Ambulatory Care

Part of the debate – in Westminster Hall at 11:00 am on 27th April 2016.

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Photo of John Howell John Howell Conservative, Henley 11:00 am, 27th April 2016

I thank my hon. Friend for allowing me to have a rest and to make the most of that time—as I get older, I need that. I do agree with her; she makes a very valid point. I am concentrating on older people because traditionally that is where the population who have used the hospital in Henley have come from. I think that in the past year only one was under 55. But as I said, my hon. Friend makes a very valid point.

In many cases, the decline that people experience cannot be attributed to progression of the acute problem for which they were hospitalised in the first place. An example would be pneumonia. Even if the disease is cured in a few days or, indeed, if a hip fracture repair is technically perfect and uncomplicated, the patient may never return to the same functional status as they had before they went into hospital.

According to the US study, between 30% and 60% of patients with hip fractures are discharged from the hospital to nursing homes; 20% to 30% of those persons are still residing in nursing homes one year later. Only 20% of one large group of patients returned to their pre-operative functional level after a hip fracture repair.

Many hospitalised patients have difficulty implementing their habitual strategies to avoid incontinence. The environment is unfamiliar. The path to the toilet may not be clear. The high bed may be intimidating. The bed rail becomes an absolute barrier, and the various “tethers”, such as intravenous lines, nasal oxygen lines and catheters, become restraining harnesses. About 40% to 50% of hospitalised persons over the age of 65 are incontinent within a few days of hospitalisation. A high percentage of hospitalised older persons discharged to nursing homes never return to their homes or community. In one study, 55% of persons over the age of 65 who entered nursing homes remained for more than a year. Many of the others were discharged to other hospitals or long-term care facilities, or simply died. The outcome for many hospitalised elders is loss of home and, ultimately, loss of place.

It is most important that relationships among physicians, nurses and other health professionals reflect the interdisciplinary nature of the whole of this process. In particular, I am a great enthusiast for the integration of the NHS with social care. That needs to move ahead very quickly to give the clinicians the responsibility for commissioning the social care that is required. Maintaining wellness and independence in the community prevents conditions deteriorating and therefore results in better health outcomes. Emergency hospital admissions are distressing.