As far as the NHS is concerned, it's clear that a growing elderly population, living longer, requiring more support, more medical interventions, and taking up 90 of the 95 spaces in the queue ahead of you when you try to get a GP appointment, is a major issue. They're filling up A&E's, they're lined up in hospital corridors, they're costing the country a fortune.
I work in a care home. The support network for the residents is staggering. There are GPs, district nurses, pharmacists, occupational therapists, dieticians, speech and language therapists, mental health nurses, psychiatrists, social workers, on-call clinicians, equipment services, and so on.
This example is very common: an elderly resident develops a pressure sore because they're old and tired and do a lot of sitting around. Their skin is fragile and they don't drink as much as they should do because their thirst mechanism has dissipated with age and they don't feel thirsty. Besides, if they drink more, they pee more, and they don't want to keep getting up to go to the toilet because they're old and tired.
The care home might need to contact the district nurses to dress the wound. The DNs then arrange for pressure relieving equipment, such as an airflow mattress, profile beds or pressure cushions (which is provided by the local authority). Maybe the wound deteriorates and becomes infected, so the GP becomes involved, prescribing antibiotics. Now that the person has an infection, they go off their food. They were already frail and lean but now their weight plummets, with their MUST score triggering a referral to the dietician. The dietician prescribes them some Ensure drinks to supplement their diet. However, that doesn't seem to do the trick because, although they drink the Ensures, they still won't eat solid food. Which then triggers a referral to the speech and language therapists (SALTs), who figure out if the individual isn't eating because there's an issue with their swallowing.
The SALT recommends that the resident only has soft or blended food and also prescribes thickening powder for their drinks, to help with their fluid intake. The pharmacist reviews their medication, changing as many pills and capsules as possible to liquid versions (which can be waaay more expensive). All of this has taken its toll on the resident, who is now bedbound. Previously only requiring some discreet assistance to go to the bathroom with one carer, now they're on a two hourly turns chart, mandated by the district nurses, requiring two carers to reposition them and attend to their continence needs. At this point, they may require bed rails to stop them falling out of bed. If they lack capacity (eg: have dementia) a DoLS (Deprivation of Liberty Safeguards) referral is sent off to the local authority. This is because bed rails are classed as a restraint and you need to justify their use.
They continue to deteriorate. Having a poor diet and fluid intake, living with chronic pain from lying in bed all day and having regular pain relief, they now require laxatives because the Paracetamol and Codeine makes them constipated. Immobile, they're now prone to chest infections and UTIs. Any fluid sits on their lungs and they're too weak to cough it up. They require antibiotics. The antibiotics don't work. The GP prescribes a second dose. This time, it just about works. They recover slowly from the infection but it brought it home to all concerned how frail they now are. The Enhanced Health Care team are contacted. They draw up, along with the individual and their family, a list of criteria that will determine whether the resident is admitted to hospital (usually only for a broken bone or if IV antibiotics are required to fight an infection). An anticipatory care plan is put in place.
Now they're categorised as End of Life. Palliative nurses come and check on them monthly, weekly or several times a day, depending on how close they are to the end. The GP has prescribed anticipatory medication, so they can be kept as comfortable as possible when they are in the final days of their life. Towards the end, they require round the clock care. This is how a lot of you will end up, whether you like it or not.
Look at how many healthcare professionals are involved. Some will be involved multiple times for different reasons. The cost is stratospheric. There will be an enormous amount of phone calls, emails, appointments, and time spent on this individual's health and wellbeing.
I haven't even mentioned falls, which can be prevalent, requiring ambulances, taking up space in A&E, then recovery wards. There's the cost of supplying zimmer frames, wheelchairs, etc. All of which are bespoke and require occupational therapists to assess.Every hospital visit for someone in a wheelchair requires an ambulance there and back, eating up more resources. I've only really scratched the surface. I've heard, anecdotally, that we spend more on healthcare in the last year of someone's life than we do for the rest of their life put together. I don't know if that's true but it feels like it is.
I love my job and I'm passionate about helping people, especially some of the most vulnerable in society, but I can't say I'm enamoured with the amount of time and money we spend on keeping people alive, many of whom say that they've lived long enough and just want to die. I don't know what the answer is. I'm just trying to paint a picture for those who are unaware of how much money is spent on caring for the elderly. Maybe that's why Hancock tried to kill so many of them?
So, to sum up, if you can't get through to your GP at 8am and are 95th in the queue, it's probably because people like me are ahead of you.