Mastodawn

Paul Brownjohn

@ChrisMayLA6

I have been wondering for some time why the NHS don't implement some sort of half-way-house care system for patients who are blocking beds in acute medical or surgical wards but who don't need the nursing and medical care provided on a hospital ward. Of course, it might be better still to hand the patients needing a high level of care back to the NHS (as was the case in the past) leaving the local authorities to offer care only to the reasonably fit and healthy elderly.

Bed blocking due to the inability of the local authorities to provide suitable accommodation is paralyzing large parts of the NHS and something needs to be done to address this issue!

James Tweedie Dec 30

@Paulos_the_fog @ChrisMayLA6 When my mother was in need of care after a major late life operation she received this via 'hospital at home" service which worked remarkably well. Daily visits (as needed) by doctors and nurses.
https://nhsforthvalley.com/health-services/az-of-services/hospital-at-home/
It seems to be implemented in one form or another by a number of health services in Scotland. Not sure about the rUK NHS.

NHS Forth Valley – Hospital at Home

NHS Forth Valley provides and manages a wide range of health services including hospitals and General Practice with the Forth Valley area of Central Scotland.

AnneH Dec 30

@Paulos_the_fog @ChrisMayLA6 Without greatly increased funding LAs couldn't possibly do this. In my area (E Anglia) patients can be discharged to nursing home but there are so few of these. Care homes in general are in crisis, are finding it hard to get staff & it's not a good time to expand. Then depending on the circumstances there may be a fight over byzantine different pots of money to fund a patient in nursing home. It's a mess.

Epistatacadam Dec 30

@Paulos_the_fog @ChrisMayLA6 they closed the convalescent homes for economy reasons and the modern NHS had no need of convalescence as it was an old fashioned concept that modern health care had shown to be rubbish.
Hubris always comes before nemesis.....

Certainly in my home town of Eastbourne, there were quite a number of establishments most/all of which were run by the NHS.

Epistatacadam Dec 30

@Paulos_the_fog @ChrisMayLA6 There was also I believe the miners convalescent home paid for by the NUM!😊

Paul Brownjohn Jan 3

I can't say I remember it but then why would I?

This also puts me in mind of "care in the community" for the mentally ill and emotionally vulnerable. Another cost saving measure that turned out, shall we say - much less kindly than advertised.

Many vulnerable people were pretty much abandoned to live in poor quality accommodation with little support from healthcare professionals.

Emeritus Prof Christopher May Dec 30

@Paulos_the_fog @epistatacadam

Yes, I think this is the issue; while in theory care in the community can be an excellent way of working with those in need of various forms of care, when it merely becomes a measure to get their care off the books then it becomes a major problem (as you rightly say, it has doen before when this approach has been declared the way forward)

@ChrisMayLA6 @epistatacadam

Paul Brownjohn Jan 3

Back in the mid-1960s I was fortunate/unfortunate to have been subject to the tender mercies of the NHS mental healthcare services. At age 15 I was admitted to bottom rung of NHS psychiatric care in a state of catastrophic depression. The hospital in which I was treated as an inpatient for 6 months, was Amberstone Hospital which was part of the Hellingly Hospital group of hospitals. That included Amberstone for relatively minor treatable mental/emotional illnesses, 'Park House' for middling to severe or more intractable mental illness and Hellingly 'Main Building' for long stay gravely mentally ill patients which included a number of 'locked' wards along with a secure unit. There was also a unit called 'Park Farm' which as its name suggests was a working farm and market garden. Most of the labour was provided by patients who were judged to need 'sheltered' accommodation and employment due to their relatively fragile mental/emotional state. The farm also supplied much of the hospital kitchens need for farm produce. One thing that stands out in my mind about that 6 months is how excellent the food was; that was in part due to Park Farm's fresh produce and a group of caring and competent chefs and other kitchen staff.

In keeping with modern trends, Amberstone Hospital is now office for NHS pen-pushers, Park Farm has long since been sold off and it's vulnerable workforce/residents pushed out into no-care-whatsoever in the community. Park House and Hellingly itself have also gone and been replaced by unthinkably tiny acute psychiatric units integrated into local general hospitals that are no substitute whatever for the long term care that they used to provide to the very vulnerable.

The idea was a laudable one but as it was subject to implementation by civil servants like Sir Humphrey Appleby who don't give a damn about anyone or anything other than making their minister look good to the voting public and cutting costs whilst incresing their head count of pen-pushers, it suffered from that very British malaise of monstrous under-funding!

Emeritus Prof Christopher May Jan 3

@Paulos_the_fog @epistatacadam

a sad story indeed

I'm not sure that many of the hospitals in Eastbourne were for convalescence. All Saints was the big one - a sprawling cluster of Victorian buildings that included its own church. It had a reputation in the town that if you were admitted to that establishment, you only came out in a wooden box. It wasn't entirely true, but there was a grain of truth in that saying!

It was used for convalescence and for respite care for those living with relatives but for the most part, it was used for long term end of life care. The sort of care that is now the obligation of local authorities.