Named clinicians for vulnerable older people – how will it work in practice?
Prof David Oliver is a Consultant Geriatrician in Berkshire and a visiting Professor in Medicine of Older People at City University, London. He is President Elect of the British Geriatrics Society.
David writes in the King's Fund blog on the how assigning named clinicians for vulnerable older people might work in practice:
Older people and their families have repeatedly expressed concerns about discharge from hospital being rushed, poorly planned or with insufficient involvement, notice or information. Lack of post-discharge support, care co-ordination or rehabilitation can lead to further deterioration in health, confidence and independence, and further stress for carers. It also risks emergency re-admission to hospital − an experience that older people often find distressing, and that exposes them further to the risks of hospitalisation. Re-admission rates are rising, especially in the over 75s.
The ‘named accountable clinician’ is also attractive to politicians and the public because of evidence that older people, especially those with complex co-morbidities, frailty, dementia or terminal illness, as well as their carers, can feel bewildered dealing with multiple disciplines and services.Professionals under-estimate the related stress and uncertainty. The recent National Institute for Health Research Care Transitions Project, with older people as co-researchers, made this very clear, with one participant saying ‘I felt like a stranger in a strange land’. If we are serious about integrating around the patient, then its tangible manifestation must be what National Voices term ‘person-centred co-ordinated care’.