Dr Vicky Price, president of the Society for Acute Medicine, features in a BBC News in-depth feature published today (12 January) on the impact of delayed discharges on patients, clinicians and the NHS.
She also featured on BBC Radio 4’s Today programme (starts 2:46:20).
Dr Price’s comments in full:
“There has been lots of good work done [to reduce delayed discharges] – buying places in care homes, integrated teams and discharge to assess, though these initiatives have not been widespread enough and often exist just in individual pockets – nowhere near enough to deal with the increasing problem.
“At the same time, we have seen the frailty and complexity of patients being admitted increasing – so we are having to run just to stay still. I think that is why the [delayed discharge] figures haven’t improved.
“People assume hospitals are good places to be, but the problem people face is that they decondition in hospital – they get frailer and then we struggle to arrange the support they need to get them home.
“We have invested in services that are stopping people being admitted in the first place. We have ambulatory care and hospital at home services, both of which are helping – but these services need to be protected and we are seeing more and more of these services being cut due to financial pressures (bedding units or reduced operational hours).
“We need to get better at recognising when people are in their last year of life – and then reacting to that. About of a third of people we are admitting medically are in that position and we admit them and end up over-treating them with interventions, scans and pills.
“It would be much better if we focused on what patients actually want; they may want palliative care and help managing their symptoms, mainly pain. Their quality of life would be much better and we would avoid a hospital admission. Evidence tells us that choosing a palliative option results in less time in hospital, better qulaity of life and less hospital admissions.
“There was a recent case I saw of a patient in their late 80s – he had 14 appointments in the next two months – cardiac, renal, liver, bone density and eye appointments. I talked to him and the only one he wanted to keep was the one with opthalmology. We cancelled the rest.
“The problem when you start trying to treat everything is that you prescribe more pills, those pills have side effects and you can actually end up making a person’s health worse.
“I think there are two problems – time and confidence. Clinicians generally know when people are in their last year of life, but it takes time to have those conversations with individuals and their family and it takes confidence.
“But when we have those conversations we actually find families feel able to take a more active role in caring for their relatives. They know it is going to be for a limited amount of time and want to care for relatives in that final year.
“Where we find families are less able to help is when they think we are asking them to provide open-ended care. In some countries the culture is different – they don’t need care homes because families step in and would think nothing of it. But it is difficult for families where people are working and dependant on two incomes. There are justifiable reasons why they can’t take on that responsibility.”
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