More support for care homes could reduce emergency admissions

A joint initiative between the two bodies – the Improvement Analytics Unit – showed that 41% of emergency admissions to hospital were for ‘potentially avoidable’ conditions such as chest infections, pressure sores and urinary tract infections. It also revealed that nearly 1 in 12 emergency admissions to hospital are for people living in a care home, an estimated 192,000 emergency admissions each year.

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 32% more A&E attendances and 22% more emergency admissions from residential care homes than from nursing homes, where residents receive in-house nursing care. This suggests 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.

A briefing from the Health Foundation – Emergency admissions to hospital from care homes: how often and what for? – also includes evaluations of four vanguard sites that increased support to care homes.  Across three of the four sites there were encouraging results, including decreases in potentially avoidable emergency admissions to hospital of up to 27%, decreases in emergency admissions of up to 23% or reductions in A&E visits of up to 29% from care home residents. Following these early findings, the NHS long-term plan announced that the enhanced health in care homes model would be rolled out nationwide, improving GP, dietician and clinical pharmacist support.

Changes that have led to reductions in the need for emergency care include up skilling care home staff to deliver more routine care, ensuring residents have access to the same GP and encouraging better working relationships between NHS and care home staff. Reducing unnecessary medication is another key factor.

‘In some of the vanguard areas, 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,’ said Alistair Burns, national clinical director for dementia and older people’s mental health at NHS England.

Adam Steventon (pictured), director of data analytics at the Health Foundation, said that keeping elderly patients out of hospital was good for patients – reducing stress and avoiding muscle deterioration for example – and could reduce pressure on the NHS. 

‘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,’ he said. ‘It also highlights that better preventative care may help to reduce unnecessary emergency hospital admissions, for example some fractures may be avoided with appropriate risk assessment and falls prevention.’

However he added that further progress could be jeopardised without urgent reform and investment for social care.

NHS Providers’ deputy chief executive Saffron Cordery said the findings were encouraging. ‘This briefing shows that where services work together and share resources, they can reduce admissions, she said. ‘To realise the changes set out in the long-term plan, health and social care must continue to work more closely together. We must urgently find a long-term sustainable solution to the social care crisis so that our future health and care system supports the ageing population to live healthier and longer lives.’

The HFMA has also explored how services delivered in the community can add value to the patient and the wider health and care economy in its briefing The value of community services: comparison with acute settings. published earlier this year.