Dr John Havard: Round the clock care could prevent hospital admissions

Dr John Havard

Dr John Havard - Credit: Archant

Many hands make light work” is a saying that was coined in the 16th Century and remains valid today. If we are to avert the decline of the NHS into a financial black hole, then decisive action is needed and everyone needs to play their part.

The CCGs have asked GPs to reduce the emergency hospital admissions of patients over 75. The Suffolk Federation that represents the vast majority of Suffolk general practices has come up with a couple of schemes that could really make a difference if implemented systematically.

What key facts are behind these ideas?

1. In the case of patients over 75, the statistics tell us 80% of those arriving at hospital in an ambulance are admitted.

2. One in five of our total population of over 75s are admitted to hospital. Most of these live alone and cannot get over short-term illnesses on their own and need help – but not ideally from the hospital.

How can we prevent patients from being admitted unnecessarily?

We have to offer safe alternatives at home. Nowadays there is frequently no available relative to move in for a few days to look after an elderly patient and ensure they are fed, watered and helped. We have always had carers and therapists able to come in during the day but these are short visits – and falls tend to happen when they are not present.

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We are planning to offer InstantCARE from A&E meaning a trained carer will look after the patient for up to 72 hours live-in care. This will enable a patient to recover quickly from an infection in their own home. The patient might have had blood tests and x-rays in A&E but if an admission is only necessary because they are too weak or confused to look after themselves, then an InstantCARER will be mobilised.

What about re-admissions?

It is surprising that over 10% of patients discharged from the hospital are re-admitted within a month. Some of these will be unpreventable but analysis has shown there is a gap in the co-ordination of community services. It seems that sometimes the community service is not delivered and so patients end up being re-admitted. This project aims to identify those most at risk of re-admission who frequently have more than one long-term medical condition combined with living alone. A care co-ordinator is going to be appointed to ensure the appropriate care is delivered to these vulnerable patients ensuring they can remain safe and well in their own homes.

Elderly patients living alone need to be better supported to keep them out of hospital. They need to be protected from unfamiliar places and infection risks that can do more harm than good – with the greatest respect to our excellent local hospitals. One simple way is to put care where it is needed round the clock and to ensure all the services are mobilised to help prevent admissions.

We need, as a country, to invest more in primary care when the work is to be done and less in hospitals who should be focusing on the acutely ill. The very opposite is currently happening.

Of course “Rome was not built in a day” (quote from 1546) but we need to actively start to embed procedures to protect elderly patients from emergency hospital admissions. “Better late than never” said a wise man from the 16th Century.