SECOND OPINION
An official report into the treat- ment of older people on the NHS provoked nationwide shock and anger. Michelle Mitchell, charity director of Age UK, explores the issues.
T
he recent Health Ombudsman report painted a very distressing picture of
older patients lying in soiled sheets, starv- ing, in pain and ignored by staff. It prompt- ed widespread public outrage as people struggled to understand how the system could fail so many older people so badly at such a basic level.
But as the media reports have died away, it is left to those working in the NHS and with older people to understand how we reached this point and to ensure the same mistakes are not repeated.
By understanding the type of care the NHS delivers in the 21st century and the chang- ing needs of the patients, we can give some context to the poor care that so many older
people receive. When the NHS formed 60 years ago, the limitations of medical sci- ence meant that in the main, hospitals dealt with acute problems such as broken limbs or life threatening illnesses among working-age adults and children.
Today, increasing life expectancy and med- ical advances have completely transformed the healthcare landscape. People who use the NHS are older than ever before: 30 years ago most patients in an intensive care ward would have been aged under 50; in 2011 the majority will be aged over 60. Today, the over 65s are the largest patient group in the NHS, accounting for 63% of consultant-led hospital care and 70% of bed days in NHS hospitals.
The increasing age of NHS customers brings with it a very different and often more complex set of health challenges. Of those aged over 65, 39% have a limiting long-standing illness and the proportion increases as people get older. So while pa- tients might be admitted to hospital due to an emergency such as a fall or high blood
pressure, in the majority of cases this will be linked or certainly accompanied by one or more long-standing conditions such as dementia, immobility, incontinence and frailty which also need to be managed ho- listically to achieve good quality care.
Treatment of older patients is less likely to be about finding a cure; instead the chal- lenge in geriatric medicine is about work- ing across different departments, sharing responsibility with other professionals as well as those providing social care to man- age conditions and improve the patient’s quality of life.
Yet while demographic change means the NHS is treating a new set of customers with different needs, the structure of the NHS and attitudes of staff haven’t adapted to the changing times.
Many health professionals still value the clinical skills we are familiar with from medical dramas – the life-saving surgery, the rare and life threatening illnesses – over those needed to work with older patients.
national health executive Mar/Apr 11 | 15
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