Introduction
In 2001, the Faculty of Old Age Psychiatry commissioned a
survey of day hospitals
for older people in the UK. This survey was conducted
with the view to establishing the number of day hospitals
and gain an understanding of their staffing and roles in the
context of local service delivery.
The postal survey identified over 400 day hospitals. Of the many
findings, the most important included:
- The diversity of service provision and related lack of
commonality in terms of staffing.
- Poorly defined and great variety of roles of day
hospitals.
- Common difficulties relating to transport.
- Poor communication with other non NHS agencies.
- Poorly described interventions.
- Lack of clinical standards and related audit.
'The
Changing Face of Day Hospitals For Older People with Mental
Illness’
Since their original conception, day hospitals
for older people with mental illness have evolved and developed,
frequently responding to the demands of local service
configuration, vested interests and demands of service users. This
has resulted in a wide variety of service provision throughout the
UK as exemplified by the Royal College of Psychiatrists survey
conducted 5-6 years ago.
Their relationships with local authority day
care centres and centres provided by the voluntary sector have at
times become blurred. A significant number of day hospitals provide
long term day care for service users, often filling gaps in social
service provision. This can be associated with considerable
problems as NHS day hospital provision (in the absence of a clear
rehabilitative program) may lead to inappropriate dependency and
institutionalisation of service users who would otherwise benefit
from more appropriate social support.
Likewise, as a consequence of lack of clarity
relating to the great variety of functions associated with
the many day hospitals across the UK, it is very difficult to
identify common standards, develop audit cycles and undertake
research into the efficiency and effectiveness of day hospitals,
their interventions and service delivery.
Reviewing the survey
As a consequence of the initial survey, The
Royal College of Psychiatrists (Faculty of Old Age Psychiatry)
mandated the Day Hospital Steering Group review the functions and
character of Day Hospitals in England with view to generating a set
of Clinical Standards and devise a clinical audit tool designed to
inform and support clinical audit within day hospitals. Even though
the work was confined to England (because of financial constraints)
it may well offer some relevance to other countries within the
British Isles.
The authors have been careful not to ‘define’
the role and nature of day hospitals for older people but have
attempted to identify functions common to most day hospitals. It is
apparent that day hospitals will vary in their emphasis in terms of
the nature of the service provision and the functions that they
carry out. Some day hospitals concentrate on one or two functions
(for example; crisis intervention or psychotherapy) whilst others
may be more eclectic, tailoring their functionality to a wide range
of patient and carer needs. It is also evident that we have been
unable to capture all possible functions of day hospitals and fully
expect day hospitals to undergo further evolution and development,
responding to national initiatives and local commissioning
needs.
In summary: ‘The
Changing Face of Day Hospitals For Older People with Mental
Illness’ is designed to inform the debate
relating to the quality and performance of day hospitals through
encouraging the adoption of standards and facilitating audit. The
document is not proscriptive, does not attempt to determine how day
hospitals should function but should be regarded as a potential aid
to encourage debate, development and facilitate clinical audit and
role definition.