We’ve seen a lot of discussion over the past week or so about the ‘problems’ created by older people who sometimes remain in hospital when there are no appropriate and suitable services in the community to assist in their rehabilitation goal – which is callously referred to in policy-making ivory towers as ‘bed blocking’ – a term I’m wholly opposed to.
Last week, Mike Farrar, the Chief Executive of the NHS Confederation stated that 1 in 4 people who were in acute hospital beds could recover at home if better support were available.
Over the weekend, the government in their own now predictable fashion, entered the ‘policy making’ platform by flinging £170 million at the ‘problem’ of older people taking up these valuable hospital beds. That computes according to this article in the Guardian as a one off payment of £1m to each council to help deal with this awkward problem.
The thing is while not wanting to scoff at money offered, it’s hardly the best targeted or thought through way of delivering a better system of care for older people.
Until we stop thinking of older adults as a ‘problem’ and their need as a developing ‘crisis’ it’s hard to imagine how we can move on from where we are – where one-off payments will need to be launched towards local authorities who are struggling in the face of having to cut services.
There needs to be a real change in the systemic process of both health and social care rather than a shifting of funds between one and the other.
The Telegraph refers to a letter published from 60 charity directors, independent experts and government advisors demanding a reform to home care services in England and urging the government not to abandon Dilnot’s proposals to change the way that adult social care is funded.
Dilnot is a start. The problem as I see it ‘on the ground’ as it were is that as the costs of social care are rising, people are less willing and able to pay for it.
This means that people are more likely to refuse preventative care or care which will avoid a more hasty deterioration which will end up being much more expensive in the longer run (not just in terms of cash but in terms of quality of life and stress to carers).
I’ve had far more people turn down services that I have assessed them as needing due to the costs involved and this is the hidden ‘secret’ of the rapid extension of the personal budgets agenda is that they are chargeable and some people end up being charged the same amount that they will receive which makes us all wonder about the level of paperwork and documentation required in the meantime.
We need to look at answers rather than just see problems and my solutions would be as follows:-
Implement the Dilnot recommendations. I don’t agree wholeheartedly with the report, to be honest, but it’s better than what we have
More synergy between health and social care budgets – whether that’s by better links at the ‘top’ or by implementing cash incentives, we can’t have the constant shift of budgets between one and the other.
If money is going to be thrown at supporting hospital discharges, please please can it be well-planned and not just hurled at the situations which are easiest to manage.
A genuine desire to implement the principles of personalisation in residential and nursing care for older adults – which can’t be done ‘on the cheap’. As a nation, we should be embarrassed that we care for older adults in residential homes that have 60+ residents. More and different models of caring must be piloted and tried.
Personalisation agenda must move away from the ‘delivery of direct payments at all cost’ as the ‘best’ outcome. Yes, that works for some but there needs to be greater consideration of other models of developing individual budgets, namely through Individual service funds and trust funds and perhaps other models.
Most importantly, as I mentioned at the start, we need to move on from the explicit ageism that occurs when we only see older people as a ‘problem’ to be solved. That is where the loss of dignity comes from. We have allowed it to happen because we don’t want to look and see it but as we get older, we will have to, and we will remember how our generation cared for our own parents and grandparents and wonder why our children and grandchildren don’t do better for us.