Older people and the “patient centred” NHS

Editor—Rowland and Pollock's editorial induces reflection on the consequences to the NHS and social services of patients admitted into secondary care in less than ideal circumstances.¹ In primary care such patients are recognised as on the brink of coping with chronic illness, increasing frailty, and confusion. In an increasingly mobile society many have no one close to them to offer support in precarious circumstances. Choice for such patients is indeed presented as an obstacle to the efficient functioning of the system that purports to protect them from destitution.

Our team recently reported a study seeking to identify such patients in primary care and offer them additional support, particularly over winter.² The data suggest that such patients can be identified and worked with proactively to reduce potential admission to hospital and an uncertain future. However, the effort of the primary healthcare team must be concerted. It requires visits, calls, and interventions, which are welcomed even if not explicitly sought.

Despite our busy lives, few of us want to see our older relatives become a burden to the state. Our experience is that the involvement of an interested primary care team expressing concern is often enough to move relatives to act when action is required. In New Zealand substantial family input is reported to lighten general practitioners' load by reducing the need to resolve social issues.³ In the United Kingdom healthcare professionals must take the initiative, but when they do we have found that the family is not far behind.