Monday, November 23, 2009

Pretzel logic.

Once every couple of months or so there's a boffin or a group on Radio 4 shouting the odds about how they can save the NHS pots of cash but keeping folks out of hospital. Last week it was the turn of the Alzheimer's Society. I'll admit to only having caught a small part of the piece, but these things are fairly predictable in their content, intensely well meaning, and woefully wrong in their assumptions, and the thing that really strikes me is, received entirely uncritically by reporters who are otherwise presented as amongst the most enquiring minds of their own or any other generation.

If I have the figures slightly wrong I apologize, but the thrust of the argument is unaffected. It seems the Alzheimer's Society had done a piece of work which suggested that at any given time a large number of hospital beds were occupied by dementia sufferers who might be better cared for at home. the number might have been as high as 1 in 4 but certainly at least 1 in 10. Now it's true that in a number of disciplines, notably general medicine, a great many inpatients are taken on to the ward and then kept longer than is medically necessary because of complex social factors, and dementia would be one of the most common of these. This means that dementia sufferers cannot be discharged as easily, needing as they often do, more community care and support, which is seldom available freely and on demand. Such discharges require planning. Planning is seemingly impossible across a weekend, and is seldom practicable on a Friday, and so these poor "long-stay" patients often stay a week or more longer than is needed simply to accommodate "Social Care".

Please don't get the impression here that I'm disparaging the organizers or providers of social care either. I know first hand how hard their job is, squeezing a quarts worth of service from a pints worth of resource is not easy at the best of times. To expect them to do so at short notice, particularly at weekends when office support has evaporated, would be plainly unreasonable.

The upshot, patients with complex care needs tend to stay longer in hospitals. This is an eternal verity. Now the Alzheimer's Society quite reasonably argue that with better input in the home admissions could be prevented, and discharges facilitated. But those resources are currently sadly lacking, and if we think the health budget is poorly funded, our social services colleagues gaze in envy from the"blasted heath" of close on a decade of "efficiency savings".

Lets assume for a minute, that some Fairy God-Social Worker were to wave a wand and overturn this to provide the network of carers and support staff we need. Let's then assume that the service they supply can kick in at the first hint of a crisis and prevent all unnecessary admissions. Let's further assume the 1 in 10 figure (which I still believe is an overestimate across the entire UK hospital population, but that's an argument for another day perhaps) is correct.

So, if every one of those patients who was in hospital could instead be cared for at home, we could reduce the hospital population by 10% overnight. If we allow that there is no-one else in line to occupy those vacated beds then we could have a whole load of spare capacity in the NHS hospitals estate. That being the case it would be a simple arithmetical exercise to close 1 in every 10 hospitals, thus saving the NHS pots of lovely cash.

To paraphrase a currently very popular Meerkat-- "Simples!"


Dr Grumble said...

Is this it?

ageing student said...

Or is it just that people in general are living longer which gives them more time to develop Alzheimers and, as a large number of in-patients are older anyway, this is just a natural event? You could say that 10% of in-patients have heart problems or breathing difficulties but I'd bet those were also a sign of ageing in the majority of patients. Off on a tangent, I used to work in an office where we closed the accounts of deceased customers. I was always amazed at the number of Death Certificates I saw which gave 'Respiratory Failure' as the cause of death. I was always under the impression that breathing was generally the most important sign of life and would have expected it to be the last thing to go for just about everyone!

Doctor Jest said...

Dr Grumble-- That's the one. No problems with the Alzheimer chap pushing for best care, it's the uncritical approach of (?) Evan Davies that gets me. Hundreds of millions in savings? Really? If 'twere that easy shirley we'd have done it all by now, everyone would live forever and poor old Nye Bevan's dream of the NHS rendering itself obsolete would have come to fruition. It's as though when they talk health in the media nowadays all common sense goes out the window, the grimy hospital window my quondam GP bequeathed money to the hospital to have cleaned at that!

A.S.-- You're right, chose any disease of "planned obsolescence" and you'd likely get broadly similar results. Turning to respiratory failure though, that's a more precise term than you think. It means it's a knackered set of lungs that kills you by literally packing up, either from the ravages of smoking or industry or -- more often-- both. That's a different proposition to Lung Cancer, or to merely stopping breathing at the end of life, which, as you say, we all shall in our time :-(