More than half a million people aged 65 and over with potentially ‘avoidable’ conditions were admitted as an emergency to hospital in England in the last year, according to figures published last month by the Care Quality Commission.
The regulator’s fourth State of care report, which considers how care is delivered in hospitals, care homes, dental surgeries and in the community, reveals that:
- almost one in ten aged 75 and over was admitted as an emergency to hospital with potentially avoidable conditions
- one in five aged 90 and over is going into hospital as an emergency when the admission was potentially avoidable
- the number of avoidable emergency admissions varies from place to place, with some parts of the country managing better than others
- people with dementia continue to have poorer outcomes in hospital
- inspectors found poor care in around one in ten of all hospital inspections; hospitals had not improved their assessment and monitoring of the quality of the care they provided
- there has been no overall improvement in the NHS in treating people with dignity and respect
- although CQC has seen some improvements in care across sectors, where inspectors find poor care it is serious and having a disproportionately large impact on people’s health and wellbeing.
The findings suggest that GPs and social care services could be working together better, the Care Quality Commission said.
‘Avoidable’ conditions are potentially avoidable because they are manageable, treatable or preventable in the community, or could be caused by poor care or neglect, such as pressure sores, bone fractures or dehydration.
NHS Confederation director of policy Dr Johnny Marshall said: “We recognise the NHS needs to work with its partners to keep avoidable admissions to a minimum.
“It takes a whole-system, cross-organisation approach, including commissioners, providers of hospital-based care, community health services and social care, to deliver the joined-up services that patients want and deserve, and which reduce the need for unplanned, ‘running-to-keep-up’, emergency admissions.
“We are keen to see a shift in the balance of health services delivered outside of hospitals. With the right services in place in the community and primary care sectors, as well as the right level of social care support, many frail older people will not require hospital-based care at all, let alone emergency admission.”
No ‘one size fits all’ solution
He went on to say: “Like patients, every health economy is different and there is no ‘one size fits all’ solution to minimising avoidable hospital admissions, but there are excellent innovations and ideas in all parts of the NHS. It is through sharing these that local NHS services will deliver what works best for local people.”
Dr Marshall added: “Through our networks and forums, the NHS Confederation offers a unique space for all parts of the health service to share information and best practice about what works locally throughout the country.”
Monitoring and review
On the need for continual monitoring and review: “It is essential organisations effectively monitor and assess quality in their organisations if they are to make real improvements. Patients, their families, and staff at all levels in the NHS, from ward to board, need to be involved in assessing quality and delivering continual improvement.”
Commenting on the CQC’s findings that since its last annual State of care report, there has been no overall improvement in the NHS treating people with dignity and respect, Dr Marshall added: “Our Dignity Commission has revealed some of the excellent progress that has been made to ensure patients and their families are treated with the highest levels of respect.
“It is disappointing there has been no overall improvement in patients being treated with dignity and respect following Francis, but there are still 91 per cent of NHS hospitals meeting this standard.