Elderly NHS burden ‘smaller than thought’

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A 70-year-old today is using less hospital admission than a 70-year-old five or ten years ago.
- Barry McCormick, treatment Director, Centre for Health Economics and Organisation, University of Oxford.

The UK’s ageing population is putting less pressure on hospital emergency departments than commonly thought, according to new research funded by the Department of Health.

Researchers in the Centre for Health Service Economics and Organisation found that people born each year from 1912 were increasingly less likely to need emergency treatment, and spent shorter periods in hospital once they were admitted.

Speaking in The Times, Barry McCormick, CHSEO Director, said that the ageing population should not be seen as an extreme burden on Emergency Care in NHS hospitals.

The consequences for emergency admissions of the larger over 65 population is cancelled by ‘cohort effects’ of lower probabilities of admission at each age. Rising emergency admissions is best thought of as the increasing tendency over time of patients to demand emergency services, and clinicians with gradually improved techniques and until recently, more resources, to admit.

Hospital beds days occupied by persons over 65 fell by 9-10% in the decade to 2012/13, despite the larger numbers of older persons. However, within the over 65 group, bed days fell sharply for those 65-84, and increased for those over 84.

“The perception that elderly people are placing an increasing burden on the hospital system needs to be moderated by a realisation that at each age people are a little bit healthier than they were in previous years and less demanding of hospital admission. A 70-year-old today is using less hospital admission than a 70-year-old five or ten years ago.”

Reductions in smoking, healthier diets, vaccination programmes earlier in life and preventative drugs such as statins are being attributed to the change. However, high levels of obesity among the young and drinking in middle age mean this trend may not continue.

The studyUnderstanding Emergency Hospital Admissions of Older People’ aims to gain an understanding of the rise in emergency hospital admissions for older people between 2001/02 – 2012/13 and formulate evidence-based scenarios for possible future trends in older emergency admissions in England.

CHSEO is part of the Nuffield Department of Primary Care Health Sciences, University of Oxford.

Read the full article in The Times.

Download ‘Understanding Emergency Hospital Admission'

Hospitals beds crisis was predictable

Letter to Evening Standard 17th December 2014 from Dr Louise Irvine:

 

"You attribute A&E delays partly to frivolous use of services by patients; but “too many people attending A&E” does not explain the winter crisis. Higher numbers attended A&E in June and July, cure yet cases meeting the four-hour performance target stayed above 92 per cent, pilule compared with the first week in December when it dropped to 87.7 per cent.

The real explanation is the mismatch between the rising trend of hospital admissions and the cut in the number of acute beds, here as evidenced by the dramatic increase in the number of people spending between four and 12 hours on trolleys before a bed is found. As admissions increase, delays in transferring patients to beds cause pressure in A&E and the four-hour performance falls. The beds shortage is compounded by delayed discharge from hospital due to social services cuts: delayed discharge figures for October were the highest since data collection started in 2010.

The impact on remaining A&Es is horrendous. Emergency doctors in Ealing describe arriving for a shift and being greeted with the words “there are no beds”. Staff spend precious time running around trying to set up beds in any corner they can find. Patients waiting for hours on trolleys risk deterioration.

This crisis was predictable and should have been planned for with proper investment. Instead we’ve had £20 billion “efficiency savings” in the past five years and another £30 billion to come, A&Es have been closed and hospital, community, GP, mental- health and social-care budgets cut.

The £700 million that the Government is throwing at the problem is intended to avert political embarrassment before an election. It’s too little, too late and unlikely to have much impact on the conditions for patients or staff in A&Es this winter".
Dr Louise Irvine, Lewisham GP, National Health Action Party

NOTE: The National Health Action Party's website offers a fuller version with additional references.

A&E has 'worst week' in England

 

A formal warning was issued over cleanliness and hygiene issues at the A&E at St Mary's Hospital, viagra Paddington.

 

Three hospitals in west London have been told by inspectors they "require improvement".

The Care Quality Commission criticised some of the care and conditions at Charing Cross, advice Hammersmith and St Mary's Hospitals.

Inspectors found at least one A&E was found to have broken equipment and was dirty.

Imperial Healthcare NHS Trust said it was not good enough and that it would redouble its efforts on cleanliness.

Inspectors found curtains of bays had brown stains on them and these had last been changed in February 2014.

Some equipment was held together by tape - such as a drip stand and a patient monitor - while an anaesthetic machine had been out of order for six days.

A portable X-ray machine labelled "clinically clean" was found thick with dust.

Hospital corridor
Inspectors found there were not enough nurses

Inspectors also saw unbagged, viagra soiled linen on the floor next to two linen bags that were full, one of which was outside the treatment room.

The inspection, which was carried out in September, also found:

  • Nurse staffing levels were not sufficient in some areas, especially in medical wards, and there was a high reliance on bank and agency staff
  • The surgical department had a significant backlog of patients waiting for elective surgery. Referral times in some specialties had breached national targets on an ongoing basis
  • Charing Cross Hospital was rated as "requires improvement" overall; its A&E and end of life care were rated good
  • Its medical care, surgery and critical care required improvement while its outpatient service was "inadequate"
  • Hammersmith Hospital was also rated as requiring improvement overall by inspectors
  • Its outpatient services were inadequate, while all other core services at the hospital were rated as requiring improvement
  • St Mary's Hospital required improvement overall while A&E and outpatient services were rated inadequate. Medical care and surgery were rated as requiring improvement

Following the inspection, CQC issued the trust with a formal warning over cleanliness and hygiene issues in A&E at St Mary's Hospital.

Inspectors have since returned and found the required improvements had been made.

The hospital's A&E department has been under pressure recently as it takes on more patients following the closure of Hammersmith Hospital's A&E department in September.

CQC's chief inspector of hospitals, Professor Sir Mike Richards, said although staff delivered compassionate care, there was too much variation in the quality of services.

"People are entitled to receive treatment and care in services which are consistently safe, effective, caring and responsive to their needs," he added.

Dr Tracey Batten, the chief executive of the trust said: "There's no doubt that what was found by the CQC was not good enough in the A&E department and we really need to redouble our efforts to ensure the standards of cleanliness and hygiene are our number one priority down there."

MP in call to shelve closure plan for A&E department at Charing Cross 16th December 2014

 

 
Downgrade: Charing Cross Hospital Picture: Google Street View

Updated: 11:49, 16 December 2014

 

One of London’s biggest A&E departments was today rated as “inadequate” by a watchdog, while a casualty unit which is due to be downgraded at a sister hospital was found to be “good”.

The report has further inflamed the row over changes to A&Es in west London by revealing failings at the unit in  St Mary’s Hospital in Paddington — which is due to be extended — while praising emergency care at Charing Cross Hospital.

Hammersmith Labour MP Andy Slaughter said plans to replace Charing Cross’s A&E with a GP-led “emergency centre” by 2020 “must be shelved” following the release of the “depressing” Care Quality Commission report. He said: “It would be madness to press ahead with the closure of Charing Cross A&E and the demolition of the hospital. West London cannot cope with the demands on its acute hospitals.”

Today’s CQC report into Imperial College Healthcare NHS Trust said it that “requires improvement” overall after checks in September at four of its five hospitals: the others were Hammersmith — before its A&E unit closed — and Queen Charlotte’s & Chelsea.

Last week, Imperial was one of two west London trusts named as among the worst in the country for delays at main A&Es, a situation critics blamed on the closures at Hammersmith and Central Middlesex on September 10.

 

Imperial was ordered by the CQC to improve hygiene and cleanliness at St Mary’s A&E — which has been done — tackle nurse shortages and explain how to cut a backlog of 3,500 people awaiting surgery at Charing Cross.

Bosses were told to ensure patients at St Mary’s and Charing Cross were not left without food and drink for “excessively long periods” and bed shortages at Hammersmith meant some patients had to sleep in operating theatres.

Among areas found to be “outstanding” were the major trauma unit at St Mary’s, the hyper-acute stroke unit at Charing Cross and the care of premature babies with feared brain impairment.

“Excess mortality rates” — in which patients die unexpectedly — at the trust were among the lowest in the country.

Professor Sir Mike Richards, CQC’s chief inspector of hospitals, said: “We saw too much variation in the quality of services. Standards of cleanliness and management were inconsistent.”

Dr Tracey Batten, Imperial’s chief executive, who was found to have created “evident optimism” since arriving in April, said: “It’s clear that we now have to redouble our efforts in a number of areas and services.”