Two reports published by The King’s Fund have highlighted how frail older people are being exposed to unacceptable standards of care in hospital because of a lack of continuity of care.
The first, Continuity of care for older hospital patients: A call for action, draws attention to breakdowns in continuity of care inside hospitals. Analysis of inpatient surveys cited in the report shows that measures of continuity of care, including the effective planning, communication and co-ordination of care, have remained static or slightly worsened between 2005 and 2010. Nearly nearly half of all patients thought they were not at all involved or only to some extent involved in the decisions that affected their care; one-in-five said they could not find a member of staff to talk to about their worries and fears; and two-fifths said that their discharge was delayed. Older people account for around 70% of occupied hospital beds. They often have multiple health needs, which make continuity of care especially important. The report has identified that the pressure to maintain high bed occupancy, reduce length of stay and meet access targets in hospitals is leading to patients being assigned the first free bed, often in the wrong ward, before being transferred again. Transfers of the same patient can happen more than once and often occur late at night. The study is based on patient surveys and evidence from hospital staff, and worryingly it showed that treatable conditions (such as incontinence and depression) are being ignored – with some hospitals even failing to test for serious diseases such as cancer and heart problems. Researchers found that failure to effectively communicate can leave patients and carers feeling isolated and frustrated. Terms such as ‘bed blocker’ are often used to describe older patients, highlighting a more entrenched problem where specialising in the care of older people is perceived as unattractive. This is often accompanied by a sense of ‘therapeutic nihilism’ whereby staff, unable to see beyond the age of the patient, leave treatable conditions undiagnosed. The report finds that the barriers to improving continuity of care in hospitals are deep rooted and systemic. The physical hospital environment and daily routines are unsuitable for many older patients who require supportive care and rehabilitation. A revolution in the way that older people experience care in hospital is needed, concludes the report. For example, there needs to be a named key worker available 24/7, complete medical records should be held electronically and all staff should be trained in the care of older patients. Commenting on the report, Michelle Mitchell, Age UK charity director general, said: “It is counter-intuitive that health services are not geared up to meet the needs of their largest users – older people. Many older people live with multiple conditions and often have complex care needs. Health services cannot deliver high quality services unless older people are treated as individuals and their care is coordinated. This is what a modern health service needs to deliver. Care will and has suffered because of the culture behind delivering services. They need to be radically redesigned to reflect their users’ needs, and to ensure care is delivered holistically with compassion and not constrained to treating body parts.” The King’s Fund has also recently published the conclusions of a two-day summit attended by senior figures from the NHS and social care, academics and organisations representing patients and older people, which addressed how to improve care for frail older people with complex needs. Five key recommendations were made:
1 Ward leaders should be identified to take responsibility for standards of care and must be given the authority to ensure that patient care is always put first.
2 Hospital boards must ensure that frail older people are recognised as their organisation’s core service users and hold managers to account for meeting their needs.
3 The Government should set the framework for delivering care, then reduce the number of central directives and make hospital leaders responsible for ensuring standards of care are met.
4 Professional bodies should mount a concerted campaign to change professional attitudes through education and training and to raise the status of caring for older people among the healthcare workforce.
5 Policymakers, commentators and society must challenge negative stereotyping of older people and change social attitudes towards ageing.
