Dr Teck Khong is a doctor and ex police surgeon. He is an Approved List Candidate of the Conservative Party.
A frail elderly lady living on her own in a ground-floor council bungalow has ischaemic heart disease, cerebrovascular disease, osteoporosis, osteoarthritis, venous leg ulceration and stage four chronic kidney disease. She is a most stoical lady.
Several months ago, her health and her independence declined markedly. She started falling frequently despite walking aids but she soldiered on with a package of domiciliary care comprising three daily visits. Toileting at night was becoming a major problem, as were risks of fractures or worse if she fell in the night.
It became apparent that she needed more help and she agreed too so Social Services were contacted for an assessment with a view to her placement in a residential care home. The assessment was carried out a month later but she was considered as not reaching the requirement for overnight care. Disappointed with that verdict, the Reablement Team was contacted but they steadfastly refused to reconsider their decision even though the lady’s condition had deteriorated.
Such scenarios are becoming increasingly commonplace as Britain faces ethical issues over the care of its elderly population. Medical services and social care are not working seamlessly to save the frail from misery and avoidable catastrophe. Enter the Better Care Fund(BCF). It underpins the activities of Health and Well-Being Boards and allocates local single pooled budgets, requiring the NHS and local governments to work more closely together, hence the term Better Care Together.
Like many Government health and social care initiatives, BCF is well positioned to enable Health and Well-Being Boards to serve the public at the interface of health and social care needs and to help those who struggle to help themselves.
If, however, the Government is to realise its ambition of a successful transformation of health and social care services, then the impasse such as that encountered by the patient described represents a significant failure of compassion and patient choice. Living in the community may confer quality of life in the elderly and even save money in the short term, but care must not be compromised by cost considerations.
As a Board Member of a NHS Clinical Commissioning Group involved in working with the local government, I see this type of challenge where patients’ needs are subordinated by dogma as clearly contrary to the ideals of Better Care Together. Politicians must therefore recognise and address the disadvantages of fragmentation and detached management in the delivery of such public services.
We know the value of programmes such as immunisation, breast screening and cervical smear in preventative public health. On that principle, I suggest that for the older generation who have worked hard and contributed to nation building, proactive care led by bold and rational medical advocacy offers genuine compassion to safeguard them and to ease their suffering in the evening of their lives. We must not ignore the inequalities endured by the frail and the elderly.