BBC:英国的医养融合改革
2016/6/29 协和老年医学

     以下内容翻译自BBC网站

     NHC：NationalHealth Service – 英国国家医疗服务体系

    

     好点子总是源自一些简单的想法，NHS与伦敦萨顿区护理部现在正尝试着更亲密合作的想法就是这样。

     当护理院的住户需要去医院时，一个红手袋已经提前为他们准备好了。里面囊括了和他们健康相关的各种重要信息与细节问题，例如当前的身体状况，需要供给的药品。除此之外，还提供了一套离开护理院时的所需换洗衣物。

     NHS在萨顿区的资深经理Mary Hopper说，“你一定不会相信，有许多人仅仅是因为找不到换洗衣物而延迟住院。甚至会有专门的工作人员前往失物招领处去给他们弄一套合身的衣服。”

     另外，护理院的工作人员将会在在48小时内前往(曾在护理院居住过的)患者所在的医院。

     而这些都能让医生和护士在照顾病患时处理的更为高效。

     这样的成果便是，老人在医院所花的时间大大减少了。比起原定的计划减少了4天时间，仅仅只需8天就完成了工作。

     而红手袋计划仅仅只是拉近NHS与护理院关系的方法之一。

     急诊率下降

     全科医生现在也被雇佣来对护理院进行定期访问。现在每位护理院住户平均每月会有6次常规检查。药剂师会前往护理院处理药品评估工作。当地的护士们也被安排前往护理院，培训护理人员处理老年痴呆，老人跌倒和糖尿病等常见问题。

     这些毫无疑问起到了很大的作用。这一项目自去年启动以来，急诊室的访问率降低了10%。这些护理院毫无疑问应该得到赞扬。圣裘德护理院的经理Patricia Fyfe说，通过合作竟能够取得这样的成果让他十分吃惊。

     萨顿区并不是NHS尝试和护理院加强联系的唯一地区，它是英国六个被资助去探索新工作方式的试验田之一。用Hopper女士的话来说，这些是在大家都认为NHS放弃了护理部门的情况下做的。她说，英国20年前曾关闭了大量常住医院，这意味着在NHS几乎没有投入资源的情况下，照顾老年病患的责任在护理部门日渐式微。

     作为服务提供者代表的照护英国(Care England)的Matin Green教授说，我们没有任何理由让护理院的住户在接受医疗服务时得到比其他人次级的服务。尽管所有的证据都表明他们确实是这么做的。

     医疗质量监管会(Care Quality Commission)查看了一些几年前的的案例，发现81家护理院中的大多数在被问及时，都表示自己没有得到来自全科医生的定期访问。这就导致了有些护理院的经理不得不自掏腰包支付给全科医生订金来保证他们的定期来访。报告显示，有时每年为此支付的金额高达2万英镑。

     解决办法

     如果萨顿区和其他几个试验区现在试用的方法能够奏效的话，现在使用的(医养)共享式方法或许可行。自二战结束，社会护理与健康护理被割裂后，他们便被分为两个完全独立的服务体系– 一个由地方等级的委员会运营，而另一个则由政府中心化组织。但是，随着国民年龄的增长，这套方式看上去已经有点过时了。

     现在，政府部门设立了一个名为“更好的护理”基金(Better Care Fund)来鼓励地方政府和NHS一起工作。这个基金今年投入了超过50亿英镑，但是它仅仅占了健康和护理部门预算总金额的5%都不到。这也是很多人想要政府更进一步加强两个部门完全融合的原因。这样激进的动作在现在或许有些稍稍出格了，但可以肯定的是，这两个部分在未来将不可避免的联系在一起。

     BBC原文：

     How red bags are bringing NHS and care homes closer

     Like many good ideas, the way the NHS and care sectors in the London borough of Sutton are working together more closely is a relatively simple concept.

     When a care home resident needs to go into a hospital, a red bag is packed for them.

     It contains their details, vital information about their health conditions, supplies of medicine, and a change of clothes for when they are ready to be discharged.

     "You would not believe how many people face delays simply because clothes can not be found for them," says Mary Hopper, a senior NHS manager in Sutton. "You have staff going to lost property trying to find them something to fit."

     The initiative also sees a member of the care home staff visiting the patient in hospital within 48 hours of admission.

     And this all helps doctors and nurses treat them more effectively.

     The result is older people are spending less time in hospital - eight days, which is four fewer than before the scheme was set up.

     That is good for the individual and good for the health service.

     But the red bag scheme is just one of the ways the NHS and care homes are working together.

     Drop in A & E visits

     GPs have also been employed to carry out regular visits of care homes, with each resident now receiving six-monthly check-ups.

     A pharmacist is on hand to visit homes to carry out medicine reviews.

     And district nurses have been used to train care home staff in dementia, falls and diabetes.

     It certainly seems to be working.

     Since the project started a year ago, there has been a 10% drop in visits to A & E.

     Those running care homes are, unsurprisingly, full of praise.

     Patricia Fyfe, the manager of St Jude's care home, says it has been really "eye-opening" to see what can be achieved through collaboration.

     Sutton is not the only area where the NHS is forging closer links with care homes.

     It is one of six "vanguard" areas in England given funding to explore new ways of working.

     This has been done in recognition of the fact that the NHS has - in the words of Ms Hopper - turned its back on the care sector.

     She says the closure of many long-stay hospitals 20 years ago means the responsibility for caring for sick older people has increasingly fallen on the care sector - with little input from the NHS.

     The sentiment is one the care sector wholeheartedly shares.

     Prof Martin Green, of Care England, which represents providers, says there is no reason why residents in care homes should get an "inferior" service to the one someone in their own home would get.

     But all the evidence suggests they do.

     The Care Quality Commission looked at the issue a few years ago and found most of the 81 care homes it asked did not receive regular visits from GPs.

     The result has been that care home managers have had to pay GPs retainers to ensure they visit - with reports that some are as high as ￡ 20,000 a year.

     So what is the solution?

     If the experience of Sutton - and the other places doing good work in this area - is anything to go by, it is forging a shared approach.

     Ever since the separate systems of social care and health care were created after World War Two, they have been treated as distinct services - one run by councils at a local level, the other organised centrally by government.

     But, increasingly, as the population ages, that is looking out of date.

     The government has set up a shared pot - called the Better Care Fund - to encourage local government and the NHS to work together.

     The fund is worth just over ￡ 5bn this year - but that is less than 5% of the combined health and care budgets, which is why some people want the government to go even further and merge the two sectors completely.

     Such a radical move is probably some way off yet, but what is certain is that the futures of the two sectors are inextricably linked.

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