Observations Life and Death

Falling through the gaps in care

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7863 (Published 21 November 2012) Cite this as: BMJ 2012;345:e7863

Re: Falling through the gaps in care

Iona Heath makes some excellent points in her article. The fundamental issue is that the NHS has not kept pace with the demographic change in society, indeed the needs of the very vulnerable, usually elderly, patients and those approaching the end of their lives are being sidelined in a health service intent more on cure than care. As the article states, the gaps through which vulnerable patients sink are many, not least the ever present health and social care divide which, despite multiple 'reorganisations' is still present in many health economies.

A return to Community Hospitals, as a means of closing some of these gaps, is emotionally enticing however it should be recognised that many of these facilities, especially the smaller ones, are more expensive to run than the equivalent beds in a DGH and it is by no means clear that younger GPs have the time or enthusiasm to manage sick in-patients in an increasingly risk averse clinical climate.

The 'gap' - at least one of them - can be closed by much closer working arrangements between Primary and Secondary Care. If patients are to be increasingly managed within their own community GPs and their community teams will need the help, support and intervention of colleagues from behind the high walls of the DGHs. A patient-centric, rather than a hospital-centric approach is surely the only way to manage an increasingly large and vulnerable cohort of patients whose problems span medical complexity, high nursing and care needs often sprinkled with a significant degree of mental health issues.

Supporting families to recognise that hospitals are no longer 'safe havens' for their sick relatives is a message which GPs, on their own, will increasing find difficult to sustain. A 'specialist' opinion is, however, worth its weight in geriatricians if not gold.

Closing the gap in care is the responsibility of the medical profession to rid itself of the gaps between hospital and the community, primary and secondary, mental health and non-mental health, cure and care.

The prize is a health and social care service which, for once, we can all be proud of.

Competing interests: No competing interests
28 November 2012
John R Hughes
Group Medical Director
Sue Ryder
Upper Woburn Place, London WC1H 0AF
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