The NHS in England could save almost half a million pounds a year if the four-fold variation in emergency admissions for the over 65s were ironed out, finds a report from health think tank the King’s Fund.
Services need to be far better designed and organised so that this age group can be cared for at home and avoid two million unplanned admissions, which account for over two-thirds of all hospital emergency bed days, say the report authors.
The report looked at four groups of PCTs, including those with the highest and lowest bed use, to understand what might underpin the fourfold difference in admission rates.
An emergency admission to hospital is a disruptive and unsettling experience for an older person whose independence will often suffer as a result, but many older people could be better supported at home or in the community, says the report.
The authors found that the drivers for bed use are complex, but included geography. There is much lower emergency bed use in rural areas than in urban ones, the figures showed. All the PCTs with the lowest bed use are in rural settings and seven out of 10 PCTs with the highest emergency bed use are in London.
Areas with a higher proportion of older people have lower rates of emergency bed use than areas with lower proportions, suggesting that these areas have prioritised the needs of older people and have better strategies in place to minimise admissions, the report found.
PCTs with the highest bed use tended to have excessive lengths of stay for patients in transition between home and supported care, suggesting community, primary and acute provider services are poorly integrated. The average stay in these PCTs is 36 days; the PCTs with lowest emergency bed use achieved stays of at least nine days shorter.
If PCTs in the top 75% for admissions reached the levels of the lowest 25% this would translate into 7000 fewer emergency beds and 2.3 million fewer overnight stays, saving the NHS £462 million a year, says the report.
This money could be reinvested in community and primary care services, it says.
The presence of a senior doctor at the admission stage; frequent medical review; specialist input and training in geriatrics, stroke, dementia; and access to therapist assessment could all help curb the admissions rate, says the report, but the key challenge is coordinating these to work together.
CCGs will need to pay careful attention to their relationship with providers as a closer working relationship will forge more integrated models of care and reduce admissions, says the report.
Candace Imison, Deputy Director of Policy at The King’s Fund and lead report author, commented: “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.”
Better design and coordination of services were needed, she said adding that cutting the number of overnight stays in hospital would “not only minimise exposure to psychological and clinical risk but would provide a model of care that is far more clinically and financially sustainable.’