Care Services: Elderly People

Baroness Emerton Excerpts

Wednesday 6th March 2013 Grand Committee

[Baroness Emerton]

My Lords, I too thank the noble Lord, Lord Turnberg, for raising this debate. I declare an interest as in the register, and add that I live in a retirement village, I am elderly and I live in a rural area where the boundaries have a postcode lottery as far as health and social care are concerned.

The Health and Social Care Act will be enacted in one month. There is a mandate from the Secretary of State to the Commissioning Board and guidance from the Commissioning Board to the CCGs. We have the theory and we must now enter the practice. The demand now and in the future, as has already been mentioned, will increase among the growing number of the elderly in the population, and we need to ensure that their health is maintained, disease prevention addressed and high-quality, safe, acceptable care given when required, with the emphasis on independent living in the community and, where necessary, adequate support given to allow this to happen. For example, prevention of admission to hospital teams can supply the necessary support to the elderly living alone to remain in their home surroundings, where they will benefit more than they would from an admission to hospital that would be more costly and open to possible cross-infection, leading to a longer recovery period. This is a cost-effective and care-effective way forward.

My first question to the Minister regards integration of organisational services and professional boundaries. What steps are the Government taking to ensure that the theory of the Act, mandate and guidance is being followed, with required training for all concerned? The reason for this question is that currently in many places there is a chaotic situation where, through the lack of training and understanding, care pathways are disrupted and there is evidence that services are not running smoothly and the safety of the patients is in question.

Currently the ambulance services are on red alert due to winter pressures and there are reports of ambulances that are unable to unload patients causing a backlog, with patients being cared for either in the ambulance or in a cold, draughty corridor for long periods before A&E takes over because of the four-hour wait deadline. Those ambulances therefore are not free to take any calls or discharges home. About 10 days ago at 10 pm, there were eight ambulances stuck for over an hour at our local hospital. Last night at 9.30 pm, I checked the local situation. There were four ambulances outside the hospital. One had been waiting for one hour and 15 minutes, one for 36 minutes, one for 20 minutes and the other for 10 minutes, with the crew looking after the patients. It appears that sometimes, to alleviate the logjam, one crew will care for two patients—two ambulance loads—in order to free up an ambulance. It would seem that there are insufficient staff to relieve the ambulance crews and, if they do, it starts the four-hour waiting time clock. The circumstances that I mention involved a majority of elderly patients. Can the Minister assure noble Lords that the Government will take steps to ensure that every opportunity is taken to improve the integration of services in health and social care?

Innovation and research is my next area of concern. The care of the elderly has lacked funding for research into physical and mental conditions, and this situation needs to be rectified as a priority. However, there have been examples of excellent innovations being developed through specific studies undertaken by healthcare professionals as part of scholarships or fellowships. Two come to mind; one involved a nursing scholar who, on an international study, was able to learn about the early detection and diagnosis of melanomas and, on return to this country, has followed this up with a training programme for GPs. The second example was someone who, on her return from the USA, aimed to reduce the mortality rates by introducing specific care bundles. Medical and nursing staff became engaged on her return, with excellent results and, in many places, there is a marked reduction in mortality rates as a result. Can the Minister assure us that there will be an equitable amount of funding for multiprofessional research and innovation specially allocated to physical and mental health, including social care for the elderly?

No Act, mandate or guidance will be effective unless there is inspirational leadership. In my experience, such leadership is not learnt by attending a course for senior managers; it has to be bespoke and fitted to the person’s potential and ability to set the values necessary for high-quality, safe and cost-effective delivery of care. I am president of the Florence Nightingale Foundation and we are able to fund 19 leadership scholars each year. They go through a bespoke leadership programme, funded mostly by the Burdett Trust for Nursing, as well as by contributions from other smaller charities. This has resulted in scholars being promoted and successfully leading services. I ask the Minister if this matter could be explored further with the NHS Leadership Academy and Health Education England to examine bespoke approaches to specific services, especially, and as a priority, to those concerned with the care of the elderly.