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 6.

    It's a consequence of the abject failure of government to meet its duty of care to older, frailer citizens.

    The NHS is supposed to meet MEDICAL needs but is having to pick up all manner of 'social care' needs as well as those who ought to be doing so are not fulfilling their obligations. Political failures causing problems to institutions already struggling to cope due to political neglect.

  • rate this

    Comment number 5.

    Yes, it's another of those "it'd be a good job if it wasn't for the customers" situatiions isn't it.

  • rate this

    Comment number 4.

    A lot of people don't want a extended few years of suffering and becoming a massive financial burden as they enter their final years. Euthanasia should be available for those suffering chronic or inoperable end of life stages. A education prog should be started so that it is seen as a acceptable option, which in a humane society it should be. I would prefer resources go to the young ones.

  • rate this

    Comment number 3.

    #2 Quite.

    Given that approx 1 in 3 of us carry MRSA on our skin it makes the idea of infection control hilarious if it wasn't so serious. Much as people like to claim they caught infections in hospital the usual scenario is that the infection they were carrying on their skin gets inside them during surgery. Put bluntly they acquire their own infection.

  • rate this

    Comment number 2.

    Us patients certainly don't help - I spent much of the noughties in & out of hospital with a serious neurological illness.

    The most shocking thing patents (& their visitors) do?

    Not washing their hands - I seem to be the only person other than health care professionals, who takes hygiene seriously, with most members of the public blithely wandering round without washing their hands.......

  • rate this

    Comment number 1.

    'Care in the Community' is being cut as coucils lose funding. So elderly people struggle at home, deteriorate, can't face going to the doctor because of poor public transport, don't feel so unwell that they will ask for a home visit and finally have a health crash. Few facilities for home nursing, family not local, friends of similar age who is going to pick up the pieces.


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