Access to health and social care services for housebound people who have a long-term condition

Healthwatch Bromley undertook research on the needs of housebound residents with long term conditions and their experience of accessing health and social care services. They heard from 74 people.

Positive findings include: 

Compassionate and supportive staff: Many unpaid carers and residents praised individual healthcare professionals for their kindness, patience, and willingness to listen, particularly those doctors and nurses who took the time to explain medical conditions clearly. 

Continuity of care: Some housebound residents had positive experiences with specific services, such as hospital discharge teams or community nurses, who provided timely support and clear guidance on follow-up care. Some residents received quick referrals to specialists who provided effective treatment plans, improving their overall health and well-being. 

GP practices: GPs who were proactive in arranging referrals, providing detailed advice, and being flexible with appointments were praised. Pharmacies: Some unpaid carers and housebound residents appreciated pharmacists who gave clear medication guidance, delivered prescriptions and provided additional health advice. 

Home care: In some instances, home care services adapted well to the needs of residents, providing reliable support that helped to maintain residents’ independence. 

Community services: Several unpaid carers found valuable support through voluntary organisations, which provided practical help, social opportunities, and financial advice and guidance. Some found comfort in peer support groups, where they could share experiences and receive emotional and practical guidance from others in similar situations. 

Despite these positive experiences, significant challenges were described, affecting both housebound residents and their carers:

Waiting times: Housebound residents and unpaid carers consistently report lengthy waiting times for medical appointments, specialist referrals, and followup care. This results in great anxiety and frustration, especially for individuals with chronic or complex conditions. Delays in receiving necessary treatment or home care exacerbate the challenges already faced by these respondents and their carers. 

Communication challenges: Effective communication between healthcare providers, service users and different healthcare services is often lacking. People reported feeling unheard or dismissed during medical appointments, particularly in situations where urgent care or clear instructions were needed. Differing definitions of ‘housebound’ between services was also identified in some case studies - fragmented communication between healthcare teams led to confusion, mismanagement of care, and missed opportunities for timely intervention. 

Continuity of care: Residents often experience disruptions in continuity of care, particularly when seeing different healthcare providers or staff who do not know them. This can compromise the quality of care, as patients’ conditions may not be fully understood or managed across visits, impacting overall outcomes. 

Medicine and treatment management: Residents and their carers face confusion and miscommunication about prescriptions, dosages, and medication effects. There is inconsistency in accessing prescriptions; some pharmacies offer a home delivery service, others do not. The absence of home visits from GPs or district nurses complicates the effective administration of medication and treatment, particularly for individuals with chronic or complex health conditions or lack of support from family/friends.

Loneliness and social isolation: Loneliness remains a persistent issue for the housebound and their carers. Many feel isolated due to their health conditions or caring responsibilities, with limited access to social activities or emotional support. For carers, social interaction becomes even more limited as they devote their time to supporting their loved ones, leaving them without opportunities for respite or connection with others. Several of our interviewees seemed to be “living lives of quiet desperation.” 

Accessing services: There are significant barriers to accessing healthcare services, particularly for housebound residents. Residents spoke about their difficulty booking GP appointments, navigating online systems, and finding wheelchair-accessible options for medical appointments. These access issues compound the challenges already faced by individuals and their carers when seeking essential treatments or follow-up care. 

Safety concerns: Patient safety is a concern, especially when care is delayed, or appointments are missed. Many residents, particularly those with mobility issues or complex conditions, have faced risks during hospital stays or when accessing services. 

Community services: Community-based support services, such as day centres or dementia support hubs, are limited and/or difficult to access. Few of these services are available locally, leaving many individuals without access to vital social interaction and tailored support, and this situation seems to be worsening. 

Financial support: Many housebound people and their carers face significant financial burdens, particularly when self-funding home care services. The cost of professional care services, combined with the lack of financial support, leaves the housebound and their carers in difficulty. The benefits system is complex and difficult to navigate. Those ineligible for financial aid face increasing anxiety about their long-term ability to access care. There was no specific reference to Attendance or Carers’ Allowances by our interviewees.