On Friday I met the Chairman and the CEO of the Berkshire Healthcare Trust. Part of our discussions were about matters which are national as well as local in their impact, so I am posting this report here as well as on my local pages.
We met against the background of Mr Hunt announcing that in future an elderly patient coming out of hospital will be under the guidance and protection of his or her own GP, who will be responsible for ensuring their continuing care and treatment goes well. I welcomed this. The Trust replied that some GP s work on their own, and all GPs need time off, so they were sceptical about how this responsibility works. I suggested they could help provide the backup to the GPs, with a telephone answering service with qualified people to ensure that out of hours calls can be dealt with promptly, and if something urgent is needed the right professionals can be put in touch with the patient. This did not get in the way of the GP being responsible for orchestrating the self treatment and nurse treatment needed for continuing care in his or her normal business hours, and ensuring appropriate services including emergency cover are in place.
I explained the problems for patients – and the consequential issues for taxpayers – that the current arrangements can produce, based on conversations and case histories from my local experiences.
Problems for patients
1. Difficulty in securing the correct supplies for continuing treatment
2. Lack of support when issuing new medical equipment for home use
3. Lack of support in providing maintenance and repair for home based medical equipment
4. Attendance by health professionals who may not have the knowledge or information to answer the actual query of the patient, even where the query is known in advance of the home visit
Problems for taxpayers
1.Wasted home visits by people who cannot deal with the patient’s query or problem
2.Issue of supplies that are incorrect for the patients needs
3.Oversupply of items required, leading to write off at end of treatment
4.Failure to get medical equipment and reusable supplies back at end of treatment
Solutions
1. Proper analysis of patient needs on exit from hospital or on first diagnosis of a home based condition
2. Suitable training for patient where they have to use medical equipment or handle supplies for self treatment, from people who know the equipment
3. Back up supply and maintenance service for medical equipment and self treatment supplies by people who are expert in these matters
4. Attendance of nurse on visit where nursing skills are needed, with the nurse properly briefed on the treatment
5. Inventory and audit of medical equipment, to ensure return of reusable items at the end of the treatment, and safe disposal of other items.
Not all these matters require home visits. Some patients can be helped over the phone or by internet where they are happy with these methods.