WHY, why, why did I suggest to the editor a week of articles looking at the way we care for the elderly in their own homes?
I don't think it was masochism, because I don't think I realised how difficult it was going to be.
After weeks of talking to people, or trying to, I'm not sure I have discovered a great deal more than a paradox. We know Scottish hospitals are under pressure, admissions have reached record levels, waiting times in accident and emergency have become harder to control and bed blocking has crept up.
Loading article content
We know the Scottish Government's plan to address this in the long term is to improve community care to prevent the elderly being shuttled to their nearest emergency department. But those who look after community care say they are, by and large, doing a really great job and the people who go into hospital, well, they're ill, aren't they? They need to be there. These are the building blocks on which the strategy for caring for the growing frail elderly population rests. But it does not add up.
Now the Scottish Government is bringing council and NHS managers together and putting them in charge of strategies for "social care", which they seem to believe will make all the difference. I fear a future Audit Scotland report will find we don't even know if it's worked because it is so difficult to tell how good the care of older people living in their own homes is at present.
The Care Inspectorate rates care at home services, but not in a way that shows whether they stop frail people having health emergencies.
When I asked health boards how promptly old people could gain access to rehabilitation services to help them continue living independently, most didn't have the answers.
Conversations I have about how Scotland is preventing elderly people being admitted to hospital nearly always end in wee stories: there's a good scheme in South Lanarkshire or Fife or West Lothian. But I have still not seen any data that shows hospital admissions dropping as a result and, in the past fortnight, I've heard two experts raise concern about this reliance on anecdotes.
We need the care received by frail pensioners at home to be the best part of the NHS, not the weakest. The notion that local solutions are required cannot continue to be used as an excuse by the Scottish Government to preside over patchwork provision, with little on paper to show what is effective. That's not okay for cancer treatment; it can no longer be okay for preventative healthcare, because we are relying on it to protect the rest of the health service.
In hospitals there are "care bundles" to ensure patients with certain conditions have treatment that is proved to save lives. We need care bundles for the frail in the community.
We must also publish and track which locations have services geared to prevent hospital admissions among the frail and which don't; and which schemes relieve pressure on the nearest general hospital and which do not. And we must start an honest discussion with the public about whether we can have the quality of care we want for the price we are willing to pay for it.