Readers' letters - 31 January 2013

No cause for alarm

NHS Property Services is absolutely committed to a smooth handover of the estate, buildings and properties that will transfer from primary care trusts and strategic health authorities to the new company in April 2013 and we have been clear that current leases will transfer unchanged.

We are aiming to ensure stability and clarity for new NHS organisations. Speculation over funding shortfalls in your story (‘NHS property company to charge CCGs to bridge cost gap’, 22 January) is unnecessarily alarmist.

‘The role of NHS Property Services will be a vital one in the day to day running of the NHS’

The running costs charged to successor bodies and tenants next year will be based on the total current costs incurred through PCTs and SHAs. We have been working with PCTs for over a year to build an accurate picture of the estate, buildings, assets and leases that will transfer so the latest data request is an update and will come as no surprise to PCTs as part of the handover work.

To date, around 3,700 assets are planned for transfer and we are working to ensure there is clarity about the terms of occupation, rent, services and related charges. We are keen to ensure there is stability in property costs, transparency for occupiers and agreement in how we utilise NHS estate and properties in the most effective way.
We aim to work in close partnership with clinical commissioning groups, supporting their business objectives as an enabler and facilitator.

The role of NHS Property Services will be a vital one in the day to day running of the NHS. The company’s 3,000 staff will help improve the delivery of clinical services and help enhance the experience of NHS patients by providing safe, efficient and well maintained estate, buildings and facilities.

Simon Holden, chief executive, NHS Property Services

Myths about hospital care

The British Geriatrics Society takes issue with Sir David Nicholson’s view that hospitals are “very bad places” to care for frail older people he expressed in an interview in The Independent on 21 January. Though recent reports, such as the ombudsman’s, show that poor quality care can be a problem, what the reports are highlighting is how that care is delivered rather than the institution where the care is delivered. There are many examples of high-quality hospital services throughout the UK.

‘General hospitals should, and will, continue to play a major role in healthcare delivery for older people’

The BGS has over 2,500 members specialising in the medical care of older people both in the community and in hospitals. We support all initiatives that enable treatment at the right time in the right place, including, where appropriate, management of some episodes of ill health without going into hospital.

However, frail older people often have complex conditions with multiple coexisting illnesses which require all the skills of the multi-professional team, and a well resourced hospital environment is frequently the safest and most efficient way of ensuring that patients improve and can be maintained in their own home after discharge.

The Cochrane Review of specialist care for older people demonstrates they are 25% more likely to be at home and alive after inpatient treatment in a unit specialising in older people’s care.

Good places

Simply put, access to care should be determined on clinical need not age.

Of course, there are examples of older people being admitted to hospital inappropriately for want of better or more responsive care in the community before a crisis occurs, and examples of older patients staying too long while waiting for step-down health or social care services.

This should be tackled as a separate issue because it is often due to historically poor investment in community services and we welcome Sir David’s recognition of that need. It should not be used as an alternative in order to deny older people the right to be admitted to hospital where this is clearly necessary.

General hospitals should, and will, continue to play a major role in healthcare delivery for older people. The trick is to ensure that staff are trained for, hospital culture is orientated towards and healthcare systems prepared for, an increasingly ageing population. This will ensure that hospitals are good places for frail older people when they need them.

Of note, the Department of Health (in England) has funded research showing that care lacking dignity and skill was associated with hospital staff perceiving that older patients “should not be there”- a myth that sadly could be reinforced by Sir David’s assertion.

Professor Paul Knight, president, British Geriatrics Society