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.
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.
Why are you making commenting on The Herald only available to subscribers?
It should have been a safe space for informed debate, somewhere for readers to discuss issues around the biggest stories of the day, but all too often the below the line comments on most websites have become bogged down by off-topic discussions and abuse.
heraldscotland.com is tackling this problem by allowing only subscribers to comment.
We are doing this to improve the experience for our loyal readers and we believe it will reduce the ability of trolls and troublemakers, who occasionally find their way onto our site, to abuse our journalists and readers. We also hope it will help the comments section fulfil its promise as a part of Scotland's conversation with itself.
We are lucky at The Herald. We are read by an informed, educated readership who can add their knowledge and insights to our stories.
That is invaluable.
We are making the subscriber-only change to support our valued readers, who tell us they don't want the site cluttered up with irrelevant comments, untruths and abuse.
In the past, the journalist’s job was to collect and distribute information to the audience. Technology means that readers can shape a discussion. We look forward to hearing from you on heraldscotland.com
Comments & Moderation
Readers’ comments: You are personally liable for the content of any comments you upload to this website, so please act responsibly. We do not pre-moderate or monitor readers’ comments appearing on our websites, but we do post-moderate in response to complaints we receive or otherwise when a potential problem comes to our attention. You can make a complaint by using the ‘report this post’ link . We may then apply our discretion under the user terms to amend or delete comments.
Post moderation is undertaken full-time 9am-6pm on weekdays, and on a part-time basis outwith those hours.
Read the rules hereComments are closed on this article