Debbie Abrahams MP, Co-Chair, All-Party Parliamentary Group on Dementia
As we ring in the New Year, I am struggling to recall a time when our health and social care system has been in such a crisis. Having worked in the NHS for 20 years before I became a Member of Parliament in 2011, I have seen my fair share of issues, but these pale in comparison to what we’re seeing now.
My recent casework has reflected the issues the system is facing, and I wanted to share a rather personal story as an example of this.
My 88-year-old mother-in-law, Cynthia, who was cared for at home by her youngest daughter, had been off her food for a few days after what we thought was a stomach bug. A few days before Christmas, she started vomiting blood and although Cynthia never complained, we knew she was in pain. The out of hours GP told us to take her to A&E at Royal Oldham, ‘because she’ll be waiting hours for an ambulance’. As we approached A&E, we saw what he meant – 12 or so ambulances waiting outside with the queue disappearing around the corner. This of course meant that if the ambulances were waiting to deliver their patients, they couldn’t attend other emergency calls.
Once Cynthia was there, she was immediately triaged, but there were dozens of people waiting, sitting on the floor, waiting in wheelchairs and on trolleys. When Cynthia went into cardiac arrest, she was quickly resuscitated. But even before the ED doctor spoke to the family, we knew Cynthia needed palliative care. The hospital staff were magnificent and accommodated our rather large family as best as they could with patience, courtesy and respect. Their kindness and compassion were remarkable given the pressures they faced with very poorly patients lying on gurneys, drips and monitors in tow, at the side of every corridor.
Approximately 18 hours after Cynthia first arrived at Royal Oldham, she was admitted to a ward. Again, the staff were fantastic. Cynthia died a few hours later surrounded by her loving family. We all got to say our goodbyes to her.
We know that thousands of people are attending A&E every day, having had to wait hours for an ambulance after a fall or because they’re too poorly or don’t have anyone to take them by car. The Royal College of Emergency Medicine have stated that somewhere between 300 and 500 people are dying each week as a result of delays and problems with urgent and emergency care.
A key driver of the crisis we’re seeing in urgent and emergency care is the long-standing crisis in social care. The lack of capacity in social care – staff, care packages, and ultimately funding – means medically fit patients can’t be discharged into the community to free up the acute beds that are needed to admit poorly patients into hospital.
The infant Integrated Care Boards (ICBs) and Integrated Care Partnerships (ICPs) are better equipped in some places where health and social care stakeholders have already been working well together. But I do worry that the different cultures, the different funding regimes and particularly the inadequate levels of social care funding, pushed back yet again in the Autumn Statement, mean that the issues we are seeing now will continue for some time. This is what keeps me awake at night.
The All Party Parliamentary Group on Dementia inquiry into the social care, ‘Workforce Matters’, which I chaired, reflected on this. There’s a lot we can do to improve care, but we can’t get away from the fact that there needs to be significant investment into social care to enable this to happen.