More infomation, less assessability

More Information, Less Accessibility
Mike Marshall MIHM, DHSM – IAH Trustee

I have probably driven my Trustee colleagues to distraction over completing my first ever blog for the West Midlands Institute of Ageing and Health. It was due in January 2018 and I was ill at the time. Since then holidays, retired life and procrastination seem to have got in the way. It’s always been the same: as a Health and Social Care practitioner / Manager/ Commissioner - reports finished at the deadline and funding bids submitted on the day (the last of which gained £2.3 million from the Government!).
Well, here I am finally at the keyboard, relatively fit and able, unlike many of the older people we seek to support through the Institute’s work.
I can travel to my GP, access hospital appointments (unfortunately not in my home town of Bromsgrove in the actual community hospital I commissioned) but in Redditch (or Kidderminster) some 7 miles away.
Should I have experienced a stroke the journey would be to Evesham, 48 miles round-trip with no direct bus route. Trains? Forget it. Older relative, no car? – no chance.

There was once a recognised centre of excellence in Herefordshire & Worcestershire at the Stroke Unit in Bromsgrove, but no more. The convenience of local potential patients and their families clearly did not feature highly in the decision.
Everything seems centralised in the south of Worcestershire. Some may recall the sad death of Callum, an 8 year old boy, living near the Redditch hospital, sent home from the Worcester hospital but relapsed later. Ambulance crew were instructed to go directly to Worcester Royal Hospital 19 miles away, despite facilities for resuscitation at the closer hospital [Redditch Standard 24/03/17]. The question remains unanswered as to whether earlier access to specialist care would have changed the sad outcome – but the instruction made no sense to local people

Accessibility is a key issue in health outcomes: -
“From 1st August 2016 onwards, all organisations that provide NHS care and / or publicly-funded adult social care are legally required to follow the Accessible Information Standard. The Standard sets out a specific, consistent approach to identifying, recording, flagging, sharing and meeting the information and communication support needs of patients, service users, carers and parents with a disability, impairment or sensory loss”.
(Accessible Information Standard, 2016, NHS England).
All very well if you can easily and readily get to what you need.
Some years ago as a Social Care Planning Officer in Birmingham my colleagues and I identified the following criteria of vulnerability: -
Over 75 years of age
Lives alone
On 4 medications or more
No car
My colleagues persuaded me to omit the “no car” given the transport availability in the city. Unfortunately this does not apply to many parts of the West Midlands. I do count Bromsgrove as part of the West Midlands health economy given referral to The QE Hospital and other hospitals from the Bromsgrove and Redditch Districts.
Physical accessibility seems to have been overlooked by NHS England. Accessibility, following Google searches, is predominantly about information. Not about getting there and actually receiving healthcare.
As a mature post-graduate student at the University of Birmingham I was told the future lay in “smaller hospitals with bigger car parks”. But….along comes centralisation – bigger hospitals with smaller car parks and a bus service, if you are lucky. Promises of special bus services abound but are soon lost.
Care Closer to home: Ambulatory Care Conditions were identified to provide care for at home as an alternative to hospital bed-based care for frail older patients. It aims to provide patients with frailty syndromes with individualised medical, nursing and therapist treatments as close to home as possible. These conditions include: -
Chronic Obstructive Pulmonary Disease
And…. Influenza
For Care Closer to Home there is a requirement for multi-professional working.
With reports of community service NHS Trusts being “over stretched, underfunded and understaffed” is there any chance of achieving this aim? With a long known and expected surge in demand of an ageing population and growth in long term health conditions such as diabetes and high blood pressure (see above) is there any prospect of improvement?
As for multi-professional working – there is essential reliance on Social Services for achieving Care Closer to Home.
A report from AGE UK brought a response from the Association of Directors of Social Services (ADASS) President, at the time, who said: “Much of this study is not inconsistent with the findings of our own budget survey published last month – particularly where colleague directors warned of the growing evidence of unmet need. The picture that AGE UK has drawn is what unmet need looks like!”

“As well as pointing to the £1.1 billion shortfall in adult social care budgets this year, our survey, which AGE UK have quoted from, showed alarming reductions in confidence by directors of adult social services that they will be able to sustain effective, comprehensive services going forward”.

There is an inextricable link between Health and Social Services. The emergence of Accountable Care Organisations will not necessarily address this. Health, Social Services, Local Authorities hold separate budgets and budgetary systems. It is regrettably about who pays for what and why and accusations of ‘cost-shunting’. Additionally the relationship between Local Authorities and National Government has many issues of concern for collaborative working in order to support Care Closer to Home.
Further compounding care of older people is the report that re-admission rates within 30 days of discharge has risen some 19.2% (2010 – 2017). Unnecessary trips and overnight stays in hospital puts a strain on older patients and their families.
To be continued, obviously…..