A relative of mine in Chesterfield received excellent care from both the NHS and social care at the height of the winter pressures earlier this year. She and her family were treated with expertise, compassion and dignity. It reminded me that these services require good organisation and adequate resources; but they also need good people.
I don’t imagine much more can be done to prepare for winter at this stage. Despite the best efforts, NHS friends predict that there will be a crisis in the next few months, its severity dependent mainly on what viruses are circulating. Once again, it will fall to the efforts of NHS and social services staff to get us through. Yet the health and care system is now under enormous pressure all year round. This is largely due to demographic changes, which mean that more elderly people need care, but face inadequate services. Too many people end up in hospital because there is no alternative.
This is not new. Problems with “bed blocking” in acute hospitals have been well publicised for years and apply equally in mental health. Three years ago I chaired a review of problems with admissions to mental hospitals for the Royal College of Psychiatrists. We found that many people were admitted because there was no alternative and there were difficulties in discharging people into community provision. It wasn’t a hospital problem but a community one.
There are three levels to the problem. First, there is inadequate provision of health and social care services in the community. Second, there are shortfalls in other public services such as housing that enable people to live in the community. Third, there has been a decline in the community infrastructure of voluntary organisations and self-help groups and in support for independent living. Austerity has made each of these problems worse. Bizarrely, there have been cuts in community services such as district nursing or community mental health teams just as demand expands. Part of the reason appears to be that it is politically easier to trim a few posts in community services than close far more visible hospital beds. Similarly, the lack of suitable housing is one of the main reasons why people are kept in mental hospitals unnecessarily.
Health is affected by many factors. The history of improving health globally has been…