AS The Herald reports today, hundreds of extra Scottish hospital beds intended to meet winter emergencies were still in use as recently as last month.
Winter and an outbreak of the nasty norovirus are both behind us. Yet some of the contingency beds, opened to cope with the resultant spike in hospital admissions, are still required to cope with demand. This suggests that for "winter emergencies", we should now read "year-round pressure".
Is this the inevitable consequence of an ageing population and lengthening life expectancies, that leave more and more older patients with chronic and complex health problems? This pressure is going to intensify as the number of over-75s doubles in the next 20 years. Simultaneously, the number living with various forms of dementia is set to double over 25 years. One response might be simply to reverse the 1400 drop in Scottish hospital beds since 2003.
However, there is general agreement that big general hospitals are not the best place for many of these patients, especially when this involves "boarding" sick people in non-specialised wards for lack of space. Besides, in the last two decades views have changed. Once hospitals were seen as the safest place for the sick but today there is greater knowledge and awareness of the danger of developing blood clots and hospital acquired infections.
If care and treatment can be delivered safely and efficiently in the community, people are able to stay in their own homes and unnecessary hospital admissions are avoided. But, as Theresa Fyffe of the Royal College of Nursing puts it, for that to happen "we need to see clear evidence of work to develop a workforce with the necessary skills to deal with the increasingly complex conditions which are presenting in the community, particularly among older people".
If resources that should be going into developing that workforce end up being diverted into reopening wards to take the pressure off bursting accident and emergency departments, the vicious cycle will never be broken. But these are difficult decisions when waiting times in A&E are at an all-time high.
The best hope of resolving this conundrum lies in the eventual complete integration of health and social care and making "care in the community" live up to its name, even if that means changing the way in which it is delivered and paid for. It may mean a new generation of cottage hospitals for short periods of respite care and a modern army of community nurses. It may not be all about money but community-based healthcare and social care both require staff with the training and the time to do their work properly. At the moment the gap between the best care possible and the best possible care is far too wide.
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