Building the future of health and social care

One of the most interesting aspects of my role as Chair of a large acute hospital is the opportunity to meet people working across our organisation, both in the hospital and the wider community. I was really pleased to be able to spend some time with colleagues in our Urgent and Emergency Care department last week. We are having a new Urgent and Emergency Care Centre constructed around the existing building; something that is hugely challenging for colleagues working in the department.

Ours is a very busy emergency department, with an average attendance of around 300+ patients a day. Seeing, assessing, treating and either admitting or discharging people is a constant challenge. Doing so in a timely way, even more so. When I got there at 9am, there were three people who had been in the department since 10 o’clock the night before awaiting a bed. The demand for care is unrelenting and has been growing since the Covid pandemic plateaued.

I asked to be shown a patient’s journey through the department. It became immediately apparent how busy the department was. Every time we stopped to discuss something, we found ourselves in someone’s way. However, it was interesting that despite the busyness, everyone was engaged in a purposeful and carefully choreographed way. I was very impressed by the care being given and proud to have such a skilled and motivated team providing that care. What was also clear was the impact that the building work was having on the operation of the department. As the construction work is progressing, parts of the existing department were having to be relocated, or even shut down, adding to the difficulties in getting people through and out of the emergency department.   

Many of the folk in the department, while I was there, were elderly patients. The impact of increasing fragility in the growing elderly population was glaringly evident. Those patients waiting for a bed were doing so because we have so many beds occupied by folk who have no medical reason to be in an acute hospital, but where there needs can’t be immediately met by other services. Regular readers of this blog will know I have personal experience of this. My mother who lives with dementia has spent the last 13 weeks in hospital. She was discharged home last Thursday with a full care package of support. Unfortunately, she fell on Friday afternoon, spent 7 hours on the floor waiting for an ambulance, and ended up back in A&E and admitted to hospital once more. She was discharged back home yesterday afternoon.

As well as living with dementia, my mother is very frail and has mobility problems, but there is no medical reason for her to be in an acute hospital bed. In fact, the hospital doesn’t even provide a safe refuge. In the 13 weeks she was an inpatient she had 7 falls. It is predicted that the number of people who live with dementia globally will rise to some 153 million by 2050. Arguably, dementia is possibly the biggest growing threat to future health and social care systems.

Increasingly there is an ever expanding arsenal of drugs being used to reduce the worst impact of the disease and slow the course of its progression. None, unfortunately, provide a cure. More and better drugs will be developed, I’m sure, over time. The lure of making enormous profits will ensure ‘big pharma’ keeps doing the research and developing new drugs. All of which, however, will take time.

So I was interested last week to read of work undertaken by folk at the University of Oxford in developing a tool that is based upon 11 risk factors, which can be used for predicting whether someone (at mid-life) will develop dementia within the next 14 years of their life. The 11 risk factors are: age, education, a history of diabetes, a history of depression, a history of stroke, parental history of dementia, levels of deprivation, high blood pressure, high cholesterol, living alone and being male. Whilst some of these factors can’t be changed (those over the age of 60 are at greater risk for example), other factors can be addressed by people choosing to modify their lifestyle choices. It’s known that up to 40% of dementia cases can be prevented by stopping smoking, reducing high blood pressure, losing weight and reducing how much alcohol you drink. However, the risk score can only ever tell us about the relative chance of developing dementia; it is not a tool that leads to a predictable definitive outcome. I think it is one of the new ‘up stream’ and evidence-based ways of thinking that the NHS has to embrace through working at a place-based, neighbourhood level.

I had one other visit last week which provided me with a glimpse of the other end of the care continuum. I was able to visit the internationally renowned cancer hospital, The Christie. I was offered a tour, which I readily accepted. Now nobody wants to find themselves there, but the facilities and environment were state-of-the-art. I was privileged to be shown inside the Proton Beam Therapy Centre. This is housed in an enormous building – read here to understand why this is!

Unlike other forms of radiotherapy, I knew absolutely nothing about this service, which is part of a £250 million national proton beam service. About 750 people use this service a year, 60% of them are children and young people. The advantage of proton beam radiation is that it can be aimed precisely at the tumour, and doesn’t harm the surrounding tissues or organs. It is about as far removed from the care my mother and others like her living with dementia receive at home as you could get, but both forms of care are just as vital.