Fit for a queen

I have never had a conversation about health with the Queen, although I've talked to people who have. As you might expect from a woman who knows how to fix a broken driveshaft, she is apparently quite comfortable discussing the more robust aspects of the trade. That will have made it easier for John Cunningham to take a history when she was recently admitted to hospital with what sounded like a bout of norovirus.

What was most impressive, however, was the duration of the admission for an 85 year old. 24 hours. The Queen and her medical team seem to have taken the view that it was in her best interests to get in and out of hospital as rapidly as possible. There is a firm evidence base for that. Although the Queen appears to be in good shape for her age, it does not take much to disturb the fragile physiology of an 85 year old. Every day spent in hospital would reduce even her formidable ability to cope. I also imagine that a) the Queen requires little additional in the way of a home care package and that b) if she did it would be fairly easy to arrange.

I am afraid to say that this does not compare well with the care we sometimes provide for 85 year olds in NHS hospitals. On a bad day an older person might wait 24 hours in A&E, and sometimes weeks for someone to fix up a social care package. And the median age of those waiting too long in A&E is now almost precisely 85. Older people have become important clients for all healthcare providers, and we need to get better at looking after them. We need to do this quickly, especially in Wales where our population is ageing more quickly than anywhere else in Europe.

What will excellent services for older people look like? I have been spending a lot of time discussing this with colleagues recently, and some key themes emerge: 1. Better anticipatory care in the community, with more proactive primary care and nursing home liaison; 2. Better recognition and early assessment of older people at the front door of our hospitals; 3. Better management of the movement of older people through hospital; 4. Better 'pull' of older people from hospital by community team in-reach, and 5. Better social care liaison with no unnecessary waits for care out of hospital.

Healthcare providers can do a lot of this themselves by changing the way they work. In some areas we will need help from our social care partners. I feel sure they will want to improve services for older people too. I'm not sure how much of a role liveried footmen will have to play, but I would like to imagine a time in the near future when all our NHS services will be fit for a queen.