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Elderly A&E unit should just be the start

PUBLISHED: 15:48 09 November 2017

Ambulances stacking up outside A&E at the Norfolk and Norwich University Hospital. Picture: DENISE BRADLEY

Ambulances stacking up outside A&E at the Norfolk and Norwich University Hospital. Picture: DENISE BRADLEY

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Opinion: A dedicated A&E unit for the elderly is great but should be just the start, says Rachel Moore

An 85-year-old living alone and feeling ill on a winter’s night will call 999 because she is scared.

It’s dark, she’s lonely and frightened, and a night feels like a lifetime.

Making that call and explaining how she feels over the phone to the control room operator might be the only conversation she has had for days.

Her panic and anxiety about feeling faint or in pain might not be what the ambulance service or A&E is designed – or funded – for. Her situation – and tens of thousands like her in Norfolk and Suffolk alone – is neither accident nor emergencies in an A&E sense.

She might not need anything more than reassurance and support.

In the ageing population of Norfolk and Suffolk, these early-hours-of-the-morning calls are frequent, and often the real stories behind the logjam of ambulances outside A&E, waiting for floor space to unload.

On-the-spot paramedics do what they can to leave patients at home, but for vulnerable elderly people, the lines get so blurred.

The Norfolk and Norwich University Hospital announced this week the first NHS Accident and emergency unit solely for the elderly to avoid long delays.

MORE: Country’s first emergency department for over 80s to open in Norfolk

Patients over 80 will be sent straight to the older people’s emergency department, where they will be assessed quicker and have access to the right help – hopefully, because we all know access to the right help in tight resources with hard-pressed staff doesn’t happen quickly.

The idea is to avoid long stays

in hospital. For old people, this means less risk to increasing

their frailty and dependence;

for the hospital, it is an attack

on the ‘bed-blockers’ – a cruel term for the elderly and vulnerable who the system cannot find the right care for outside hospital.

And this is the problem. Spending NHS resources on a fast-track elderly-specific A&E is part of the solution, but, in the whole near-crisis situation of an escalating elderly population, largely in rural areas, it’s like sticking a cheap plaster on a gash and expecting it to be the solution and healer.

Too many elderly people end up in hospital for too long because of a desperate lack of community resources. Loneliness, fear and isolation make a vulnerable old person call 999, more than any health symptom.

They feel safe in hospital. Loneliness and isolation in the community makes people lose confidence.

If there was response within the community, GP-surgery-based community nurses and nurse practitioners, 999 calls and ambulances delivering the elderly to the doors of our A&E departments would be drastically cut.

But that takes massive investment and a change of policy to invest and build services locally, in the community, rather than centrally.

Health and social care have become so entwined, in elderly-heavy counties like Norfolk and Suffolk, it can be the only way – although budget cuts to social services for home helps and

other care have fallen by 11 per cent in five years. The NHS feels alien, hi-tech and new-fangled to old people. The touch-screen signing-in system in their surgery reception baffles them.

They want to deal with people, and people they know. They remember the district nurse, the family doctor, home visits and community services, however informal. They need them again.

In an ideal world, the GP surgery would be the hub of an army of elderly-focused nurses and carers, which would then ease the pressure at the acute end.

This may sound like la-la land luxury, but if we are going to care for the rising numbers of elderly properly and use hospitals efficiently and for what they are designed for, a community-focus is the only way.

When the new unit opens later this month, about 50 patients a day will be seen by the unit’s team of A&E consultants, consultant geriatricians and specialist nurses.

The chief executive of the Norfolk and Norwich University Hospitals describes it as a massive step forward. That remains to be seen, but it is a start.

Flags were waved more than 30 years ago about impending pressures on services from the quickly rising elderly population, scattered remotely across our counties, but it’s taken a crisis until anything has been done, just in time for the flu season.

Centralising services might be the short-term answer on paper to efficiency, but the people needing the services aren’t central. Long-term solutions should be on their doorsteps.

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