Older people and the “patient centred” NHS

Editor—Rowland and Pollock discuss many of the problems and inequities of the Community Care (Delayed Discharges) Act.¹ They do not mention that inpatients under the care of a psychiatrist have been specifically excluded, although most psychiatric inpatients also occupy acute beds which in many places are in short supply.

My service has always had an excellent working relationship with the local social services department, and I have found that delayed discharges are usually due to shortages in staffing and resources and not laziness or incompetence.

It seems now that people will have to be prioritised for services for financial reasons and not on the basis of need. People living in the community will become a lower priority, with psychiatric inpatients the lowest priority of all. The government does not seem to regard the blocking of psychiatric acute beds as a problem.

This legislation may also be counterproductive to multiagency working because inevitably resentment will build up when mental health teams see their patients marginalised in favour of general hospital inpatients.

Old age psychiatrists may think twice before transferring patients from medical or surgical beds to psychiatric assessment beds knowing that their social care will be prioritised if they stay where they are. This is likely to lead to admissions to residential or nursing home care for people who might have been rehabilitated at home, given more time and appropriate multidisciplinary and multiagency assessment and treatment.