Frailty & Care of the Elderly

I have now sent you five blogs expressing the view that frailty is not inevitable – it is preventable. If everyone was more physically active the prevalence of frailty would fall and over time the number of frail elderly would progressively decrease – prevention would be better than the need to provide the facilities for managing this scourge.

Even I, though, have to admit that a general increase in the exercise taking of our population will take a long time to achieve – and that any effect on the prevention of frailty will not be along any time soon. In the meantime we do need to improve the services provided for the dependent elderly – the so called “Social Care” system.

The view from inside

I am lucky to have a friend who has been very involved with the provision of both health and social services. This is his take on the problems.

I shall call him David – he was Chairman of a County Health Authority covering the care of about half a million souls with a budget of  £1/2 billion.

“Early on I was made aware of the problem of bed-blocking and set out to tackle the Chairman of the County Council Social Services.  I rang and asked for a meeting to discuss funding of social care, but instead of a meeting he invited me to spend a day with him. He took me first to a large house milling with people and explained that it was housing for children who were put on planes by their parents in very poor countries and who on the flight destroyed their passports. They arrived at Gatwick Airport as stateless lone children, responsibility for whom fell to West Sussex County Council Social Services.

“We then went to a school for disabled children; until then I had no concept of the lives of disabled children and had hardly ever seen one. This school, not the only one in the County, looked after and educated children with the most terrible disabilities, many so damaged they could do nothing for themselves. I had thought of Social Services as merely providing care for people at home. My eyes were opened.

“I was Chairman of a home for Disabled ex-Servicemen; we gave home to any disabled ex-serviceman or woman whether they could pay us or not. Social Services referred many to us, paying less than the keep of someone old but capable. However they referred disabled service people, some very seriously disabled. The charity made up the difference.  This became increasingly difficult and the Chief Executive asked me to request higher payment from Social Services: a waste of time.

“Hospital care is paid for by the NHS, funded by Government taxation. When someone needing care is discharged from hospital (s)he passes into the care of Social Services, funded by County Council rates/council tax. With the problems faced by Social Services it is unsurprising that they should seek to leave people in hospital. There is no way round this while the two are funded from different pots. The only way forward is to fund Social Services within the NHS which requires extra Government taxation and a reduction in rates. It will be a brave politician who seeks to achieve that.”

What next?

As far as the care of the frail elderly is concerned, the main message from David’s experience is the separation of financial responsibility. Hospitals are funded by the Government via general taxation while social care is funded via local authorities via the rates. Each has its own corner to defend.

We need a joined up process and funding for a holistic approach to those who need hospital treatment, with aftercare being part of the package. In the meantime the queues of ambulances outside A & E departments seem bound to grow.