Wednesday, 14 January 2015

Recognise what charities can do in A+E

On the sofa at 6.45 this morning! That is, on the sofa for ITV’s ‘Good Morning Britain’, where I was talking about how charities and social enterprises can work with the NHS to relieve pressure on A+E.

Of course we often forget charities have been working in hospitals for centuries. Indeed we used to run them. Not that I want to see a return to those days, but I do think people in the NHS increasingly see the value of our sector – professional staff  and trained volunteers – working alongside medical staff to ensure the right care and treatment for the frail elderly.

It’s scandalous that so many hospital beds are occupied by people who are not sick but cannot get back to home because of social conditions. It’s scandalous that older people who attend casualty are signed off by medical staff but end up in hospital because of a transport breakdown or worries there is no one back at home and it’s bitterly cold. Hospitals are bad places for people who are not sick. And it’s a senseless use of scarce hospital resources.

Addenbrookes, a hospital ACEVO has been working with on this issue, says 20% of their beds are occupied by older people who don’t need medical care. This is not a clever way to run our NHS. And charities can help solve that problem.

Last year I worked with my CEO colleagues in 3 big national charities whose mission is to support older people in the community: the Red Cross, RVS and Age UK. We worked up a proposal for Government that would ramp up the role of our sector in hospitals and in the community. We wrote to the PM setting this out. Letter is here.

We have been working on this since and discussing with hospital CEOs etc. There is great interest, but also, frankly, huge barriers in the system to implementing this.

Yesterday, along with a range of colleagues from the sector, I went to a meeting with the Cabinet Secretary and the Department of Health Permanent Secretary to talk about how to mobilise support for the most stretched A+E departments. It was productive and helpful. I was tasked with providing a report to indicate what we might do in the short term for the highest-priority hospitals and I'm now busy talking with my CEO members on what this might mean. I have until Monday to report back. I have a round table with some of the charities most involved tomorrow morning to discuss practicalities.

Longer-term we need to grip this issue and sort it. The point I made at yesterday’s meeting was that there are 3 main barriers to change:
  • Culture – the NHS doesn't generally understand the modern third sector and too often thinks of ‘do gooders’ not professionals.

  • Systems – the third sector is not embedded inside hospitals at A+E, or on the wards, in planning or in early discharge teams.

  • Commissioning – this is done on transactions not outcomes. There are no incentives for hospitals to work with the third sector and the current commissioning process generally ignores it.

Now we need both to help in target areas, to secure better care for our elderly citizens, and to seek organisation reform. Ultimately we need radical approaches to health and care that galvanise the third sector. Systems that move us from the margins to a partnership approach in the NHS and in councils, that does the best for the individual’s well being.

One of the earliest tasks for our charity sector, a millennium ago, was securing good health and care for the sick and old. It’s time the nation rediscovered the genius of charity.

No comments: