Examination of Witnesses (Questions 400
- 403)
WEDNESDAY 20 MARCH 2002
MR ANDREW
WEBSTER, PROFESSOR
CAMERON SWIFT,
DR ANDREW
DEARDEN AND
MR BRIAN
DOLAN
400. Could I just say, are we agreed that this
would help with delayed discharges, are we saying clearly that
it would have an effect on them?
(Mr Dolan) You asked us the question, how do you share
it, and I was scribbling down a few notes. One is publications;
that Lancet paper is a seminal paper, it is a very fine
piece of work. The NSFs are actually a very useful lever for making
things happen, and I think a lot of the Government documents and
policy documents need to give examples of good practice, and "Here
is where you can go." Working with the winter emergency service
team, when we do feedback to all of the organisations, which is
both primary care and acute organisations, we say, "If you
want to develop discharge lounges," for instance, "this
is a good place to look, if you want to do this." There is
a chap in Barts called "the man with the van", and what
he does, he goes round, somebody has a fall, and all they really
need is for somebody to put a rail by their toilet, and he goes
out and he puts one up, with an OT; it saves a fortune, it saves
his salary multiple times. The other thing is around local champions,
people who celebrate what they are doing as widely as possible,
and I do not think it is any harm, now and again, where the evidence
base is unambiguous, that we say to the NHS, or social services,
"Make it happen; stop messing about, stop saying, `Oh, well,
we have to pilot it, or we have to do this, or we don't like it
because we're doctors, we're nurses, we just don't like the idea,'
just make it happen and insist that it happens." And things
like the Patient's Charter, although there were complaints about
it and concerns about it, and things like the Labour Government
have brought in this (? anxiety to pass ?), actually what they
do is they up the anti for the Health Service, and I do not think
that is a bad thing. It was no bad thing for the last Government
and this Government to say, "If you are a patient coming
to an emergency department you should be seen within 15 minutes
by a registered clinician," that is no bad thing, because
up to that point you might wait a half an hour, and that is not
good for patient care. So I think you, collectively, have a real
opportunity to make things happen by just the reports that you
do.
(Mr Webster) I was simply going to make the point
that with the creation of a whole lot of primary care trusts,
who hold most of the funds, there is perhaps the opportunity to
introduce some real financial reward, because if there are real
benefits to going out and putting a rail in somebody's house,
which there are, massive, and studies that we have done, and have
followed up, show huge savings from doing that, and if there are
real advantages in having the equipment in the doctor's surgery
or in the nurse's van, rather than in the hospital, well they
should reap the savings, should they not, because they will have
the money that they will not then need to spend on the acute hospital
beds. So, I think, if the system, and the basic structure of allocating
the money to those trusts, to develop better primary care and
to release resources from elsewhere, is there, in principle, what
has to be done is to make it work, and it would be possible for
people in the current structures to do that.
Dr Taylor
401. Two questions to the Audit Commission,
to which, in view of the time, I am not asking for the answers,
at this moment, I am asking for them in writing later. I am totally,
completely confused by the two major political parties arguing
about the numbers of care home beds that are closed; in Prime
Minister's Questions this afternoon, the Leader of the Opposition
put it at 50,000, the Prime Minister put it at 19,000. Could you
give us an authoritative statement of exactly the number of care
home beds that have closed in the last few years? That is the
first thing? The second thing, in your evidence, you say: "Agencies
must develop proactive strategies for maintaining a sufficient
supply of residential and nursing home places of an appropriate
quality," could you expand on that in writing, because I
do not know quite how they are going to do that? Really, just
to get those two bits in writing, if possible?
(Mr Webster) Yes, we will be able to do that.
Sandra Gidley
402. It has sort of been hinted at; we have
heard, while we were away again, quite a bit about developing
alternative models for care, such as hospital at home, exploiting
new technologies, telemedicine, that sort of thing. You highlighted
earlier the problems with just getting electronic patient records
up and running. So I always hesitate to ask this question, but
is there any mileage in those other models, and, realistically,
will there be any developments along those lines?
(Dr Dearden) I always like to start from a low-tech
side of things first, because actually I think that is very much
what helps. If you take, for example, a virtual ward idea, as
a GP, sometimes I admit people because I have an elderly person
with a chest infection who is confused, it does not mean that
they could not quite happily stay at home but they would need
someone to make sure they are fed, washed, take their medication
and they are safe. Now if there is not a carer there to do that
I am limited in what I can do. So a virtual ward, for example,
could have a 20- or 24-hour sitter, someone who is there just
to make sure that their social needs and medication are done,
perhaps ten of those homes, or beds, in a sense, with a senior
nurse that does a ward round in the morning and a ward round in
the afternoon, but is available then, by telephone, should something
occur that the carer then actually needs. What you have then is
a virtual 10-bedded unit. Now you could expand that or shrink
that, as you wanted to, you could bring in OTs or physios, if
you needed them. That kind of low-tech type thing could be used
to help stop people going into an acute hospital, but could also
be used in helping them come out of an acute hospital, where what
they really need is someone just to watch them for two or three
days. Now we talk about the kind of hotel services, but I think
that one is actually a home-based, supportive service, so that
we can call it a virtual ward, if you want to, that sort of thing;
now that is fairly low-tech, it does not need the kind of telemedicine-type
things, it would simply need a telephone line, or a mobile `phone,
or a bleeper, or whatever would be necessary for that sort of
thing, yet it creates fairly simply and fairly straightforwardly,
and could be done, actually, very, very quickly, 10 or 20 beds,
a nurse-led, therapy-involved, unit to help support people at
home, where they do not need to go in, or that will help them
come out quicker. So although the very high-tech stuff is sexy,
it is attractive, it attracts money, it attracts people into it,
there is a significant area of what I would call people-tech,
low-tech stuff, that would actually be as helpful, if not more
helpful, and certainly much easier to organise.
Chairman
403. We have one or two areas we have not touched
on, but I am conscious we have gone on a considerable length of
time, and it is pretty unfair to pursue the issues any further.
Can I, on behalf of my colleagues, thank you, gentlemen, for a
very interesting session, we are most grateful for your help with
this inquiry. We will follow up with one or two points, and certainly,
Mr Webster, you have got a list of questions from Richard Taylor.
(Mr Webster) I have got my homework, yes.
Chairman: Thank you very much, gentlemen.
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