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02.12.16

Lack of carer support is piling the pressure on NHS emergency care

Source: NHE Nov/Dec 16

Heléna Herklots, chief executive of Carers UK, explains why a lack of community services support is leading carers to reluctantly take their loved ones more and more to A&E departments.

With an ageing population, the demands on our health and care system are growing. We are all too aware of the challenges facing our NHS, particularly, as the winter months approach, how more and more visits to A&E departments are stretching the ability of emergency departments to cope.  

Whilst the majority of these visits are unavoidable, our new research shows that a significant number of carers are reluctantly taking their loved ones to A&E because they are not getting the right support from community health and care services. 

This is a regular occurrence for mum-of-four Stephanie Nimmo. Stephanie, who cares for her two sons with autism and her daughter who has a rare genetic disorder, said: “I want proper arrangements when my child is unwell – not to have to resort to A&E because our community nursing team only operates 9-5, Monday to Friday. We spend enough time in hospitals as it is, we only want to visit them when our child is acutely unwell: why can’t we have community-based support for our child’s chronic conditions so that we don’t have to trek to A&E for something that a less complex child could visit their GP?” 

Our new report, ‘Pressure Points – carers and the NHS’, found that, like Stephanie, one in five carers who took their loved one to A&E over the previous year felt they had no option because it was impossible to see a district nurse or a GP out-of-hours, and another one in 10 didn’t know where else to go. 

In addition, four in 10 carers who had taken their loved one to A&E in the past year believed their admission could have been prevented with more (55%) or higher quality support (50%) for the person they care for, more local support for them as a carer (32%) or access to a district nurse (25%).  

Growing NHS demand forcing early discharge 

Growing demand on NHS services presents a number of issues for families. Our research shows that it is forcing many people to be discharged from hospital too early, often without the right support in place at home and without proper consultation with their family and friends. Over half of carers we spoke to said that the person they care for had been discharged from hospital too early, with one in 10 saying their loved one had to be readmitted as a result. Not only is this counterproductive for the health of the person being cared for, but it also causes undue stress and anxiety for families and friends who are often unprepared to take on caring responsibilities or co-ordinate aftercare at such short notice. With readmissions costing the NHS £1.6bn annually, it is vital that people are not discharged too early without appropriate support in place. 

Jonathan Corbett, who has been caring for his wife round-the-clock since she was diagnosed with viral meningitis one year ago, said: “Although I give staff my details I rarely get a phone call to say if and when Chelsea is going to be discharged, and often I only find out when Chelsea messages me. Chelsea will sometimes be pressurised to vacate her bed ASAP as they apparently need it for someone else; this then pressurises me to have to get things sorted quickly for going to collect Chelsea and her return. I find this very stressful, especially if Chelsea is still feeling unwell and we’re not sure if she’ll be ending up back in A&E again.”

As the NHS, local authorities and social care look to reconfigure services locally through a variety of mechanisms, it is vital that carers are a clear group that are identified and supported. Mainstreaming carers into the plans and ensuring that their identification, involvement and support will be critical to the future of carers’ ability to care and the sustainability of the NHS. 

Carers UK has looked at a number of different areas where projects and plans to reduce emergency admissions or improve hospital discharge are being implemented. For example, an initiative by East and North Hertfordshire NHS Trust in Lister Hospital found that supporting carers before their loved one was discharged reduced readmission rates. More information on this project, and further best practice examples, can be found in the Pressure Points report. 

The majority of care provided in the UK is not by doctors, nurses or care workers, but by family and friends. Indeed, 6.5 million people in the UK care, unpaid, for a disabled, older or seriously ill family member of friend. With more and more families picking up caring responsibilities and older people with care needs being encouraged to stay at home for longer, a step change is urgently needed to boost investment in community services and involve carers in decisions about the support they, and their loved ones, need to manage at home.

FOR MORE INFORMATION

The ‘Pressure Points – carers and the NHS’ report can be accessed at:

W: www.carersuk.org/pressurepoints

Tell us what you think – have your say below or email opinion@nationalhealthexecutive.com

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