Against this backdrop, hospitals are experiencing record levels of emergency activity and delayed transfers of care. The recent high-profile Care Quality Commission report on Addenbrooke’s Hospital highlighted a high number of acute beds occupied by patients medically fit to leave. A recent audit by NHS Benchmarking showed that while only 5 per cent of people aged over 65 who are admitted to hospital stay for more than 21 days, that 5 per cent accounts for more than 40 per cent of all bed days.
There’s pressure on hospitals from emergency readmissions too – emergency readmissions within 28 days of leaving hospital run at around 15 per cent for people over 65 and overall numbers are rising. Improving support for older people at home – either to prevent hospital admission (or readmission) or to facilitate discharge when they are ready to leave hospital – is key to patient flow and ultimately to delivering the four-hour A&E waiting times target.
Behind the system issues and the growing workforce and funding pressures in acute hospitals, there is a real human story.
Healthwatch England’s recent report, Safely home, described in harrowing detail the personal stories of patients and their families who felt that their discharge from hospital was unsupported or premature. It also described patients marooned in acute beds unable to move on. This echoes previous reports from Age UK, the National Institute for Health Research and the Royal Voluntary Service.
It’s a stressful environment for clinicians and operational managers, who are under constant pressure to prevent hospital admissions, discharge patients sooner and get them home when capacity and responsiveness in primary and community health services is lacking. Social care has also suffered, with an estimated 40 per cent cut in revenue since 2010, and with many people receiving no statutory care despite their needs being classed as ‘substantial’. In addition, few carers for older people get formal support.
It can be too easy for acute hospitals to place all the ‘blame’ on those services and not do enough to put their own house in order and work more collaboratively across organisational boundaries. It’s also too easy for those services to throw blame back onto hospitals when people cannot be discharged because of a lack of support within the hospital to facilitate it. We need to move away from these behaviours.
Hospital inpatients are increasingly old. Many are living with frailty and most have a degree of functional impairment – either in mobility or other activities of daily living. Many such patients leave hospital less mobile and independent than when they were admitted – making rehabilitation after acute illness and injury a core business not just for hospitals but also for their partners in ‘step-down’ intermediate care services. These services also have the potential to provide ‘step-up’ (admission prevention) care, for early supported discharge from the hospital front door or wards.
The National Intermediate Care Audit has shown insufficient capacity or responsiveness in these step-up/step-down services, though they work well for people who use them who often report good person-centred outcomes.
Against this backdrop, The King’s Fund is hosting two small interactive workshops.
The first, on 15 December, will focus on older people leaving hospital – including how to improve the quality of hospital discharge and patient experience, prevent readmission and reduce delays. We’ll be hearing speakers from Healthwatch England, the Royal Voluntary Service and Derby Teaching Hospitals NHS Foundation Trust, and there will be plenty of time for sharing ideas and experience with other delegates.
On 9 February, we are devoting a day to improving intermediate care services. Speakers include NHS Benchmarking, South Warwickshire NHS Foundation Trust and Sandwell and West Birmingham Hospitals NHS Trust. We hope you can make it.
We won’t solve the very pressing problems facing the NHS unless we crack these wicked problems. What’s good for the system – joined-up care and a focus on maintaining independence – reflects what older people and their families want to see too.
- Find out more about the workshops: Improving the experience of older people leaving hospital and Intermediate care for older people
- See our resources on making care fit for an older population