Health July 25, 2019
Better community care needed to prevent 4 in 10 emergency admissions

By News Feature - Accountable Care Journal

New analysis from the Improvement Analytics Unit, a joint initiative between NHS England and the Health Foundation, has found that more than four in ten (41 per cent) emergency admissions to hospital involving care home residents could be potentially avoided with better provision of preventative primary care, community support or NHS care in care homes.


The analysis comes as the NHS rolls out the Enhanced Health in Care Homes (EHCH) initiative to improve residents’ health and reduce avoidable emergency admissions.

The briefing,  Emergency admissions to hospital from care homes: how often and what for?  published today by the Health Foundation, also includes evaluations of four local sites where the NHS worked in partnership with care homes to step up the support they received as part of vanguard initiatives to improve care in care homes. Encouraging results were found across three of the four sites, including decreases in potentially avoidable emergency admissions to hospital of up to 27 per cent, decreases in emergency admissions of up to 23 per cent or reductions in A&E visits of up to 29 per cent from care home residents.

Following the early findings, it was announced in the NHS Long Term Plan that the EHCH model will be rolled out nationwide to give everyone living in a care home improved GP support and more visits from specialists like dieticians and clinical pharmacists.

Upskilling care home staff to deliver more routine care, ensuring that residents have regular access to the same GP and encouraging better working relationships between NHS and care home staff are all things that are thought to have contributed to care home residents needing less emergency hospital care.

The analysis published today is the first national study of emergency hospital use by care home residents and showed that more than four in ten (41 per cent) emergency admissions to hospital were for ‘potentially avoidable’ conditions such as chest infections, pressure sores and urinary tract infections. It also reveals that nearly one in 12 emergency admissions to hospital are for people living in a care home, an estimated 192,000 emergency admissions each year. This makes up 7.9 per cent of the entire number of emergency admissions.

An estimated 340,000 older people in England live in residential or nursing care homes. To improve their care and help reduce emergency admissions to hospital and A&E visits for care home residents, the NHS has been working with care homes across the country to step up the support they receive.

The analysis also finds that, nationally, emergency admissions to hospital and A&E visits were particularly high in patients from residential care homes, where the care of residents is provided by non-clinical staff. There were approximately 32 per cent more A&E attendances and 22 per cent more emergency admissions from residential care homes than from nursing homes, where residents receive in-house nursing care.

The report findings suggest the opportunity for reducing emergency admissions and A&E attendances by increasing NHS support may be most significant in residential care homes than in nursing homes.

Adam Steventon, Director of Data Analytics at the Health foundation said: "Our evaluations show that by increasing NHS support and improving partnership working with care homes it is possible to reduce emergency admissions to hospital and A&E visits among care home residents and local sites have made good progress on integrating services, despite real pressures in social care."

Mr Steventon went on to say that, without further reform and investment for social care, further progress may be jeopardised.

Professor Alistair Burns, National Clinical Director for Dementia and Older People's Mental Health at NHS England, also commented on the findings. He iterated that people want to know their relatives are being looked after to have the best possible quality of life, which is why extra support for care homes has formed a key part of the NHS Long Term Plan.

Professor Burns said: "In some of the vanguard areas, which today's report with the Health Foundation shows, these measures made a huge difference to residents' health and when fully rolled out they will mean older people in every part of the country will benefit from personalised, specialist support in their care home."


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