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Love your Lambert

The idea that the Lambert could be closed by the Clinical Commissioning Group after it takes control of medical spending next year has shocked people across Thirsk. At last week’s meeting of Sowerby Parish Council, County Councillor and leader of the District Council Neville Huxtable said “I am as alarmed as everybody. We want the best possible care we can obtain for residents in Thirsk and Sowerby, and I shall be doing all I can to maintain services at the Lambert.” The plan for the combined redevelopment of the Cherry Garth and Lambert sites goes by the name of Option A. Chair of the Parish Council Mark Robson said “I was concerned to hear that Option A had fallen.” He spoke of the concern he has received from numerous local residents.  I also spoke to District Councillor Gareth Dadd, who has made the redevelopment something of a crusade. His disappointment is huge, especially as the early sounds from the Primary Care Trust and the Clinical Commissioning Group were positive. He emphasised that Option B is alive and well, involving just redeveloping the Cherry Garth bit.South Tees NHS Trust gave me some information about the piece of research that has had such an influence on the Clinical Commissioning Group. It was carried out in October 2011 and looked at seven community hospitals that are scattered around the Friarage in Northallerton and the James Cook in Middlesbrough, including the Lambert. The research used software by a company called Medworxx, a respected American company with expertise in “patient flow”, which means patients coming into hospital and leaving. In each of the seven hospitals there were patients who didn’t need to be there, and could be looked after in “another facility” or at home. On average 49% of the patients could have been elsewhere, theoretically.The reasons for people being in “the wrong place” were various. They included waiting for a bed in another hospital, waiting for a social care package to be arranged, receiving treatment which could be given somewhere else if somewhere else was available, waiting for further investigation or waiting for a review by a doctor. Within the seven community hospitals the researchers concluded that 49% of patients were ready for discharge and could receive an alternative level of care somewhere else or at home.  The summary provided by South Tees does not break this down by hospital, though I am trying to get this information. Apparently 90% of the patients in the Lambert on the day of the survey didn’t need to be there.  The thought that the Lambert might close is frightening. One thing that is clear to me from what I have been reading is that the existing organisation of health services is not right. There is a better way of doing it that will save money, keep elderly people out of hospital more and help them live better, longer lives. Here is how it goes.Our population is ageing; people are living longer in health and illness. However, current hospital and medical care doesn’t work well for them.  Basically, it waits for an elderly person living at home to have a crisis – a broken limb, a stroke or the onset of mental deterioration. An ambulance attends, and the patient is taken to a hospital that deals with this sort of crisis, an “acute” hospital. Here the elderly person is in strange territory, distressed, may well stop eating and drinking properly, is at great risk of infection or further injury, quickly loses independence and may cease to be able to live at home. Often, as was the case sadly with my mother last autumn in a London hospital, going into hospital can be their last journey in life. Once admitted to hospital, the patient has to stay there until somewhere is found for him or her to go. Research by the King’s Fund has shown that more than two thirds of emergency admissions are of people over the age of 65.  Delay in discharging them blocks a bed needed for someone else, crowds the ward, and is wrong for the patient and wrong for the hospital. Acute hospitals have doctors who can deal with the acute problem. They are not geared to rehabilitate the elderly patient.  All this means that a single fall or stroke can mark the end of independent life for an elderly person.And yet: almost all older people want to live in their own homes as long as possible, and if not at home at least in their home community.  The present system tends to place an elderly person in a long term care home. This is expensive and offers a poor quality of life. What is more, if you project this forward as the number of elderly people mushrooms, it becomes impossibly expensive. There is a better way. They have it in Denmark. Can you remember back as far as 1987? In Denmark not a single nursing home has been built since 1987. The core of health care for the elderly is to keep them at home, with whatever form of nursing or other care they individually need. The first stage is not to wait for someone to become an emergency. In Denmark every person over 75 is entitled to two home visits a year from a trained health worker who can identify  nursing or practical care needs. Translate that into the NHS and you would have GPs involved in outreach to their patients, actively looking for signs of change that need support instead of waiting for a crisis. Each patient could have a care plan. Community services are co-ordinated to ensure that help that is needed is provided. This can be shopping, cleaning, home nursing to clean wounds – it depends on the needs of the individual. It could include programmes to keep people fit and well. It can also include palliative care in the final stage of life.Elderly people will still have accidents and become ill, but the approach to their care in an acute hospital is different. The hospital is “elderly friendly” and as soon as the patient is admitted, there is someone – not the doctor or surgeon – with immediate responsibility for getting the patient home soon if at all possible. That can mean “high intensity”  home nursing care initially. At present long term care homes absorb patients, suck them in and everyone expects that is the final stage. In a refocused health service, efforts would be made to rehabilitate the patient, to make them active again and move them on, if not to their home, then to some form of sheltered living.Of course there will always be elderly people who have developed a cluster of problems, physical and mental, which mean that independent living is genuinely impossible, and they would need to be in care homes, and those would be specialised units, with the trained staff able to do the best for these residents.Given that caring for a larger longer-living elderly population is a major demand on our health care system, we need now to recruit, train and retain sufficient professional and support staff to deliver this service. We need to create today the experts for tomorrow. And finally we need the elderly and their families to understand and have confidence in the new strategy. Why should they have doubts? “Bring me my bow of burning gold! Bring me my arrows of desire! Bring me my spear! O clouds, unfold! Bring me my chariots of fire! I will not cease from mental fight, nor shall my sword sleep in my hand, till we have built” – not Jerusalem, but a perfect health service -  “in England’s green and pleasant land.”I can begin to understand the idea driving the CCG that patients won’t be treated in hospital if any alternative is possible. Call me worried, but I remember a government policy in the 1990’s to discharge people from mental hospitals into the community and provide them with the necessary community support. That was a failure, leaving many vulnerable people without the support they needed. Let us not see the same happen to patients, particularly the old and frail  with no political voice and no family locally.


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