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Acute to Primary Care at Tipping Point?

Is it me or is UK healthcare changing faster than we expected?

I mean, we thought a switch from acute and late-stage to primary and prophylactic care was inevitable. But have we reached a tipping point?

We thought it likely that the NHS would be unable to afford to manage predicted levels of chronic illness. After all, about 2 percent of the UK's population is over the age of 85 (about 1.2m) and that is expected to increase to 6.5 percent (about 4.2m) by 2056. The UK also has the fastest growing rate of obesity in the developed world, another predictor of increased levels of chronic illness.

Falling demand for staff seems to presage change. NHS overspending has led to large-scale redundancies and reductions in job vacancies. Two years ago, physiotherapy looked like a safe career bet; however, the Daily Telegraph reports 93 percent of last year's graduates do not have jobs. Demand for doctors and nurses has also fallen.

A shift in emphasis from late-stage care to prophylaxis is inevitable. As a consequence, independent and public sector organisations will almost certainly compete for the opportunity to establish the remote monitoring and management of patients and local facilities like the community hospitals of yesteryear.

But--in my case--predictors of a quick change are offset by experience. A few weeks ago my father-in-law suffered a mild stroke. Being of independent spirit, he was keen to go home, and the hospital into which he was admitted was keen to discharge him to free a bed. Fair enough.

Home he came with the promise of an "immediate" home visit by speech, occupational and physiotherapists. After two weeks he had his first visit, occupied entirely by the therapist filling out a nine-page assessment form. Now three weeks after discharge he is still waiting for his first session of treatment.

Maybe the tipping point is still some way off.


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