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
    0

    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.
    Alan

  • rate this
    0

    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
    +1

    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
    0

    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
    -1

    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.


    But

  • rate this
    +2

    Comment number 121.

    Stop this drive to ever extend life, allow people to be assisted to end thier lives if they wish, or define in what circumstances they end their lives.
    I do not want to be in the position where I can't care for myself, can no longer drink from a beaker and have thickened fluids piped into my mouth or fed through a hole in my stomach. I'd want putting down.

  • rate this
    +5

    Comment number 120.

    Protected staffing levels need to be recorded in law so that understaffing cannot be used as an excuse for poor practice. My mother in law was on a ward at Reading hospital with 40 very sick elderly patients many with dementia, with only 1 nurse and two health care assistants to care for them. How can nurses have any chance of offering excellent care with such a low staffing levels

  • rate this
    +2

    Comment number 119.

    I agree with Little Old Me. The only disease that I can think of that has been eradicated in the last 100 years is smallpox

  • rate this
    -1

    Comment number 118.

    for me elderly people need immotion, love, they need to make them feel that they are not problematic area from which we have to escape!! This is the medecation for all diseases!

  • rate this
    0

    Comment number 117.

    96.Jabdi - "...are not more diseases/ illnesses today than there were, say 100 years ago. In fact there are even less because we have wiped out many...."



    Care to list these diseases that have been "wiped out"...???

    There are hardly any - modern medicine has mostly just come up with treatments &/or preventative treatment to reduce the impact, but few have been wiped out.

  • Comment number 116.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this
    +2

    Comment number 115.

    105 DavidUSA
    A recent study undertaken by US researchers found that the worst 20% in England in terms of health were healthier than the best 20% in the USA.
    They had to re-analyse the results because they couldn't believe them.
    Live expectancy is higher in the UK than the US and the infant mortality rate is lower.
    And England doesn't compare with Scandinavia.
    Alan

  • rate this
    +3

    Comment number 114.

    From a mental health service point of view, this is absolutely true. We see so many inappropriate long term admissions, it's become very frustrating. Patients suffering from genuine mental health illnesses such as Schizophrenia and severe bi-polar get over looked when we are having to deal with people with anti-social personalities that disrupt the every day running of an acute mental health ward.

  • rate this
    +2

    Comment number 113.

    111. All for All

    You are correct to identify the association. But bowel cancer is caused by cellular genetic damage, not bowel tissue damage.

    Nature/ quantity of diet can, if only slightly, affect metabolic rate, not DNA replication rate.

    Cancer is caused by faulty checking mechanisms, absence of Hayflick limit, increase replication rate etc. none of which are affected by diet.

  • rate this
    0

    Comment number 112.

    Not the patients but the dinosaurs who operate within the NHS, who crave power but fail to take responsibility.

  • rate this
    0

    Comment number 111.

    Jabdi @108
    "Nothing to do with diet"

    We can be misled by ancient learning & lacunae!

    There is association between increase in DNA-replication & 'mistakes'

    Malignant transformation long known of in chronic skin ulcers and in ulcerative colitis (frustrated healing activity). Not impossible quantity & nature of diet might increase cell loss, increased replacement rates contributing to bowel cancer

  • rate this
    0

    Comment number 110.

    109.All for All - learned a skill worth working at I think.
    108.Jabdi
    Ah, so much time wasted on questioning, should have realised we knew everything already. Must go, just love watching the moon being pulled across by those chariots. . .
    Ps. have framed the 'nothing to do with diet' bit.

  • rate this
    +1

    Comment number 109.

    Steerpike@106
    "control of happiness"
    Happy knack, genetic or learned

    But listed experiences @103 can seem 'very real', miserable and frightening and degrading even for the toughest youngster, devastating with family to care for and to watch as they 'go under'

    Don't underestimate the 'energy' of those who have led us to current pass, just Quislings perhaps, but Mammon (un-Holy Spirit), everywhere

  • rate this
    +1

    Comment number 108.

    106. Steerpike

    Cellular replication rates are controlled (ironically) by our genes.
    Cellular repair only occurs when damaged (physically, by bacteria etc)
    We have proteins which ensure that genes are correctly replicated, without single mistake.
    As you age, these mechanisms begin to fail, and faulty genes are replicated.
    This effectively leads to cancers emerging.

    Nothing to do with diet.

  • rate this
    0

    Comment number 107.

    alan @91, "simply don't have resources" (for) "elderly people with multiple chronic illnesses & severe cognitive disorders" (& young with multiple chronic self-abuse & severe vulnerability to addiction pushers)

    alan @104, "in 10 years time NHS healthcare will only be freeā€¦ to people on benefits & senior citizens (unless by then incomes equal, all tax-payers)

    Blinkers still on, could be right

 

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