James (not his real name), is 69 and receives four social care visits a day. After ending up in hospital in need of oxygen, he falls into a familiar trap for patients with complex needs. Although discharge coordinators in the large teaching hospital in central England expect him to be medically fit within a couple of days, the company in charge of his care package declines to suspend it, closing his case instead.
Now the hospital must start from scratch, consulting with social services to establish a new care package. It’s a process that frequently takes more than a week. In the meantime, James is frustrated that he cannot leave the hospital, and the respiratory ward where he has been placed is left with another unnecessarily occupied bed.
Iris has been living independently before she falls and breaks her hip. She’s taken to hospital where she undergoes surgery and, after a few day’s recovery, she’s ready to be discharged. However, the operation has made her much less mobile, meaning she cannot go back to independent living straight away. The operation has made her frail and a lingering heart condition starts playing up again. If she’s too well for the hospital, but too immobile to live at home, where can she go?
Patients like Iris and James highlight the problems facing even the wealthiest healthcare systems, where there are persistent gaps between expenditure on healthcare and the funding and provision of social care. This trend, which is reaching a critical level in mature economies with aging populations, is being exacerbated by tight budgets and increasing demand on healthcare systems.