THE BLOG

The Perfect Storm? Tackling the NHS Crisis Isn't Impossible

08/01/2015 13:07 GMT | Updated 10/03/2015 09:59 GMT

Apparently on Christmas Eve in Norfolk where I live homecare providers had no spare capacity to look after any more older people in their homes. This prevented hospital discharge and made hospital admission more likely.

In addition GPs were shut for the Christmas holidays. The first point of contact for the NHS therefore was the 111 service, which in many cases was advising patients to attend A&E or call an ambulance, or A&E itself.

By New Year's Eve the pressure on A&E at the Norfolk & Norwich hospital was intense. Late morning that day thirteen ambulances were stacked up outside the hospital, with patients being assessed inside ambulances. The hospital declared a major internal incident as it tried to clear A&E.

Similar situations have happened and are happening across the country. All this has taken place before severe winter weather has hit the country and without a flu or other epidemic.

Some commentators have also suggested that expectations in the internet age have risen so far and so rapidly that everyone expects treatment 'right now' for their medical problem however big or small. The baby boom and the ageing population are adding to the numbers of young and old needing care.

All in all, a perfect storm. All of the above require attention - this is not a problem that has one quick fix solution or can just be addressed by more resources (human as well as financial), important though they are. Looking at the whole system points to some answers.

Keeping people, particularly older people, out of hospital must be key. Preventing admission, supporting discharge and reducing re-admission to hospital are fundamental.

Sorting out the 111 service is crucial so that better advice is given as early as possible. Even better, as one GP tells me, would be ensuring patients speak with experienced clinicians including GPs who are better placed to manage patients' conditions and risks.

Cuts in district nursing and cuts in local authority funded homecare services also need to be reviewed and reversed. Without these services in local communities, older people will inevitably end up in hospital, whether or not it's the best place for them.

In the longer run, we need one system of health and care to oversee, plan, commission and deliver the joined up support that older people need.

Some parts of the country are doing this much better than others, so rapid sharing of good practice is required, together with effective local leadership and joint working.

Bringing agencies together and sharing resources must happen with more urgency. But all agencies must recognise how their actions impact on the others, positively or negatively.

Just one example is the disastrous cuts by local authorities in funding for homecare services.

Tightening eligibility criteria has meant fewer older people getting care while the number of older people grows. And fees paid to homecare agencies have been squeezed reducing the time available to provide care. As a result of poor homecare, more older people are ending up and staying in hospital much longer than necessary.

Reviews left by families on Good Care Guide show real unhappiness about the quality of homecare services. These concerns range from the turnover of staff, consistency of carer and inadequate training to poor communication by care workers and managers.

Sorting out homecare is a crucial part of sorting out the NHS crisis. But without a whole system response and without the funding to back it up, will older people get the homecare services they deserve?

None of the above is impossible but it requires real leadership at all levels to make it happen.