Hospitals are not Homes: We Must Care for our Parents

The lack of proper care for the elderly, in their homes – ideally, provided by friends and relatives – is causing a funding crisis in the NHS. 

The sad reality of the NHS today is that sick, elderly people are being forced to sleep in corridors because there is nowhere else for them to go. This is not an exaggeration but a fact. Corridors are noisy and brightly lit, so these individuals are being made to endure sleep deprivation as part of their inpatient care.

If I point out that the NHS spends over £45bn each year on hospital care, you’d probably assume that the executive layers of healthcare hierarchy could find some room in that budget for the one of the most basic requirements of a hospital. Regardless, our TV screens in the early weeks of this year were populated by concerned consultants and doughty nurses looking frustrated while the voice-over described what is always referred to as “unprecedented pressure” on services.

One of the problems often raised to underline this pressure is the drop-off in A&E waiting times. The very particular metric used is the percentage of patients who leave the department within four hours (either back through the front door or into an overnight ward). Performance against this target fell to an all-time low last winter. This doesn’t (necessarily) reflect the competence or efficiency of emergency care staff but rather the backlog of patients causing a shortage of beds.

Put simply, if there are no beds on the admissions ward, the acutely unwell patients being admitted are stuck in the emergency department. Thus there is less space and manpower to attend to the growing crowd of patients sat in the waiting area, or the long queue of patients being brought in by ambulance.

The bottleneck occurs when admissions units struggle to transfer patients into long-stay beds. This happens when there is a backlog of patients – often elderly, frail ones with multiple health problems – awaiting discharge into a social care placement. (For the uninitiated, this means transfer into a home or organising visitors who will help with personal care, meals and medications).

Changes to funding for social care undoubtedly have an impact on outcomes. Some things, however, money can’t buy. There is an absolute shortage of carers and part of that is because it’s a demoralising, poorly-paid job. Carers have few qualifications and a paucity of training. Even where there are carers available, local authorities need a lot of convincing to free up funds even for three fifteen-minute visits per day.

Red Cross Social Care.jpg

The Red Cross provides social care to ‘top up’ what the NHS can’t afford. Providing surrogate children for the elderly is expensive.

The NHS budget has, since its inception, skyrocketed. Partly this is because the service is a victim of its own success, with newer, better treatments for increasingly complicated diseases.

The 50-year-olds who would have died of consumption in the postwar era can now live into their eighties. Their survival brings with it, however, the attendant care requirements, follow up appointments and frequent admissions for pneumonia or falls.

One other thing that has changed since those times is the way in which families take responsibility for their elderly relatives. Again, yes, the life expectancy and burden of disease is now greater. We see, often, aged couples who “care for each other”, but when that mutual dependence is shattered by bereavement, it is often left to social workers, rather than offspring, to pick up the pieces. Though there are often eldest sons and daughters who “help out when they can”, working a full time job usually precludes this.

Anecdotally, I often come across Asian families who are reluctant to see their parents admitted to a care home or residential institution. There is some observational data for this in the US, as well as in the UK. I have seen arguments that this is often a racial stereotype.

One significant factor accounting for this difference could be the higher birth rates among Asian ethnic groups. Larger families are, on the whole, better equipped to provide care for their elders. Safraz Manzoor noted that there was a surprising proportion of single-child parents among the residents of a home in south London for elderly Asian people and goes on to talk about certain traditional expectations about how offspring look after the men and women that raised them.

I struggle to believe, really, that taking responsibility for the care of our older population is somehow an alien or un-English belief. Nobody would be happy to see their mother or grandfather left to suffer on an uncomfortable bed in the middle of of a corridor.

But as a society we want to eat our cake and have it. Generation Xers want world class care from the NHS (whose epithet, the “envy of the world”, is becoming ironic); they don’t care to pay for the same. They are the first to complain or demand a word with the nurse in charge if their is any perceived failure on the part of hospital staff and yet there are many older individuals who say their family rarely visit them.

I am not worried so much about the current 50-somethings, as when they retire they will (on average) be healthier, better nourished and better educated than their parents. But given that the population triangle is slowly inverting, there will still be a great number of retirees who need some kind of support.

As a nation accustomed to the largesse of the NHS, we now need to view health and social care through a different lens.

Any reform to funding structures or tax revenue streams will be pointless unless society – that is, children and that web of civil society institutions once called ‘the parish’, not the taxpayer and the government – takes up the care of those who just need caring.

The NHS will only be affordable if it is thereby freed up to fulfill its intended purpose: as a service primarily for the use of the sick and vulnerable with nowhere else to turn.

Olivia Sanderson is a medical student at King’s College London.

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