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NHS needs a revolution in Primary and Social Care Now

Ten years ago, as my late husband suffered the end stages of bladder cancer and heart failure we tried to navigate our way through a health service which was in some respects woefully inadequate to meet patient needs in all sectors.  At that time, it was clear that if a patient was scheduled for treatment, the system worked reasonably well, but if an urgent issue developed, the system did not have the capacity to admit and treat all urgent needs.

What happened to us is now history.  Following his death, I wrote to all agencies that had been involved in his care outlining the chain of events we had tried to deal with over a period of eighteen months.  I made it clear that I was not writing to make a formal complaint but to make all professionals involved in his care aware of the failings that the patient and family had experienced.  A reflective review was set up at which a senior consultant, representative of the district nursing service, GP and senior executive of the hospital were present.  The aim of the meeting was to reflect on what had gone wrong and put solutions in place for the future.  One of the main problems identified was the lack of communication between primary, secondary and social care.

Changes were put in place and ten years on my new partner receives monthly chemotherapy.  To date his cancer treatment has been exemplary, but once again, this is scheduled treatment.

I do not know what professional medics say that they need but as a family member of patients in need, I have seen where the system breaks down.

Firstly, in access to GP care.  If patients cannot get an appointment when they need one, a chronic illness develops into an acute one, which will soon be in an ambulance, the waiting room of an over-stretched A&E department and may require subsequent admission.  Secondly, development in modern medical and surgical techniques has meant that patients are often medically fit enough to be discharged but not well enough to take care of themselves at home.

I am old enough to remember when GP run cottage hospitals and convalescent homes were the norm.  The former had the advantage of nursing care and supervision by GP’s.  This meant that a patient’s GP was aware that a patient had been discharged from a main hospital and of their medical and care needs before they went home, creating a bridge between acute hospital care and being home alone.  Follow up care (something we lacked 10 years ago) was therefore more likely to be assured.  The latter provided a place of rest and recuperation for those that were not fit enough to be at home with permanent trained staff available to provide care and rehabilitation.

Our experience of the social care system was chaotic and revealed an extraordinary level of waste in terms of resources.  Discharge was followed by assessment and a two week period of support from a specific service.  This was followed by re-assessment and possibly a continuation of the care or transfer to another branch of the service.   After this, we had to arrange private carers. If the patient was re-admitted or circumstances changed then the whole process started again.  We had sixteen re-admissions in an eighteen-month period. The result was hours of box ticking, delay in discharge, sometimes a wait of several days before the first carers appeared and inconsistent care. all of which contributed to need for re-admission.

Setting aside issues of pay, exhaustion and demoralisation amongst professionals, if these problems are ever to be resolved in the long term there is a need for a substantial increase in the number of GP’s, reduced ratio of patients to GP, and extended access to GP’s through weekends and holiday periods.  This can only be done if the number of GP’s is increased, enabling overworked GP’s to work reasonable hours while making the service more available to all who need it, when they need it.  In the longer term this could have a substantial impact on the number of patients forced to use A & E and emergency admissions.

More GP’s would also be needed to support a new local cottage hospital system. Government managed to commission opening of Nightingale Hospitals at the start of the pandemic in a short time.  This same will and initiative is needed to support social care.

Science and Medicine continue to make discoveries and find solutions to health problems that were untreatable only a few years ago but these improvements and all the money that has been poured into them are useless if the system is unable to provide primary and acute care when a patient most needs it.

My professional background is in Psychology specialising in the dual affect of the mind on the body (psychosomatic) and the body on the mind (somatogenic).  It is well known that stress and fear increase perception of pain and make the body more vulnerable to the onset of disease.  Loss of a loved one impacts the lives of those left behind for ever.  As a nation, irrespective of party politics, we have a duty to find a solution to these problems now.

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