Thinktank warns that patients who stay in hospital instead of going home are wasting NHS resources
The NHS must get frail, elderly patients out of hospital faster in order to free valuable bed spaces and beat the service's financial squeeze, health experts have warned.
According to a new analysis of NHS bed use by the influential King's Fund thinktank, hospitals need to do more to help older people who have had a stroke, pneumonia or broken hip to return home more quickly so that they are not wasting resources.
The report urges hospital bosses to cut the small but disproportionate number of old and very old patients who arrive as emergencies but end up staying for at least a fortnight, at a cost of �200 a night, often after they have recovered. The NHS in England cannot keep treating such patients for so long if it is to have any chance of meeting the government-imposed target of finding �20bn in efficiency savings by 2015, warns the King's Fund.
Given that acute hospitals have to contribute �8bn of the �20bn, "reducing unnecessary use of hospitals offers a key opportunity for significant savings", says the study. The NHS in England could save more than �1bn a year by ensuring that both elective and emergency patients leave hospital sooner, the NHS Institute for Innovation and Improvement estimates.
Bed use for planned procedures is under control, especially as medical advances mean that the average length of stay after surgery such as a hip replacement has fallen. While such patients form 55% of all hospital admissions, they occupy less than 30% of total bed days. "This means that reducing bed use by emergency admissions offers greater potential to deliver an overall reduction in the use of hospital beds," adds the institute.
NHS figures show that the number of patients being admitted as emergencies, the amount of bed days they occupy and the total staying for at least two days have risen since 2007. That trend was unsustainable given that the NHS was facing its toughest financial challenge in living memory, said the King's Fund chief executive, Professor Chris Ham.
Most emergency admissions are short; half of those patients stay for under 24 hours. The NHS's main bed use problem involves the 10% of patients who stay for more than two weeks, as they account for more than half of all emergency bed days, the study says.
Four out of five longer-stay patients are 65 or over and more than 30% are over 85. "Typical diagnoses among older patients with very long length of stay include stroke, hip fracture, pneumonia and urinary disorders, dementia and delirium," the report finds.
Some of those who stay in when they are fit to be discharged are at risk of contracting hospital-acquired infections or can find their extended stay frustrating or distressing, while some become depressed or lose their independence as a result.
Patients occupying as many as 42% to 55% of bed days would be better treated at home, with or without medical support, or in a nursing home rather than in hospital. "This change of setting, if appropriate, would also save money ? acute hospital care costs about �200 per day and private nursing home fees are less than �100 per day," the study says.
Ham added: "This analysis is a wake-up call for the NHS. A high proportion of hospitals' budgets go on a small proportion of patients. It's a waste of NHS resources. We need to use our resources more effectively by targeting this small group of older patients with complex needs."
Hospitals needed to identify such patients earlier and give them better, more joined-up care from their specialists in both mental and physical health, such as physiotherapists and experts in memory loss, in order to speed their discharge. "At the moment many of these older patients don't get a good deal from the NHS. Medical care of them needs to improve. It is too often fragmented and needs to be integrated," said Ham.
Mike Farrar, chief executive of the NHS Confederation, who last week claimed one in four hospital patients could be treated elsewhere, said hospital bosses were worried that a lack of social care could also increase the number of frail elderly patients being admitted.
Andrew Lansley, the health secretary, backed the King's Fund's call for hospitals to do more to shorten older emergency patients' length of stay. "Patients have a right to expect that they are looked after well and that the treatment they are given helps them to recover. No one should stay in hospital longer than necessary," he said.
Source: http://www.guardian.co.uk/society/2011/dec/31/nhs-hospitals-treatment-elderly
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