Taking care to the patient

As the number of older people in the UK continues to rise we find that more and more people want the opportunity to live in their homes for as long as they possibly can.

The social benefits are obvious; so too the financial ones to be gained by the Welsh NHS if, in the long term, hospital admissions can be reduced.

Our proposal is that upon reaching the age of retirement, each person living in Wales will qualify for a ‘Stay at Home’ assessment by social services. An MOT, if you like.

The purpose of the assessment would be to ensure that people have the necessary support in place to enable them to stay in their homes for as long as possible; giving social services an opportunity to make any necessary home adaptations as early as possible, as well as assessing future need. Data collection of this kind is woefully inadequate in Wales and too often health and social services find themselves playing catch-up.

The assessments would also have a huge impact on the way local authorities procure services for the elderly. There is legitimate criticism, at present, that older people are not being consulted on the shape of the services they receive. Indeed, the Wales Audit Office recently found that only 45% of citizens who are actively engaged with councils are being asked for their views as the council develops its plans for older people.

Stay at Home Assessments allow for the collection of data which will better inform the delivery of local council services, not to mention planning for future home adaptations; such as the installation of stairlifts, handrails, shower seats and ramps, all of which can materially improve the safety and comfort of recipients.

Early intervention would also be an effective way to prevent hospitalisations in the first place, but also to help clinicians to better plan for a return to the home environment after a hospital admission, thereby reducing incidences of so-called ‘bed blocking’.

Ultimately we need to take steps to help people to live independently for longer, empowering people to stay in their own homes, but – crucially – also reducing anxiety levels for friends and family concerned about the safety and comfort of their loved ones.

This measure is as much about empowering individuals to make choices about their long term wellbeing as it is about shifting the emphasis on the provision of health and social services. Imagine how much easy the work of an Occupational Therapist would be if they had access to information about a patient’s home environment when planning for their discharge from hospital.

Delayed transfers of care (pejoratively described as ‘bed blocking’) are increasing in Wales, with the median unnecessary hospital stay currently at around 27 days. The financial cost to Welsh NHS resources is extraordinary, at approximately £21m a year.

Then there’s the impact on emergency response times, admissions and waiting lists.

It’s a familiar picture. Mrs Jones arrives at an A&E unit in an ambulance, only to find that she cannot be admitted to the unit because there are too many patients already there, waiting for access to a ward bed. Mr Davies, meanwhile, can’t be discharged from the ward because clinicians can’t be sure that his home is properly equipped for his return. It’s a vicious cycle that affects every part of the Welsh NHS.

We believe that home visits would clear some of that blockage, in a cost-effective way.

An individual hospital bed costs £255 per night, and with 4.4% of all hospital beds currently occupied by patients whose transfer has been delayed that represents 487 beds, across Wales, every day. In contrast, the equivalent rate for the visit of a social worker is around £32 per hour.

That said, we would also explore the potential for the policy to be implemented and delivered in conjunction with third sector organisations and charities; making the most of the existing reservoir of talent and expertise that Wales has to offer.

In the long run, it is my belief that early assessments of a person’s need and their home environment would help to eliminate delayed transfers of care altogether, keeping older people in their homes longer, and reducing the burden on the Welsh NHS. It’s a simple, pragmatic solution and I look forward to working with colleagues of all parties to take the idea forward.