I’ve seen first-hand the problem with a lack of care in the NHS - Jayne Dowle

An important new study has confirmed what those of us with elderly parents already know, older people waiting to be seen in A&E are more likely to end up stuck in a corridor than younger ones.

Anyone who has ever sat in an emergency department will have likely witnessed ill and confused over-80s lying on trollies or slumped in wheelchairs, waiting to be treated and moved through the hospital system.

This is in the hospital, don’t forget. The one place where they should feel safe, protected and cared for.

However, new analysis by the Nuffield Trust, an independent health and social care think tank, reveals that elderly patients, particularly those over 81, are disproportionately subjected to waits exceeding 12 hours in A&E departments, often receiving what’s known as ‘corridor care’.

‘Corridor care’ is defined as treatment in unsuitable environments lacking privacy, basic amenities, and conditions for rest; nearly 3,000 patients daily experienced this in England in May, the Nuffield Trust discovered.

In addition, last year - twice as many (43 per cent) of over-80s faced a wait of more than 12 hours for admission into hospital from A&E, compared to 19 per cent of 21–30-year-olds.

This is bad enough, but those aged over 80 are also far more likely to suffer from myriad health problems, including frailty and confusion, which compounds the distress they are already experiencing as they wait, and wait.

The cynical assumption is that elderly people are more complicated to diagnose and treat, and younger people tend to turn up to A&E with rather more straightforward medical emergencies. There is some truth in this generalisation, but the reality is that A&E is only one piece in the jigsaw journey of hospital admission, treatment and eventual discharge.

It is often the case that the delays and reliance on corridor care happen because beds are not being freed up fast enough to accommodate elderly patients.

This is chiefly because unlike A&E, social care and other services which support discharge do not operate round the clock or even into the evenings and at weekends. This means countless in-patients can be literally stuck waiting to go home with a support package in place, or to a residential care home, because there is no-one available to sort out the paperwork.

Many voices are calling for Andy Burnham to address this crucial link in the chain as a key part of his reforms to social care.

“Increased attention towards the ‘back door’ of the hospital, including social care and other services which support discharge, would be a welcome step towards bringing bed capacity down and easing overcrowding and we hope this is included in his [Burnham’s] thinking,” says Dr Ian Higginson, president of the Royal College of Emergency Medicine. “Emergency departments operate 24/7, but many of the services which support them and discharges are not currently delivered into evenings and weekends. This isn’t just a matter of beds, it’s a matter of good operational practice.”

At the very crux of this is the disconnect between the NHS and social care. These two services should - ideally - act seamlessly together, but rarely do. As Higginson indicates, “operational practice” requires significant improvement, but the big issue is - as always - money.

The NHS and social care are funded in entirely different ways. As I’ve found with my own elderly parents, who pays for what leads to wrangles which add to delay.

My mother died last September after a year-long stay in residential care following two months in hospital with myriad health and medical conditions. My abiding memory of the hospital is doctors obsessed with the family signing a DNR (do not resuscitate) form. It never came to that, thankfully, but I did ask one particularly persistent consultant if this was his way of freeing up beds.

My father had a catastrophic stroke in May and spent weeks in the local hospital’s rehabilitation unit.

He is now back home receiving a further six-week period of care and rehabilitation under what’s known as Early Supported Discharge. Already, this promised six-week period has been challenged by the hospital, who have tried to offload the caring aspect to social services after just a fortnight, meaning he would have to contribute to his own care costs immediately.

He will do eventually, we know this. But given he’s gone home and freed up a bed, the attitude was frankly callous, not caring at all.

I have seen from the inside that the NHS will get out of paying for anything it thinks it can get away with, and that sorting out funding for social care can be a distressing, even humiliating process.