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.
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