We get ill. We have accidents. These are facts of life we rarely have any control over. We often require some form of medical intervention, whether it be surgery or treatment. What happens when the medical intervention has taken place? We are sent back to resume daily life at the pace we experienced before the illness/surgery/treatment. There is no place for recovery in modern life. No time or financial support for convalescing. This can lead to subsequent complications that then require further medical interventions, that take up more valuable healthcare resources.
In the UK, we encourage patients to access community based after care and outpatient follow up. This can be patchy and costly, although admittedly cheaper than inpatient care. We don’t allow people to recover from major surgery or serious illness away from the home but not in hospital. Our care system is privately run and is a business model designed to provide nursing care based on our ability to pay and with profit as the main business principle.
Many years ago, there was access to convalescent homes that provided short term after care for patients leaving hospital. It was a system that acknowledged the enormity of major illness and surgery. It gave patients time to recuperate and return to full fitness. It wasn’t an open ended care model but a short term intervention as part of the overall care package.
Some countries particularly in the EU still provide this type of aftercare for patients. The state supports and recognises the importance of allowing time for healing, time to recover. Today, we have very high expectations of what our healthcare system can provide but none of this factors the value of time being a great healer. Patients are often left floundering at reduced capacity, resuming work and home lives when not fully well or fully fit. We are an impatient nation that does not tolerate illness or time to heal. Our government has a finite budget for healthcare and particularly at this very difficult juncture, suggesting we think about convalescence; seems a ridiculous idea.
But what if we restructured our health service to include NHS convalescent care? Where the medical interventions are minimal but outpatient services such as physiotherapy, community nursing and outpatient aftercare; were based within and focused on convalescence. Where this wasn’t the preserve of those well off enough to go to exclusive spas or clinics to rest and recover? That we restructure support in the form of sick pay to cover loss of earnings.
Who will pay for this you ask? You could start by taxing those who earn over £100K a year at a higher rate. The UK could actively follow the Scandinavian models of social care and taxation. Where there is an acceptance of high taxation in return for free healthcare and education. The UK seems to aggressively follow the US principles of paying as little tax as possible yet at the same time, expecting free healthcare and education. We can’t have both unfortunately. Restructuring NHS after care could cover some of the cost but ultimately, we have to decide what our priorities are. How much work time is lost from people relapsing or working at reduced capacity because they have not recovered properly from major surgery or illness?
This all seems ludicrous during a global pandemic where frontline NHS services are at breaking point. It would require a major rethink of healthcare provision to acknowledge the necessity for short term convalescent care. I believe we could improve the overall health of the nation by factoring in short term recovery time, by acknowledging the need and value of rest. So many conditions should factor rest in but rarely is it seen as important. You can’t expect a champion racehorse to run at top speed, a few days after surgery. Footballers having had major surgery are not forced back into matches straightaway. Why is a woman having had a hysterectomy or a man recovering from a slipped disc less important?
Ultimately it all comes down to two things. Money and a willingness to change how we perceive illness. We are often sold pharmaceutical products based on the speed of their effectiveness. Quick means good. We take painkillers and expect them to work immediately. Tablets will usually take up to 30 minutes to start having an effect. We are impatient patients. We see adverts for medicines that show instant cures yet the truth is far from that. We are told by orthopaedic surgeons that following the knee surgery/hip replacement; the patient should regain movement straightaway. I understand the value of mobilising post surgery but there rarely seems to be any factoring in of decreased mobility or inflammation post surgery. Wouldn’t it be better to discharge a patient post surgery to convalesce for a week or two in order that they could concentrate on regaining mobility and at the same time, allowing them time to rest and recuperate? The interventions could be low key but the time factor would be of value. Sending someone home to cope with everyday life in an environment not geared up to aid their recovery, seems a stupid way of going about things. Families will often assume because the patient is discharged, they are fine when often they aren’t.
Convalescence seems a good system we chose to get rid of. We don’t know the value of many things until we have dismantled them in the name of progress or financial priorities. We need to get back to caring for people and not just treating their acute conditions. We need to learn how to be more patient with those who just need a break for a few weeks in order that they can get better. It’s that simple.
The John Linney 