Key issues arising from the day
COMMUNITY
Activities
Affordable activities with contemporaries not just 'traditional' activities for older people or carers but access to an affordable range of activities within the 'normal' community
Assessments
Community, social work, hospital admission, hospital discharge assessments it is felt all assessment processes need a more open inclusive policy, to take into account the needs and wishes of patients and the relatives and carers. Professionals should discuss with people before any decisions are made, not make assumptions about them; it is felt that this could help to reduce bed blocking and ensure that people are encouraged to remain independent for as long as possible.
Community Support and working together
There was strong feeling that groups and organisations should be working together to make the best use of scarce resources and that coordinating action and information would enhance the services available but that this should be organised and managed locally in the locality to make best use of the facilities, volunteers and support already established.
Equipment
The length of time waiting for assessment for equipment was a cause for concern and also the lack of knowledge about the best way to get equipment and where it could be obtained. Some people felt that equipment should include things often considered 'luxury' such as reclining chairs but which may be essential for some people.
Gardening
Work in the garden such as grass cutting, clearing leaves from lawns and paths, annual pruning were all considered problems for some older people and also for some carers who had little free time and in some cases were older themselves.
Help in the Home
The main emphasis was on physical help such as cleaning, cooking, going shopping with someone not just having someone do the shopping, changing bed linen, washing particularly large items such as bedding, ironing. The emphasis was on people being available to support at a reasonable rate not just the supply of equipment.
Information
The largest and most common theme - clear, useful, easily accessed, readily available, simple not complex, co-ordinated, locality based and locality managed, one stop issue.
In Patient Support Scheme
Voluntary service hospital based to support people with no outside support in the locality with personal care washing, toiletries etc.
Reliable Trades people
A number of older people and carers identified the need for a list of reliable and recognised tradesmen. There have been a number of reports about (older) people being cheated by unscrupulous trades people. A local register of recommended trades people would be useful. It was suggested that the local Chamber of Commerce may be prepared to undertake this.
Replacement Relatives
Extension of the Age Concern Scheme within the community to develop separate community support for older people living alone and carers who are isolated with little local support from family.
Respite Care
Access to respite care that is varied and flexible was identified as essential. Many older people had access to traditional respite such as short stays in residential establishments, day care or sitting services, but it was felt that more use could and should be made of more flexible schemes such as supported holidays in hotels, or shared holidays with patient and carer but with appropriate support - in a 'normal' setting.
Training for older people and carers
There were a number of suggestions for training and advice for both older people and carers. A series of two hour tasters had been held recently on using PCs and it was felt that these could be extended and expanded to include a range of training topics.
Transport and Travel
There were particular concerns about transport for people isolated because of their physical frailty, caring role or rural situation. It was agreed that there was no simple answer, but transport to some activities and special transport for those who otherwise could not get out were two issues raised.
These covered a wide range of issues listed below
Waiting
Waiting lists too long
Waiting for doctors to give information because nurses not allowed to
Waiting time in hospital and waiting rooms for the actual appointment
Waiting to go home - older people in hospital too long - no one to care at home
Waiting for Assessment admission and discharge often delayed seldom made with patient and carer, usually made over their heads
Operations
Cancelled operations once in hospital and all arrangements have been made at home
Being starved pre-op (especially if operation then cancelled)
Distress caused for patient and partner
Difficulty because of arranging alternative carer for Carers looking after someone else.
In Patient Care
Finding someone in the ward to talk to
No nursing care - very technical not good personal care
Patients not always washed daily
Food - cold, badly presented. Limited choice for older people
Not being able to reach food hungry
Patients being sent home with bed sores
Mixed wards - especially when getting better (can be fun... - for the few!)
Shorter hospital stays patients not always ready to go home
Who are the staff? Names printed too small to see
Many patients don't understand the uniforms
Who can give you information usually several conflicting statements
All day visiting allows flexibility for relatives and friends but might not always aid recovery for patients
Difficult for patients to get support when they have no close relatives.
Appointments
Suitable times tendency to give date and time not consult on best day and time for patients exception outpatients at Princess Anne
Sometimes difficult to attend especially if caring and can only have sitter at specified times
Parking - missed appointments or late for appointments often the result - can affect health professionals too.
GP/Surgeries
Concern about length of time patients had to wait before they could get an appointment with the GP, the length of time they had to wait in the surgery before they actually saw the GP.
Home visits - delays and discouragement
Times of surgery opening needs to be more flexible and appointments available on different times and days
Name tags too small.
Who do you see in the surgery and for what?
It was acknowledged that GPs were very busy and that their time was limited but there were suggestions for alternative solutions such as nurse practitioners to relieve the pressure on GPs and allow a patient to seek advice in a shorter time scale.
General
Closure of nursing homes (funding, politics - vicious circle)
Staff
Concerns about staff and their own needs
Staff have their own pressures
Staff too busy.
Staff money not good enough
There are examples of good practice and excellent service delivery but these show up the not so good areas.
District nurses should be able to pass patient onto community support service when they have to close the case
Information about hospital services is difficult to find Patient information should be readily available and up to date.
More day surgery excellent idea
Cancer care very good
Ideas and suggestions
Hospital voluntary workers to help feed patients
Not too many managers shouldn't be too many
Appointments
Failed appointments
Parking problems availability and access
Couldn't get there transport, other responsibilities
Forgot appointment memory loss, too many concerns
Inappropriate appointment already been seen by different specialist
Personal circumstances have changed in hospital, loss of close relative
Reminders e.g. telephone call re appointments would be helpful.
Many of the issues raised on the day have already been raised in the past (see Appendix 1 and 2)
Information Plan
Some issues will form part of a proposed information plan to be initially promoted by the participant organisations and other interested agencies
Consultation ongoing
As a result of requests received on the day a further Information and Consultation Event will be held in the autumn to give feedback on the outcomes of this day and to pick up any specific concerns or new issues and encourage debate.
Community Support
Age Concern and the Carers Forum will be looking at the suggestions and planning a range of solutions to meet the community needs expressed these will include a community network, better communication for people who are alone or isolated.
Training
Age Concern and Romsey and District Carers Forum will be developing two-hour workshops for older people and expansion of training for older people and carers in cooperation with other organisations and agencies.
Health
The issues as raised will be passed to appropriate health commissioners and providers.
Social Services
There was no representative of Social Services at the Information and Consultation Day and participants noted this as a negative response. One written contribution gave credit to the services the contributor had received from social services. Issues raised about social services will be passed to the local Service Manager for consideration.
Other Issues
Other issues will be passed to the appropriate organisations for them to use as part of their business plans and best value reviews.
The evaluations were positive and included requests for a further Information and Consultation Day relating to the expressed needs of participants. There also appears to be support for further group sessions to be held to enable participants to express their views and to both offer and gain further information.
