Pathways to care success

Nobody deserves to stay in hospital any longer than they want to or
indeed than they need to. Older people make up about 70 per cent of
hospital admissions and so it is no surprise that they tend to be
those that end up staying in hospital too long.

Let’s be clear, being in hospital is bad for people, unless they
need to be there. It’s still easy to become institutionalised,
making it much harder to return to independence and normal

When I was nursing on long-stay psychogeriatric wards 35 years ago,
we used to line frail older people up to have their baths, taking
their teeth out, bathing them one by one, then putting their teeth
back in and dressing them in identical ward clothes. No one
complained, there were no grumbles, unless from time to time we
gave them the wrong teeth. There was no privacy, no individuality
and not much hope for anything different either.

Many of the older people I nursed remembered the poor house system.
Thankfully, the worst excesses of that regime are gone and yet some
of the deprivations that older people suffered in my care are still
with us today. What I find difficult about “bed-blocking” is that
for whatever reasons we are still not doing our best for those in
our care. What does it take for that to happen? The government
hopes to persuade social care chiefs to put much, if not all, of
this year’s new money into tackling delayed discharges. Few of us
would argue with giving greater priority to the needs of older
people. Most know that much more can be achieved if we put our
medical, social, psychological and physical heads together, but
such a meeting appears to be illusory.

The concept of partnerships is rapidly being replaced by networks,
whole systems and care pathways. Networks are about thinking,
working and managing services, issues and conditions across
boundaries. Whole systems is a way of describing what works in the
totality, it implies every aspect of creating, building and making
services work around groups of individuals in need or “care
groups”. Care pathways are a way of describing what happens to
individuals in those care groups over a period of time.

It is possible that we have finally, across health and social care,
made that quantum leap to how we, as professionals, provide for the
needs and wishes of those who need our services.

Julia Ross is executive director for health and social care
at the London Borough of Barking and Dagenham.

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