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This paper explores factors that might be driving the significant variation in use of hospital beds by patients over 65 admitted as an emergency.
It considers the contribution made by patient-based (demand-side) factors, hospital (supply-side) factors, the availability of community services and resources, and broader system relationships (how care systems and staff work together and relate to each other) in driving the observed variation in length of stay and rate of admission. Its conclusions are based on new analysis by The King’s Fund of Hospital Episode Statistics (HES) and local population-based data.
Key findings
The potential reductions in bed use by patients over 65 are considerable; if all primary care trusts (PCTs) achieved the rate of admission and average length of stay of those with the lowest use, 5,700 fewer beds would be needed across England.
The links between bed use and access to community services such as GPs, community nursing and social care are not clear cut. But PCTs with the highest bed use tended to have excessive lengths of stay for patients for whom hospital was a transition between home and supported living.
Areas that have well-developed, integrated services for older people have lower rates of bed use. And areas with low bed use also deliver a good patient experience and have lower readmission rates.
Areas with higher proportions of older people have lower rates of bed use. These areas may be more likely to have prioritised the needs of older people and to have developed integrated service models.
Policy implications
PCTs with the highest acute bed use should develop strategies across the care system and align ways of working to identify ways to reduce usage. All clinical commissioning groups would benefit from benchmarking the relative use of acute beds in their area, and the related rates of admission and length of stay.
It is clear that organisational integration alone does not deliver improved performance. The key to reducing use of emergency beds lies in changing ways of working across the care system rather than implementing piecemeal initiatives. Organisations need to prioritise whole systems approaches if they are to deliver a real shift from hospital to community-based care.
Download the appendices for this paper
We have produced information on the length of stay, emergency bed days and emergency admissions for each PCT in England. This information will show PCTs where their organisation ranked with others in our analysis. The emergency bed days per PCT also show where the additional bed savings we have identified exist.
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