Are the patients the problem?

Patient Two thirds of hospital admissions are people over the age of 65

On unveiling the package of measures in the government's response to the Stafford Hospital public inquiry, Health Secretary Jeremy Hunt said he was confident the changes would ensure problems on such a scale would not slip under the radar again.

A clearer system of rating hospitals and better regulation of managers and healthcare assistants, he argued, would ensure greater accountability, while better training for nurses could create a culture of compassionate care.

But in some ways the changes ignored the elephant in the room: the changing nature of the patient population.

It is an open secret that hospitals in the 21st Century are full of patients that should not be there.

A combination of the ageing population and advances in medicine have meant that there is a growing number of frail, elderly people who need intensive care and support.

But all too often that is not available in the community, and so they end up in hospital as an emergency case.

Two-thirds of hospital admissions are people over the age of 65. Many have multiple chronic conditions, such as heart disease and dementia.

In fact, the change in the patient population has been so acute that a King's Fund study has put the average age of a patient at over 80.

That is presenting problems for staff that no amount of training and resources can counter.

'Wrong place'

As one nurse, who has worked in the NHS for over 30 years, told me: "The patients we are seeing in hospital are completely different from the ones that were being admitted when I started out.

"These patients need a complex package of care and support.

"They need help washing, dressing and eating round-the-clock. It requires a lot more personal care than the hospital environment is designed for."

However, it need not be like this. The evidence suggests as many as a third of hospital admissions could be prevented with better systems in place in the community.

But instead of going down the numbers being admitted as emergencies is actually on the rise - it is up by nearly 40% in the past decade - and that is having a damaging impact on hospital wards.

The Royal College of Physicians has warned hospitals are "on the brink" with a mindset developing among staff that many patients are simply in the "wrong place".

Its report, Hospitals on the edge?, cautioned staff against such defeatism, but it was also clear for that to change there needed to be progress on keeping people out of hospital.

To be fair, it was a point acknowledged on Tuesday by Care Services Minister Norman Lamb.

During the government press conference to announce the response to the public inquiry, he said it had to be a "top priority", conceding "a lot of hospitals have large numbers of frail elderly that perhaps with better care would not have ended up there".

Improving the culture, accountability and transparency is clearly important, but the defining challenge for the health service over the next decade and beyond could prove to be something completely different.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this

    Comment number 126.

    Spending more money does not necessarily improve health.The USA spends about 16% of its GDP on health-care compared with about 9% in the UK and Americans are significantly less healthy than Brits on average.
    It's more to do with lifestyle, taking exercise, getting out of the car and walking or cycling, and eating smaller portions of food containing less fat and sugar.

  • rate this

    Comment number 125.

    79.All for All

    "John f H@77 Rings entirely true"

    They seem to have backed down today - a strategic retreat in the face of threats to retaining their employment and that I would call the Police and cite them as Elder Abusers - helped by a pamphlet outlining patient's rights from Age UK! (Factsheet 78 Safeguarding older people from abuse.)

    Guess they were trying it on! (& will do so again!)

  • rate this

    Comment number 124.

    117. Little_Old_Me
    119. stereotonic

    We are talking about UK diseases, not worldwide. And in the past 100 years we have effectively defeated fatal infectious disease, to the extent where oesophagus cancer is more common than any single infectious disease.

    You said we had more infectious diseasess/illnesses, and that's simply not true.

  • rate this

    Comment number 123.

    Of course patients are the problem in NHS hospitals, the fact that they can turn up expecting to get treatment for their ills upsets the management and targets that are prevalent nowadays, the age of a patient is irrelevant they are just a hindrance that has to be put up with.

  • rate this

    Comment number 122.

    No, the patients are not the problem.

    The politicians, managers, bankers, and even a few rogue medical staff ... just some of those responsible for the mess are the problem.

    But don't blame the patients.

    Unless they are drunks. Or overweight. Or smokers. Or addicts. Or attention seekers. Or poor.

    Then you can blame the patients.

    The patients are the problem.



Comments 5 of 126



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