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 8.

    I would reduce visiting times to once per day for half an hour and be very strict on it's enforcement. It is very difficult to do your work when being watched and deflected from your duties by the "expert" joe public. Also patients should be informed when they are admitted to hospital what care they should expect to receive, most think it is a Hotel service, when it is definately not.

  • rate this

    Comment number 28.

    The ideological love for the NHS by the political classes will always hold our health service back but then what else has Labour got to fight for these days?

  • rate this

    Comment number 63.

    ben @56
    "Don't become ill"
    Carers ARE there
    Miracles ARE wrought
    Not enough staff, due to 'pay deals'
    False economy on facilities
    Self-imposed fear of being 'disappeared'

    alan @57
    'need voluntary euthanasia'
    Context to make possible

    Equal-income security of ALL
    Agreed central to democracy
    Employees-all, even in solo business
    Home-renting, no capital to corrupt

    No fears, leaving with dignity

  • rate this

    Comment number 30.

    No doctors are there are 231,000 employed by NHS and paid on average £100,000pa which costs £23,000,000,000 per year

  • rate this

    Comment number 7.

    Where Patients cause difficulties is in the constant blocking of plans to dispose of unsuitable buildings. The amount of money spent on running 1880's 'Hospitals' is enormous in heating and maintainence, simply to give a second rate clinic service. It seems that even with free travel so many patients are reluctant to travel a few miles to a properly built modern facility.


Comments 5 of 126



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