Bruce Keogh (The NHS rose to the challenge of Covid, but its next test may be even harder, 18 February) makes salient points about the post-pandemic NHS, with emphasis on older people. The six tests are useful, but his focus on digital technology does not reflect the needs of older people, many of whom do not use it. In fact at times, it seems an administrative deterrent to manage demand rather than to enable patients to access services. Will the NHS fund digital training for older people?
His comments about keeping older people out of hospital are doomed unless four critical issues are dealt with: reform of the funding system for social care; doing away with the iniquitous system of “continuing healthcare”, classing those with dementia as not ill and robbing many older people of their life savings; raising the “carer’s allowance”, recognising that this care saves the NHS large sums every year; and moving healthcare staff from hospitals to the community, enabling GPs to provide a more comprehensive service.
Without these actions, the NHS will continue to be hamstrung in its efforts to reduce unnecessary admissions and long stays in hospital.
Penarth, South Glamorgan
• There is a danger of missing the crucial issue of how integrated health and social care will be delivered at a local level. During the pandemic, the NHS introduced a system called “discharge to assess” (D2A). The immediate pressure was to get patients out of hospitals as soon as possible, but D2A is part of a continuing “home first” approach. D2A assumes that the majority of patients can be discharged straight home from hospital. It does provide for patients who may need more support before returning to home-based independence, but the numbers are assumed to be small and they are supported only on a limited basis.
Because of the closures of community hospitals and a lack of resources, too many people fall through the gaps between hospital and home, NHS and local authority, and are sent home without adequate support, or placed in care homes miles from where they live.
The promised reform needs to guarantee that integrated health and social care is properly provided after people are discharged from hospital, across the country, at a local level.