People are living longer but that extra life is not always a healthy one. Keeping people ticking along who have increasingly complex, and often multiple, long term health conditions comes at a cost.
Over the next few months you are going to be consulted on ‘Better Care’ a plan that sets out how the Leicestershire health and social care economy intends to respond to the £398m identified funding gap by 2018/19.
These changes aim to move the care of the frail, elderly and dying out of hospital. They are likely to lead to the reduction of 427 beds at Leicester Hospitals and a reduction from 3 to 2 acute hospitals. The Better Care team admit that “These changes will require a significant increase in capacity in primary care, social care and community care”.
Readmissions to hospital of people within 30 days of an emergency admission is a good marker for success. If people are only returning to hospital when absolutely necessary, we know the changes are moving in the right direction.
In 2012 there were nearly 10,000 readmissions to Leicester Hospitals. 21% were considered to have been “avoidable”, needing improved co-ordination between the acute hospital, primary care, community and social care services with “more explicit, agreed, accessible End-of-Life Care Plans.”
Nearly four years in the planning, is Care Better now? A repeat study of readmissions shows there were a staggering 5,000 readmissions in the first, admittedly worst, three months of 2015. The proportion of readmissions considered by clinicians to be “avoidable” is now three times higher at 67% and “specifically related to the lack of care planning for patients with long term conditions or needing end of life care.”
Mean while hospital managers are still discussing “the challenges of implementing a joint care plan which could be accessible to all relevant health care services, and could be updated accordingly.”
People are still being discharged from hospital with a terminal diagnosis, clearly in the last weeks of life, with no Advanced Care Plan. Their families are expected to cope until their GP has managed to pull together the social and nursing care their loved one desperately needs.
As readmissions rise and Leicester Hospitals reel from bed-crisis to bed-crisis, hospital managers are still asking themselves “ Who should help families plan home-based care for the frail, elderly and dying?”
The answer seems to be “Anyone but us.”