Sunday, 29 January 2017

Shimmy, shimmy: Probably not the answer to solving our health and social care problems

Occasionally certain words stick in my mind for a while. PROBABLY was such a word this week. The global brewer Carlsberg of course made the word famous in its long running marketing campaign, first started in 1983 – probably the best beer in the world. Although the company decided to drop the phrase in 2011, it has been reprised off and on since then, sometimes humorously, and at other times, not so. Remember the 2015 ‘beach body ready’ advertisement? it was unacceptable and crass, particularly as their marketing skills have proved so successful in the past. Will they continue to use the phrase in future advertising? - Probably.

Anyway I am digressing. Last week I attended a number of Board meetings during the week, the first of which was at Start in Salford, a creative arts and wellbeing centre, who work with vulnerable people from all walks of life, see here. Much of the discussion was around the uncertainty of achieving financial security in order to continue their work, a similar situation in the Haelo Board meeting I attend later in the week. Interestingly, Haelo also draws on the arts in delivering their improvement science innovations to health and social care organisations (see here).

At both these meetings the discussions included identifying sources of future funding; how to grow; whether they were doing the right things and doing these in the right way. Despite the increasingly complex and turbulent world both organisations work in, they have got access to some great strategists; they have clearly articulated ambitions and aims; and whilst the opportunities maybe challenging, these are built upon achievable objectives. Do I think both organisations will still be here this time year? - Probably.

At this month’s Trust Board meeting, members (including the public) heard a presentation on our mortality statistics. The Summary Hospital-level Mortality Indicator (SHMI) describes the ratio between the number of patients who die following admission to a particular hospital and the number that would be expected to die compared with the average population, and the presenting condition. Hospitals not meeting their SHMI targets can be put into special measures, and the Board replaced. Given this unpalatable outcome, is it is possible to fiddle the figures? – Probably. Would any Trust do that? – Probably.

SHMI, despite its statistical underpinning doesn’t provide a true picture of how the quality of care impacts on death rates, and even if it did, we need to remember that just 3.5% of all deaths are deaths that occur in hospital. Of these deaths, a similar figure (3.6%) might have been prevented. Likewise, SHMI absolutely fails to distinguish between those patients admitted for treatment or admitted for ‘human or comfort care’ due to failures in local social care service provision. Does this mean more older people are coming into hospital to die? – Probably.

The Board at Wrightington, Wigan, and Leigh NHS Trust is blessed by having Martin Farrier, a Consultant Paediatrician, absolutely committed to providing high quality family centred care for children. He also leads on the Trust’s work on reducing mortality across all areas. He is best described as the ‘Brian Cox’ of mortality. He understands statistics, loves data, can communicate the most complex of issues with great humour, authenticity and authority. He enables everyone to better understand what might be involved. Last week he took the Trust Board through what lies behind the current SHMI situation. It was both an interesting and challenging presentation.

Whilst the overall number of patients being admitted to the hospital continues to decline, the number of patients over the age of 75 being admitted continues to grow. There was 11% more patients admitted from care homes in 2016 than in the previous year. There are more people over the age of 65 living in Wigan (59,000) compared to Salford 39,000, which has a more typical city population. Many of these people will be living with dementia and have other comorbidities of complex life shortening conditions. Is this a situation that is likely to get worse? – Probably.   

Recognising the emergent and growing problems posed by these demographic shifts Martin offered us a glimpse into a possible future and the very difficult choices we might need to consider. However, things we could do now that would help deal with current pressures on services included the creation of an acute health village - if people pitch up at the hospital lets just treat them with a full range of services, not just A+E; adopt less heroic approaches to the care and treatment of the elderly and frail - for example, Warfarin as a stroke preventing medication, ceases to be beneficial due to the increased risk of falls and internal haemorrhage in the 75+ age group; instead of ‘Do Not Resuscitate’, consider ‘Do Not Bring Back to Acute Care’ agreements.  Are these changes likely to be resisted by many practitioners? Probably. 

For the future, should we consider the creation of ‘Care Villages’, shared communities where ‘human’ as well as ‘health’ care might be better provided for those living with conditions such as dementia; where we might really gain the benefit of digital health opportunities; and where the current social care pressures that impact upon hospitals could be shaped by a different economic model and funding approach? Probably. Uncomfortable thinking? - Probably. But shouldn't we be doing something about it? Absolutely!