This newspaper launched its NHS: Time for Action campaign 20 months ago.
The fact that the effort is still required speaks volumes. The issue of hospitals, health care and the elderly has not gone away. In fact, as the Royal College of Nursing Scotland's briefing reminds us today, it is as pressing as ever. Why?
RCN Scotland's evidence is not anecdotal. Thirty-five inspection reports from Healthcare Improvement Scotland (HIS) have been analysed. All of Scotland's 14 territorial health boards and one special health board have been surveyed. The picture that emerges is deeply worrying.
Most of the hospitals inspected did not screen and assess older people appropriately for mental impairment. Three-quarters of the institutions failed to attend properly to the issue of nutrition. In more than half of the hospitals, improvements were needed in dealing with the risk of pressure ulcers. Bad enough?
At issue, according to RCN Scotland, is a systemic failure. Hospitals facing increasing demands, not least from an ageing population, are struggling to cope. Too many elderly patients are stuck in a faltering system, shuttled from bed to bed, or "boarded" in wards unsuitable for the treatment they require. Too many cannot be discharged. The consequences, in terms of much-needed beds, are well known.
One serious charge levelled by the royal college is that NHS boards and hospitals are failing to learn from their mistakes or, alternatively, to share knowledge derived from lessons learned. If true, and as an issue of management, this is inexcusable. The whole purpose of the inspection regime introduced in 2011 was to reassure the public, encourage improvements, and promote the sharing of good practice.
The higher aims, of course, involve compassion, respect and dignity. Hence the importance of RCN Scotland's briefing. The "beds crisis" is not just bad for the health service as a whole. It is cruel to older patients and damaging to their care. In a fundamental sense, the NHS is adding to its burdens when it allows this sort of mismanagement.
The greatest majority of patients enduring delayed discharges are aged over 75. In the third quarter of last year there were 111,210 occupied "bed days" because of such patients. That was an increase of 18,147 on the previous year. We cannot, in any sense, go on like this. We certainly cannot allow such a situation if there is a serious intention to integrate health and social care.
There's the nub of it. Elderly patients awaiting a place in a care home; patients waiting to go home; patients awaiting community care assessment: each a number on a growing list. All of the services involved are under increasing pressure, but to allow backlogs to become problems for hospitals alone would be intolerable, not least when the Scottish Government aims to have as many older people as possible cared for in the home or community.
It's a noble aspiration. It is, undeniably, what most patients want. The evidence says that, thus far, it is no better than an aspiration.
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