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Number of older people with unmet care needs soars to record high

Age UK highlights the enormous cost to the NHS of delayed discharges due to a lack of social care.

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Numbers of older people who don’t get the care and support they need soars to a record high of 1.4 million.

New analysis by Age UK highlights the enormous cost to the NHS of delayed discharges due to a lack of social care, and how more older people than ever are missing out on the vital care and support they need.

The numbers of older people in England who struggle without the help they depend on to carry out essential everyday tasks (ADLs), such as getting out of bed, going to the toilet, washing and getting dressed, have increased to a new high of 1.4 million, meaning nearly one in seven older people now live with some level of unmet need. Experts at Ashton House say that assistance should be provided to those that need it the most.

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Age UK also found that among the 1.4 million people with unmet care needs, 307,581 require help with three or more essential activities, of whom 164,217 receive no help whatsoever from paid carers, family members or friends.

1.6 million people don’t get the help they need.

Taking into account other necessary tasks such as shopping, cooking or managing medication, the numbers of older people who don’t get the help they need rise to nearly 1.6 million people, a five percent increase in the last two years. Among this group over half didn’t get any help at all.

The Charity has also calculated that delayed discharges from hospital due to social care not being in place cost the NHS £289,140,954 a year equivalent to £550 per minute.

This new analysis needs to be seen against a context in which between 2009/10 and 2016/17 spending on adult social care in England fell by eight percent in real terms. As a result, over the same period, the average spend per adult on social care fell by 13 per cent, from £439 to £379, and an estimated 400,000 fewer older people received social care as the eligibility criteria tightened in response to insufficient resources.

‘Inadequate’ social care system.

Caroline Abrahams, Charity Director at Age UK said: “Age UK’s new analysis shows the huge impact on older people and on the NHS of our wholly inadequate system of social care. The Government often says they have invested more in social care over the last two years, but it’s not been nearly enough since the numbers of older people going without the support they need are continuing to rise – and quite sharply.

“If an older person needs social care but can’t get it this is a sure-fire recipe for them to become weaker and less well. They are at far greater risk of not eating enough and of falling and hurting themselves because of trying to do more than they really should. And it goes without saying that their lives are likely to be diminished and made more miserable. Is this what we want for our parents and grandparents, husbands and wives, older neighbors and friends in 2018? We have to do better.

“The Government will no doubt point to the fact that they hope to publish a Social Care Green Paper in the autumn, but a Green Paper will not in and of itself deliver any new funding for social care for several years and it is obvious that the system needs a major injection of cash right now. The responsibility for fixing this lies firmly with the Treasury: the Chancellor must take action to shore up social care in his Autumn Budget. The experts say there is a funding gap of about £2.5bn and that’s the kind of extra money that our older population needs to see. Anything less means the numbers struggling alone without help will keep going up.

“Age UK’s new analysis also shows that delayed discharges due to a lack of social care is costing the NHS a staggering £550 every minute. The extra funding announced recently for the NHS is warmly welcome, but it will do a lot less to help our GPs and our hospitals than it should do for as long as the Government allows social care to continue to decline.

“Taken together these numbers show the folly and sheer wastefulness of the Government’s failure to invest anything like enough money in social care. We all depend on the NHS so we all lose out if it has less money to spend due to the lack of social care, but there is no doubt that it’s our older population who are paying the highest price of all – with their health, their happiness and sometimes even their lives.” 

Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Nurse with patient in bed

Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 

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Observations

A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.

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Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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