her independence is hardly less debilitating than the physical injuries.

This is the dilemma facing tens of thousands of patients, their families, and wards across the country every day.

What happens afterwards? Is there a sufficient network of family, willing neighbours and friends to cobble together enough support during recuperation? The answers to these questions are so often uncertain that the only safe option is to keep the patient in hospital, even when past the need for acute medical care.

The result is bed-blocking, costing the NHS £3bn every year. My relative has been part of that statistic more than once.

But now there’s an answer, and I really hope that the politicians who talk up the NHS but don’t always match the rhetoric with resources have the sense to grasp and develop it.

For the first time in about five years of frequent stays in hospital – each with a difficult aftermath – she was transferred to a community care bed in a council-run nursing home.

She can have up to six weeks of residential care under the supervision of medical staff, and a structured rehabilitation programme, including physiotherapy, which will work on her mobility to reduce the risk of suffering further falls.

It’s not just the medical care. The help with washing and dressing, the absence of worry about making meals, and being able to get proper rest in her own room, rather than on a busy hospital ward with its inevitable round-the-clock activity are all of immense help in her recovery.

Consequently, she left hospital without an undercurrent of worry about being able to cope, irrespective of how much family and friends rallied round to help. It’s been touching to see the lift in her spirits this has produced. And it’s not just her.

There are others on similar programmes in the same home, and they too are gaining in confidence from not just being looked after, but made ready to go home.

Of course, the eternal problem of resources besets this sort of care. There are not enough places to go round, and that’s why the Government should pump money into them.

They relieve pressure on hospitals by freeing beds, and by placing emphasis on getting patients as well as they possibly can be before final discharge reduce the likelihood of their needing to be re-admitted.

If our NHS is to cope with the ever-increasing number of elderly patients as people live longer, this broader model of care is the only realistic way forward.

Hospitals can’t be expected to embark on weeks of rehabilitation once medical issues have been addressed, but nor can frail and vulnerable patients simply be sent home to cope as best they can.

There can be a cycle of repeated hospitalisation for a lot of elderly patients like my relative, in which one bout of illness follows another, partly it seems to me because there is a never a complete recovery from each.

Breaking that cycle by having a halfway house between hospital and home where there is the time and professional support for proper recovery is not only cost-effective for the NHS, but it is also the most compassionate course of action.

For once, amid NHS problems that often seem intractable, this looks like a way forward. It has a cost, but so be it. It’s worth it.