New approaches to avoiding hospital admissions in the first place—and getting people home faster after they have been treated—hold important lessons. But don’t roll them out across the country just yetby Ruth Thorlby / October 19, 2017 / Leave a comment
Picture this. It’s mid-winter. You’ve managed really well since your fall last year, but today you’re not feeling quite right—you’re dizzy and under the weather. Getting through to your GP is hard, and you don’t like to bother them anyway, and your spouse thinks you should go to A&E.
At A&E there are lots of doctors and nurses, rushed off their feet, and you wait. You can’t quite remember, when they ask you, the names of all the pills you are supposed to be taking, and you are feeling more poorly as each hour goes by. So, when they say they aren’t sure what’s wrong but want to admit you, just to be on the safe side, you see that it’s probably for the best.
And so a journey begins, which at its worst can mean staying too long in a bed while the system tries to organise the extra care needed when you get home. Sometimes this takes so long people become weaker and unwell again.
Improving the quality of care for people at risk of both unplanned hospital admissions and delayed returns home has been a priority in the NHS for some years, and is seen as key to the NHS’s survival this winter. These people are generally—but not exclusively—likely to be older, with several conditions.
So in February, the government set the NHS a target of reducing daily delays in discharging people from hospital to around 4,000 by September, after hitting a high of 6,660. The logic was sound: delays in getting people home has a knock-on effect throughout the hospital, putting pressure on bed occupancy in wards, and making it harder to admit people from accident and emergency departments—which is when patients can be stuck on trolleys. The latest data suggest that although delayed discharges have fallen, the 4,000 target has been missed, and emergency admissions are creeping ever upwards.
How then to affect real change? The recent CQC State of Care report warned that the whole system is at full stretch, particularly where different services have to work together. Clearly, the NHS is starved of funds, so more money would help. But beyond money, it’s about enabling staff to think of new ideas and make change and it’s worth looking though some recent schemes set up to tackle the problem.