Picture the scene.
Mr A, a frail elderly man with mild dementia, lives alone. His daughter arrives at his home one evening to find that he has an upset stomach but has fallen on the way to the toilet. The woman calls NHS24 and a GP soon arrives to assess Mr A, who is then admitted to hospital. He stays for several weeks in hospital being treated for a stomach bug, his confusion increasing in the strange environment and his mobility problems worsening.
What, instead, about this alternative scenario: Mr A is identified in advance as being at risk and has a plan put in place setting out exactly what steps should be taken if he becomes ill or needs additional support? Instead of a GP, a crisis team responds to his daughter's urgent call, assesses Mr A, and helps clean him up and get him into bed. Arrangements are made for him to visit the GP next morning, while plans are made for carers to come in and suport him for a few days until he is better. His case is reviewed on an ongoing basis.
He never sets foot in a hospital ward.
That scenario is one possible vision of the future set out by NHS Greater Glasgow and Clyde in a recent board paper and, if Scottish hospitals are to cope with the growing pressures upon them caused by the ageing population, such community-based care must become reality, not just in Glasgow but all over Scotland.
Without a radical shift into such care, Scotland's largest health board alone will need 500 more beds by 2020. Consider those same pressures having an impact on Scotland's other 13 regional health boards and thousands more beds will likely be required Scotland-wide.
The Herald has been campaigning this summer for a national review of hospital and community care in order to assess how much capacity exists within the system and how much will be required in future. Already the system is under pressure and that pressure will only increase.
Without action, as the health board highlights, ever more precious resources will be sucked into growing emergency wards, leaving less available to fund the required expansion of care for people in the community.
That is why the health board is testing a rapid-response community health service model designed to prevent hospital admissions.
This is welcome news but time is of the essence, given the massive pressures on bed space the board anticipates. When it comes to rolling out the community health service more widely, arrangements will have to be made to fund the transition. How likely is it in reality that funds will be able to be freed up by reducing numbers of inpatient ward beds in advance of the full roll-out of a community health service? Those are vexing questions which must be carefully but urgently considered.
Ultimately, however, such changes offer a vision of the future for Scottish health care that is not only more sustainable but - crucially - geared more to the interests of patients.
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