Care of the elderly – a medical negligence time bomb?

A report commissioned by Age UK and the Royal College of Surgeons, ‘Access all Ages’, which is a follow up to their initial one in 2012, reveals that many elderly people are being refused elective surgery despite such surgery being key to their quality of life. In another report, recent figures suggest that 30% of patients are responsible for 70% of NHS spending.
 
The majority are people with long term health issues, many of whom are elderly with multiple, chronic conditions. Both reports suggest that many of our elderly are caught in a downward spiral of health deterioration with the health and social care systems either unwilling or unable to help them. The management of chronic illness, in particular, presents both the NHS and the social care system with a dilemma – how to prevent the ‘revolving door’ syndrome where patients are admitted to hospital, stay beyond when is medically required, are discharged home where care is inadequate and then find themselves back in hospital.
 
NHS heading for crisis
 
The Health Select Committee (chaired by Dr Sarah Wollaston) has warned about the impending crisis facing people with long term conditions, many of whom are elderly, if NHS budget cuts start to bite before a proper community care programme is implemented. As medical improvements enable those with chronic conditions to live longer, including the elderly, there is an acknowledgement that the way in which their care is managed will have to change if the NHS is not to be overwhelmed. The statistics are alarming: 70% of NHS spending is taken up by approximately 30% of patients who represent around two thirds of outpatients and take up 77% of hospital beds.  In addition, if surgery is being refused on the basis of age then even more elderly patients will find themselves in hospital when they can no longer cope at home.
 
Budget cuts threaten community health care
 
Although the motivation behind the launch of the Better Care Fund next year is to improve the cooperation between the health and social care systems in order to deliver a more joined up service, with the intention of keeping individuals with long term conditions out of hospital, the debate about funding continues to rage. The Select Committee estimates that at least £4bn will need to be found by 2016 to cope with the rising tide of those with chronic conditions – which helps to give a sense of perspective to what the £3.8bn Better Care Fund will be under pressure to deliver. The social care system does not have adequate funds to cope with the number of elderly people relying on their services at the moment, let alone in the future, which is why so many are ending up unnecessarily in the health system.
 
More collaboration – and more funding
 
The general consensus is that greater collaboration is needed between GPs, community health services and specialists in deciding a care plan for each individual. This is encapsulated by NHS England initiative ‘The House of Care’ which is designed as a framework to enhance the quality of life for the elderly and those with long term health issues. At its core is the need to monitor and implement best practice so that the latest clinical improvements can be put into practice; and the implementation of individual care programmes so that patients and their carers learn to manage their own condition more effectively. However, as with all these initiatives, the devil is in the funding – with ongoing cut backs and shortfalls, all these ideas will struggle to take root.
 
This article is courtesy of Jeanette Whyman, a specialist medical negligence solicitor with Wright Hassall comments “Care of the elderly is reaching crisis point: there is much talk and a multitude of proposed initiatives – but all run up against the same problem – who’s going to pay for it? Improvements in how people are physically looked after in hospital are welcome but this doesn’t solve the issue of where to send them once they no longer need hospital treatment. The problem is only set to get worse: if greater longevity is not matched by a will to ensure that quality of life is maintained through surgery and proper back-up then the outlook, for those facing old age, is pretty miserable. The likelihood of the health service facing increased numbers of medical negligence claims from elderly people and their relatives is virtually guaranteed”