How can we help older people leave hospital?

30 Jun 2016

David Oliver of The King’s Fund recently commented on a National Audit Office (NAO) report called Discharging older patients from hospital. It addresses the issue of patients who are medically fit for discharge, but instead left stranded in hospital.

It gave me a sense of déjà vu: I spent some time when younger nursing in elderly care. The NAO report immediately took me back to Mount Vernon Hospital, Barnsley, in the 1970s. Many patients were fit to go ‘home’, but they had no suitable home to go to. So they would stay on our ward: getting less and less confident, more and more ill and institutionalised, inadvertently preventing the admission of other patients, and costing the NHS more and more money. The remembrance I vividly relived when reading David Oliver’s piece was one of the first cruel-to-be-kind things I was told by a Senior SEN in my informal induction training at Mount Vernon: “We don’t want patients here because people die in hospital.”

Turns out things have got worse regarding what are now officially labelled ‘delayed transfers of care’. Between 2013 and 2015, reported delayed transfers of care went up 31%. In 2015 that totalled 1.15 million NHS bed days. 85% of the relevant patients were aged over 65.

As in the 1970s, waiting for social care arrangements remains the biggest cause. Since 2010, waiting lists for home care packages have doubled and those for beds in nursing homes have increased by 63%. Not a shock: increasing numbers of old, frail and medically complex patients + 10% cuts in real-term funding for social care over the past five years = recipe for misery.

The NAO estimates the current cost of those bed-blocking delays to the hospital sector is £820m per annum and that the cost of alternative community services for all those patients would have been £180m. A net annual cost of £640m.

So what’s the solution, beyond further funding? David Oliver makes a number of suggestions, but let’s pick these two:

  • rapid response teams providing ‘wrap around’ services in people’s own homes can prevent hospital admissions in precisely the group of patients most likely to end up delayed
  • delays that are simply down to poor collaboration, information sharing and procedures at the join between hospitals and local social care providers can be avoided or reduced. For example, some trusts have minimised delays by providing single point of access, telephone referral, and assessment using one team.

How can we help? In this case, simply by providing systems that integrate health and social care – either EMIS Health systems or third party systems – and let the information about these vulnerable patient flow freely for their benefit. For most people, connected health and social care will make their lives better; for some it can even save their lives; for everyone it can save the NHS’s money.

If nothing else, by linking health and social care we can stop people marooned in hospital being forgotten but not gone.

This article was written by Chris Spencer.