The dangers of trying to keep patients out of hospital at all costs
SIR – Stephen Powis, the medical director of NHS England (Comment, April 11), discusses plans for the effective integration of health and social care. This is an excellent, if longoverdue, policy objective. No patient should languish in hospital awaiting rehabilitation or social care.
However, Professor Powis risks reinforcing the idea of “community good, hospital bad”. It is unsurprising that frail older patients admitted with pneumonia, heart failure, stroke, malignancies or late-stage chronic pulmonary disease might lose weight and muscle. Many have renal impairment, diabetes, metabolic disturbances or dementia, and receive complex medications, with the risk of drug interactions and toxicity.
Such patients should not be denied rapid access to acute hospital medical assessment facilities, and too much emphasis on “admission avoidance” risks both delaying diagnosis and increasing the length of their stay.
Readmission rates need more attention. Between 12 and 15 per cent of the frail elderly are now being readmitted within 30 days.
Timely, safe discharging requires enhanced medical and nursing input after hospital, not readily forthcoming from stretched GP services. An integrated outreach service from departments of medicine for the elderly to support rapid discharge may be a way forward.
Liverpool
SIR – Maximising the appropriate use of volunteers is a crucial step in providing integrated care.
Well-managed volunteer teams can play a key role in improving patients’ health and wellbeing in hospital, and also in helping patients to return home more quickly. Small, simple, human things can make such a difference to someone dealing with ill-health, especially if they are older.
Volunteer support at mealtimes can improve nutrition and hydration, which enhances patients’ recovery and minimises time in hospital. Volunteers also help those with mobility problems to be more active, preventing the muscle deterioration that often leads to patients being stuck in hospital.
Volunteers can free up hospital space by improving the discharge processes, ensuring that people leave with the right prescriptions and assistance. This is particularly important for patients without a wider support network. Older patients helped back into their homes by volunteers report increased confidence and happiness, and this helps to reduce readmission rates.
While there are currently around 78,000 people volunteering with acute NHS trusts, their role is rarely incorporated into NHS strategies. This is a missed opportunity: we urgently need volunteering to be recognised as a priority. If we can unlock the full potential of volunteers, we can ensure that patients, NHS staff and healthcare providers benefit more quickly.
Founder and Chairman, Helpforce London WC2
SIR – Two ignoble, vainglorious leaders, the world in their hands, testing each other’s nerve amid an Islamic battleground. God help us.
Leigh-on-sea, Essex
SIR – Surely we have had enough experience to know that statements from Russia – whether made in the Kremlin, the UN or the London embassy – will seldom, if ever, be true.
Chichester, West Sussex