How does a health service faced with mounting demand and flatlining funding guarantee high-quality care for vulnerable elderly people?
This dilemma was a thread running through the Fourth Annual Wales Medicines Safety Conference in Cardiff on 16 October 2014, organised by the Royal Pharmaceutical Society (RPS).
The event, which focused on Wales’s ageing population, was timely — it happened to coincide with the release of a report into the standard of elderly care in the country’s hospitals.
Unannounced inspections were carried out at all 20 district hospitals over the summer, prompted by the ‘Trusted to care’ report released in May 2014, which had found “unacceptable” failings in aspects of elderly care at two hospitals.
Unveiling the findings of these spot checks at the RPS event, Mark Drakeford, minister for health and social services, said they showed that the problems identified by ‘Trusted to care’ were not endemic to hospitals in Wales. However, the inspections did highlight significant medicines management issues.
A new report from the Welsh Pharmaceutical Committee and the RPS, entitled ‘Your Care, Your Medicines’, was also launched at the conference. It describes how the introduction of individual medicines care plans could improve integration and quality of care in the NHS. RPS Welsh Pharmacy Board chairman Mair Davies said the ambitions described in ‘Your Care, Your Medicines’ could help some of the problems identified by the spot checks.
As much social as medical
In his speech, Drakeford discussed the “paradox” of over-treatment and polypharmacy; how some elderly people had “huge lists of medications, confusing in themselves and often leading to mistakes and errors in administration”.
Many older people’s bodies struggle to metabolise and excrete such quantities of medicines on account of their physical condition, and often the drugs no longer have an active effect in the patient’s body, he said.
“We have a polypharmacy-driven way of responding to older people’s needs, while at the other end of the spectrum, we have evidence of the most basic health needs not being attended to at all.”
This includes simple actions such as checking hearing aids are working and whether spectacles give adequate sight. “How we devise a model of care for people at that stage in their lives is as much social as it is medical,” he said. As much attention should be placed on allowing people to live their lives as on the “fiercely medical way” of dealing with ill health, he added.
“I think pharmacists are very well placed indeed to help us with that conversation and with marrying the two worlds, because pharmacists are a bridge between the medical and the social.”
Baroness Ilora Finlay, a professor of palliative medicine at Cardiff University, also called for pharmacists to rationalise patients’ “diet” of medicines. “Do you really want to eat 20 tablets for lunch?” she asked. “Get some nutrition into people, and take responsibility for what you see around you.”
“Your strongest tool in supporting people is to listen: with your ears, with your undivided attention and with your heart,” she added. “And look at them, see what the person is in front of you; then your professional skills can help sort out whatever the problem is.”
The cost of poor care
Finlay said the NHS in Wales was almost punch drunk with reports of bad care and neglect, but it was important not to become desensitised to the warnings, and to realise that poor care costs the NHS more. “The longer we carry on allowing poor care to happen anywhere within our line of vision, we are driving our own country further into deficit, we’re doing ourselves a disservice and we’re stacking up problems for the future,” he said.
Sarah Rochira, older people’s commissioner for Wales, said pharmacists must always remember the emotional aspect of good patient care: “I think it’s really important to remember how older people feel when they touch many of our services. The reality is that they need support from our health and care services. They are frightened, vulnerable and scared. You have to begin with that at the start, before we can care. It’s not just about the functional aspect of care.”
She said the way healthcare was organised in Wales made it difficult for different parts of the system to work together. “Take polypharmacy as an example of systems struggling to talk. The impact when we get it wrong, when we don’t talk to each other, is devastating.”
Davies said: “Improving the care for older people is critically important for the NHS in Wales: we have a growing population of older people and an ever-increasing number aged over 85 years. All of us in this room have the potential to change things, to offer better and safer patient care, and to improve the health outcomes for older people in Wales.”