Poor care at homes leads to thousand of elderly being admitted to hospital

The failure of GPs, community health services and social care services to work together means large numbers of over 65s are admitted to hospitals, the King’s Fund think tank has found.

Researchers found that 2.3m overnight stays in hospital could be prevented if all areas of the country performed as well as the top 25 per cent.

This is the equivalent of 7,000 hospital beds, or several medium sized hospitals full of elderly emergency cases every night of the year.

Savings of £462m could be made which could be reinvested in community services to keep the elderly well at home, the report said.

However, there are growing concerns that swinging cuts in local authority budgets are already affecting social care for the elderly and putting further pressure on the NHS.

The King’s Fund found there was a fourfold variation in the use of emergency hospital beds between the best and worst performing primary care trust areas.

Where hospital services were well integrated with community services such as primary care nurses, GPs and social care, emergency bed use was low.

Rural primary care trusts and those with large elderly populations also had low emergency bed use, it was found.

Experts said the findings were ‘important’ and proved that the NHS needed to move away from providing so much care in expensive hospitals and invest more in care closer to home.

High bed use was a combination of large numbers of emergency admissions and those patients staying a relatively long time in hospital, the report said.

The primary care trusts with the highest emergency bed use were: Trafford, Manchester, Hounslow, Wandsworth, Haringey Teaching, Waltham Forest, Lambeth, Hammersmith and Fulham, Bristol, and Ealing.

Those with the lowest were: Torbay, Herefordshire, Cornwall and the Isles of Scilly, Devon, North Staffordshire, Shropshire County, Great Yarmouth and Waveney, North East Essex, Norfolk, Redcar and Cleveland.

The report concluded: “Our analysis demonstrates a significant opportunity to reduce the overall rate of use of emergency hospital beds by people over 65 while at the same time not threatening and potentially improving the quality of patient care.

Katherine Murphy, chief executive of the Patients Association: “This is a really important report and its implications need to be recognised.

“However, even whilst the NHS is forced to adopt huge efficiency savings, the needs of patients must be put first. Where clinically viable, patients want to leave hospital as quickly as they can.

“But we don’t want to see a return to the days of targets that distort clinical outcomes.

“Patients should be treated for as long as needed, and clinicians should not be put under pressure to discharge patients before it is safe to do so.

“Patients also need to be given the choice of where they want to be treated and many would opt for treatment in their own home or in the community but we must make sure the services are available to them in the community to allow this to happen.”

The findings illustrate why the NHS needs to change to move patient services out of hospital and into the community, experts said.

Jo Webber, deputy director of policy at the NHS Confederation which represents most health service organisations, said: “These are striking figures. They help explain why we in the NHS have been arguing for radical change to the way care is provided.

“We know in many cases hospital may not be the best place for older people. They can often receive more appropriate and tailored care in their own homes and in community settings.

“We need politicians and the public to guide us and help us shape services for the patients of today and tomorrow. We would urge them to avoid simply defending the existence of particular buildings because that is where things have been housed in past.

“If we are to make this happen then we will also have to work harder than ever before with our social care partners to produce new and innovative ways that allow people to, where possible, stay in their own homes and live independent lives.

“For the sake of patients and our health services, we must act now and share the expertise of those trusts that are getting it right. We cannot wait until the pressures overcome us.”

Candace Imison, deputy director of policy at The King’s Fund and the reports’ lead author, said: “An emergency admission to hospital can be distressing and unsettling for older people and increase their dependency.

“Currently two thirds of emergency bed admissions are for elderly people and our research suggests that we can significantly reduce these numbers.

“With better design and co-ordination of services focused on the needs of older people, we estimate that the NHS could reduce overnight hospital stays by 2.3 million annually.”

Health Minister Anne Milton said: “This report shows that driving up quality is not only good for patients but can also save the NHS money.

“This is why we are focusing on integrating care. We want the NHS to provide more preventive care, which will mean fewer patients need to be admitted to hospital.”

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