This blog was contributed by Dr Nick Goodwin a speaker at Age UK’s annual For Later Life conference. Nick is CEO of the International Foundation for Integrated Care and a Senior Fellow at The King’s Fund, London where he leads their programme of research and analysis for improving and integrating care for older people and those with long-term conditions.
When my elderly father was in hospital recently his experience of an uncoordinated, chaotic and impersonal service was both dispiriting and disturbing to both him and his family. Whilst clinical decision-making was good, and as a result his physical health returned through the miracles of blood transfusions and intravenous antibiotics, the experience undoubtedly took a large piece out of his mental wellbeing and future self-confidence.
The underlying problem was a lack of care co-ordination. The lack of information sharing on diagnosis, procedures, results and next steps led to worried waits about the seriousness of his condition and what, as a family, we needed to put in place for home care support. Different and conflicting advice and feedback from doctors and nurses was unhelpful. The lack of communication between wards, and between nurses on the wards, meant that his medication regime for Parkinson’s was often ignored despite constant reminders. No help was given to support discharge, and no plan put in place.
Worst in his experience was the seemingly uncaring attitude of nurses in doing the most basic of tasks (like supporting him to go to the loo, feeding him, or changing his bedding). We surmised this was the result of their long hours, the lack of appreciation and support for the role internally, and probably in their training, to deal with the most tough job of all – caring for older people with complex needs and at their most vulnerable. I will remember forever the curled lips, blank faces and distant eyes– they were working in the war zone, and only just surviving themselves.
Walking the wards of this clean, but rather unloved, hospital I began to wonder how things could be made different. The enormity of the challenge seemed just too much – like trying to change the wheels on a speeding car (one without brakes). Sadly, my experience with research at The King’s Fund confirmed that my father’s experiences were likely to be typical rather than rare. Having promoted the cause of better integrated care to older people for many years, my energy to promote this agenda was redoubled. All people who work away from the front-line need to experience the reality of what the NHS faces, a balanced scorecard doesn’t quite cut it.
Given the financial crisis and uncertainties about the future of health and social care funding and provision it is logical to feel pessimistic. However, I have seen too many excellent examples internationally where it is possible to improve care experiences and outcomes – and save costs – through better and more integrated care. Developing ‘person centred co-ordinated care’ is currently high on the political agenda in England and this has unleashed a huge and dynamic response at a local level to do things differently. I hope that the political will for change can support and encourage this, and also in a way that avoids a debate on systems and processes, or choice and competition, and becomes routed through a new culture of collaborative care at the front-line.
Age UK’s annual conference, For Later Life, is taking place on Thursday 25 April. If you cannot attend, you can still follow and contribute to the discussion on Twitter using the hashtag #forlaterlife