Friday, July 29, 2005

Comments on the Consultation

Full document is available on the Trust's web site.

I am urging everyone not to complete the standard consultation form (which many of us believe will give meaningless answers). Instead of this the best thing to do is write a letter with your genuine concerns to this address:

The Mount
Church Road
SO50 6ZB

Tel: 023 8067 3673 Fax: 023 8067 3674

But - here are some of the points I shall be chasing up (and some comments and observations) which may give you food for thought.

p3 of the document claims that "older people would prefer to be treated at home when it is safe and appropriate to do so"
I would agree with the claim that recovery, and return to independent living, can be hastened with the appropriate care and it is particularly important to try and keep people out of the acute beds in Southampton General Hospital. What the PCT appears to have ignored is that there is a top class rehabilitation unit at Romsey Hospital which is well used by local GPs. Some of the local GPs have suggested that getting a grip on the discharge planning from Southampton would be the most useful change but this doesn't appear to be something that is even being considered.

A recent independent study has shown that 84% of people in local community hospitals could have been receiving their care in a more appropriate setting e.g. at home. Apparently this is not happening because the local support services are inadequate.
This is actually very insulting to those people who are currently in beds in the local hospitals. I suspect none of them think they are needlessly taking up a bed - and neither do the GPs who admitted them.
The PCT have been very coy about this survey but I now have my hands on a copy. The 84% were actually those who were not clinically assessed as being acutely ill. If you think about it it is clear that many community beds are either occupied by those who are terminally ill or who have a chronic condition that has got worse and needs stabilising.
A closer look at the document and it is clear that over half of them were assessed as needing 24 hour nursing support (some needing consultant support). Clearly these people are sick and frail and it beggars belief that we are suggesting that their use of a community hospital bed is inappropriate.

The same study also shows that there are a significant number of people in an acute nursing bed (eg General Hospital) who would be more approprately cared for in a Community Hospital Setting. Doh! So here we have some much vaunted survey which actually highlights a need for at least some community beds

So what are the implications if more people are cared for at home?
Think on this.
Currently, if someone is poorly and in a community hospital then all their care needs are taken care of. In addition to their health needs they are washed, fed and provided with TLC. There is someone always on call and there is peace of mind for relatives (and sometimes even a short break for a carer)

With home based care anything deemed a nursing need is paid for. If someone is frail and needs help with washing, dressing, eating etc this is personal care and these services are provided by Social Services. These services are also means tested. At a time when someone is ill they have an added from of stress. They also have to cope with a number of people coming in at different times of the day. This can be distressing for older people who like a routine and like familiar faces. There is also no peace of mind for relatives.

It is not clear what communication there has been between PCT and Social Services and who will pick up what bill as Social Service are already overstretched.
Are there enough people to provide these services which are already overstretched because of the poor wages in the sector?

Financial data is scant so we have no idea how any nursing support teams will be composed or what the cost is? I assume that rapid response teams will have to have a minimum of two people on at any one time in order to be able to lift someone? We are not told how many teams or what area they will have to cover.

These staff will have to be retrained but there is no timescale for implementation (but we are told that implemetation will start in Nov 05 which leaves little time for further consultation, planning or training)

How will community numbers compare with current staffing numbers? What extra infrastructure is needed and has this been costed?

On p5 the document says "Anyone who needs hospital care will get it, either at one of the community hospitals or another facility" Clearly if they shut all community hospitals then other facilities will have to be used but it is not sure what or where (if it is a nursing home who will pick up the cost?)

The document contains some stats on projections of numbers of elderly people but gives no analysis of what the increased health input will entail.

We are told that there has been an increase of 20% in the number of emegency admissions over the last three years. There appears to have been no analysis of how much of this was down to the disastrous out of hours services.

The Govenment mantra is choice - where does choice come into these proposals if all community beds are closed?

p14 claims that the PCT are committed to providing bed-based care settings. It is not clear how this is going to be achieved if all the beds are closed.

I could go on and on and on (a bit like a duracell battery) but as this is by far my longest posting ever I will just end by encouraging people to e-mail me if they have any questions.