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Older people will not be abandoned

Many older people feel abandoned by the UK Government’s scandalous response to Covid-19. The ridiculous confusion caused by the Health Secretary directly contradicting his own government’s advice and the ‘airbrushing‘ of older people from government statistics on the virus are symptomatic.

Here public health campaigner Mike Downham suggests three urgent demands we should be making to the government, and offers some advice that we can share with older people we know right now.

The coronavirus epidemic across the UK continues. We are in danger of becoming numb to the appalling number of deaths reported every day. Total deaths at 29 April stood at 26,097. Every one of those is a human being lost. The government’s response to the epidemic has failed spectacularly.

This article addresses a specific issue which has come to light – that some people who develop symptoms of coronavirus infection, especially older people, are not getting to hospital in time to be treated successfully, and some people are uncertain whether they want to go to hospital at all.

Urgent demands to the government

The government should act now to address this issue by ensuring:

1. That NHS 111 is adequately resourced to respond to all calls for advice within 30 minutes.

We know of people who have had to wait for hours, even days to get advice, some of whom have given up trying.

2. That GPs are adequately resourced to encourage and support all of their patients who are over 70 to make Advance Care Plans if they wish to.

General Practices vary widely in the extent to which they are delivering this encouragement and support, despite its recognition as best practice.

3. That clear guidance is made widely available to people over 70.

The government has failed to issue clear guidance, so we have had to produce this guidance based on experience gathered informally from patients and their families.

But we’ve got to a point in this epidemic where anything we can do ourselves to save lives has become the priority. We need to continue to make demands on the government, but this government is so profoundly out of touch with the realities of people’s daily lives that we can’t just sit and wait for the government to deliver. We can all act by spreading the following advice to as many older people as we know, and by offering to talk to them about it on the phone, even offering our readiness to be phoned at night, if we feel able to do that.

The advice

While there is clear guidance for older people about avoiding coronavirus infection, many remain uncertain what to do when they get symptoms which they think may be due to infection by the virus.

Even if they decide to phone 111 or their GP they may find it takes a long time to get through to them. This can be extremely stressful, especially if they’re living on their own, but also for partners or others living with them.

It also means that some severely ill older people aren’t getting to hospital quickly enough. By the time they get to hospital they may have become too ill to be treated successfully. It’s been established that for people with breathing difficulties their risk of dying increases the longer it takes them to get to a ventilator.

If they arrive at hospital and are judged to be too ill for ventilation, they may find their only option is to stay in hospital to be made comfortable, unless they have made an Advance Care Plan which clearly states that they would want to return home. Hospitals and their staff could be saved valuable time if arrangements were securely in place to return some patients home for palliative care, if they so wish. Some older people with severe symptoms may decide they would rather stay at home than go to hospital at all, but this is an agonising decision which they need support to make.

Here are four questions which many older people are asking and the best answers known to us at present. This relates to older people who are in reasonably good health. Older people with chronic conditions which put them at additional risk need more individually tailored advice which many of them have already received.

Question 1: I’m over 70 but in reasonably good health. How ill should I be before I phone 111 for advice?

If you have a new cough and/or a fever (i.e. if you feel feverish, or if a thermometer shows your temperature is raised), but don’t have shortness of breath or any breathing difficulty, there’s no need to call 111. Drink plenty of fluids. Take paracetamol when you need to. Stay at home for seven days. If you have shortness of breath or any breathing difficulty, phone 111 for advice straight away. Also phone 111 if your cough, fever or other symptoms get worse during the next seven days, or haven’t improved by the end of the seven days. This advice is based on the ‘NHS inform’ website.

If you become less well while waiting to get through to 111 and it’s in working hours, try calling your GP for advice. If you can’t get through to your GP, or it’s not working hours, you may want to discuss what you do next with a relative, friend or neighbour to help you decide whether you should consider calling 999.

Question 2: What will 111 do when I get through to them?

They will assess your symptoms over the phone, to decide if this is likely to be coronavirus, how severe your illness is, and find out what support, if any, you have at home. They will give advice about what you should do (for example stay at home, call an ambulance, etc.). They should have access to your Advance Care Plan if you’ve made one with your GP.

Question 3: Can I choose to stay at home even if advised to go to hospital, and what help can I expect to get if I decide to stay at home?

You are fully entitled to choose to remain at home even if advised to go to hospital. What support you will get at home depends on what’s available in your area.

Question 4: Should I try to decide now whether or not I want to go to hospital if advised to do so, and whether or not I would rather come home if I become too ill to be treated in hospital, or wait to make these difficult decisions until I become ill?

You should be finding out from your GP now what’s available and what medical help you would be able to get if you decide to remain at home. This would be part of discussing your Advance Care Plan with your GP. You can contact your GP now for this discussion: don’t wait until you are ill.

Your GP will make a record of your Advance Care Plan, which will be made available to the NHS 111 service, so they will have access to your Plan if you phone them for advice. You should also discuss your Advance Care Plan with your family/those who support you. It might not be possible for you to stay at home if you don’t have enough community/family support or if your symptoms can’t be adequately managed at home.

And you can always change your mind about what you want to do at the time.