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High cost of unscheduled care for MS patients

Emergency admissions for MS patients costs NHS £43m per year

Adrian O'Dowd

Wednesday, 18 November 2015

CCGs, GPs and specialist nurses should plan for and provide better care for patients with multiple sclerosis (MS) to improve treatment and avoid the high costs of unscheduled hospital admissions, according to a new report.*

The report by the Multiple Sclerosis Trust in collaboration with NHiS, a company that provides commissioning support to the NHS, has highlighted the scale of numbers of people with MS who are admitted to hospital each year.

For the report, the authors examined Hospital Episode Statistics (HES) data from the NHS in England over the past four years.

They found that 14,960 people with MS in England were admitted to hospital as an emergency in 2013-14 – around 17% of everyone with MS.

Of the 23,665 emergency admissions, 8,695 were repeat admissions – where the person with MS was admitted for a second or even third or more time in the same year.

These non-elective admissions cost the NHS £43m in 2013-14, says the report, which was an average of £1,820 per admission.

Analysis of the data showed that the most common reasons for emergency admissions were bladder and bowel issues, respiratory infections and MS itself (including MS relapse), many of which could be prevented with greater emphasis on preventative care.

One of the authors Sue Thomas, chief executive for commissioning excellence at NHiS, said in the report: “This could be achieved by identifying patients at risk and addressing the issues before onset of a crisis.

“MS nurse specialists are ideally placed to identify this group of patients and provide proactive care, also involving GPs, neurologists, AHPs [Allied Health Professionals] and community services.

“CCGs need to ensure that they have in place appropriate pathways for identifying and managing bladder problems in MS … and GPs have a key role to play in this.”

There was wide variation between CCGs nationally and between CCGs within the same strategic clinical network in terms of their admission rates and costs for MS patients, said the authors.

The Multiple Sclerosis Trust published a report** last week about its GEMSS project (Generating Evidence in Multiple Sclerosis Services), which found that many MS specialist nurses had unsustainable caseloads.

It has called on the NHS to ensure that everyone with MS has access to an MS nurse with a manageable caseload so that nurse can help identify potential problems that could lead to hospital admission and coordinate care to help prevent it.

The new report says: “A better understanding of the prevalence of MS both nationally and locally at CCG level, as well as improving the admissions data that CCGs are using and more accurate and consistent coding are essential and present opportunities to reduce cost simply through strategies that target the reduction of non-elective admissions.

“As for people with MS themselves, well planned services that provide intervention through sufficient provision of skilled clinicians are vital to their wellbeing.”

Amy Bowen, director of service development at the Multiple Sclerosis Trust, said: “Our report shows that if more emphasis was placed on anticipatory care for MS patients, many of these hospital admissions could be prevented. This would reduce NHS costs and vastly improve quality of life for people with MS.”

* Thomas S, Mynors G, Simpson S, Meade N, Bowen A. Measuring the burden of hospitalization in multiple sclerosis: A cross-sectional analysis of the English Hospital Episode Statistics database 2009-2014. NHiS Commissioning Excellence and Multiple Sclerosis Trust, November 2015.

** Mynors G, Suppiah J, Bowen A. Evidence for MS Specialist Services: Findings from the GEMSS MS specialist nurse evaluation project. Multiple Sclerosis Trust, November 2015

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