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An evaluation of the impact of community-based interventions on hospital use: research summary
- Authors:
- STEVENTON Adam, et al
- Publisher:
- Nuffield Trust
- Publication year:
- 2011
- Pagination:
- 14p.
- Place of publication:
- London
The Partnership for Older People Projects (POPP) were established by the Department of Health in 2005, with the aim of encouraging local councils to work in partnership with the NHS and voluntary, community and independent organisations to improve the health, wellbeing and independence of older people. This report evaluates eight POPP interventions and examines whether these interventions were successful at preventing unplanned hospital admissions. A sophisticated person-based approach that involved comparing the outcomes for participants in the interventions with matched controls was used. New data linkage techniques developed with the NHS Information Centre helped obtain person-level data about hospital activity without compromising confidentiality. The control groups were very well matched in terms of a wide range of characteristics including age, sex, area-level deprivation, medical diagnosis, predicted risk of hospital admission and prior health care use. This research method allowed precise measurement of the impact of the interventions on hospital use.
Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data
- Authors:
- GRAVELLE Hugh, et al
- Journal article citation:
- British Medical Journal, 6.01.06, 2006, pp.31-34.
- Publisher:
- British Medical Association
This study aimed to determine the impact on outcomes in patients of the Evercare approach to case management of elderly people. Nine primary care trusts in England that, in 2003-5, piloted case management of elderly people selected as being at high risk of emergency admission were involved in the study. Main outcome measures were rates of emergency admission, emergency bed days, and mortality from April 2001 to March 2005 in 62 Evercare practices and 6960-7695 control practices in England (depending on the analysis being carried out). The results found the intervention had no significant effect on rates of emergency admission (increase 16.5%, (95% confidence interval –5.7% to 38.7%), emergency bed days (increase 19.0%, –5.3% to 43.2%), and mortality (increase 34.4%, –1.7% to 70.3%) for a high risk population aged >65 with a history of two or more emergency admissions in the preceding 13 months. For the general population aged 65 effects on the rates of emergency admission (increase 2.5%, –2.1% to 7.0%), emergency bed days (decrease –4.9%, –10.8% to 1.0%), and mortality (increase 5.5%, –3.5% to 14.5%) were also non-significant. It is concluded that case management of frail elderly people introduced an additional range of services into primary care without an associated reduction in hospital admissions. This may have been because of identification of additional cases. Employment of community matrons is now a key feature of case management policy in the NHS in England. Without more radical system redesign this policy is unlikely to reduce hospital admissions.
Briefing: understanding the health care needs of people with multiple health conditions
- Authors:
- STAFFORD Mai, et al
- Publisher:
- Health Foundation
- Publication year:
- 2018
- Pagination:
- 26
- Place of publication:
- London
This briefing paper reports on an analysis of data from 2014 to 2016 for 300,000 people in England to examine the number of people with multiple health conditions and what needs to be done to address their complex needs. The analysis found that one in four adults had 2 or more health conditions, equating to approximately 14.2 million people in England. Over half of NHS costs for hospital admissions and outpatient visits and over three quarters of the costs of primary care prescriptions were for people living with 2+ conditions. Those in the most-deprived areas were also more likely to experience multiple long term conditions at an earlier age than those in the less deprived areas. The report sets out six steps the NHS could take to improve care for people with multiple conditions: supporting those with multiple conditions to live well; developing new models of NHS care for those with multiple conditions; resourcing the vital role of primary care; designing secondary care around those with multiple conditions; using data and sharing information to improve care for those with multiple conditions; and evaluating what works. (Edited publisher abstract)
Horizontal or vertical: which way to integrate? Approaches to community services integration and consequences for emergency hospital activity
- Authors:
- WYATT Steven, MILLER Robin, SPILSBURY Peter
- Publisher:
- NHS Midlands and Lancashire Commissioning Support Unit. The Strategy Unit
- Publication year:
- 2018
- Pagination:
- 29
- Place of publication:
- West Bromwich
In 2010, Transforming Community Services policy required primary care trusts to decide how they organised the community health services they delivered; vertically integrate with an acute trust, horizontally integrate with a mental health trust, or set up a stand-alone community trust or Community Interest Company. This report explores the impact this choice had on the level and growth in emergency hospital use in older people and considers the wider implications for the NHS as it develops new models of care and integrated care systems. The report concludes that that decisions taken to structurally integrate community nursing services and the form of this integration (vertical or horizontal), did not systematically and differentially influence the rate of emergency hospital use of older people. The findings suggest that mergers and organisational changes should not be confidently promoted as a means of reducing hospital activity, and that local healthcare systems the freedom to develop their own approach of partnership working. (Edited publisher abstract)
Unblocking: securing a health and social care system that protects older people
- Authors:
- THOMSON Alex, HOWELL Steven
- Publisher:
- Localis
- Publication year:
- 2015
- Pagination:
- 41
- Place of publication:
- London
This report sets out proposals to address the problems faced by the health and social care system as it needs to cater for an ageing population. It proposes a rethink of services by building the care system around the very different needs of individuals in order to provide person-centred co-ordinated care. The report draws on interviews with health and social care experts and a survey of over 100 local health leaders. It discusses some of the main symptoms of a lack of integration between health and social care services and the negative effects they have on older people's experience of the system. These include delayed transfers of care and unnecessary hospital admissions. It then looks at the causes of these problems at a national and local level. The lack of focus on prevention, a lack of integration between health and social care, lack of appropriate housing for older people, and divides between the care workforce are some of the issues discussed. The report then proposes some solutions to improve care and facilitate greater integration between health and social care. Recommendations include: shift the blame away from patients by using the phrase 'preventable bed occupation' instead of 'bed blocking'; the introduction of single, place-based commissioning budgets for 40-55 year olds and care provision for those over 85 to improve co-ordinated care for older people; making acute trusts statutory members of Health and Wellbeing boards to help reduce fragmentation of the heath and care system; getting the Government to commit to a fixed five-year budget to allow for long-term strategic planning; and increasing the flexibility of primary care by supporting technology and innovation. (Edited publisher abstract)
Armchair theatre
- Author:
- BULLOCK Roger
- Journal article citation:
- Health Service Journal, 1.6.00, 2000, pp.22-23.
- Publisher:
- Emap Healthcare
Argues that the government's plans to get elderly people out of acute hospitals and into private care to free beds may leave older people fearing hospital admission as they once did the workhouse.
Responding to the winter crisis
- Author:
- McNALLY David
- Journal article citation:
- Professional Social Work, December 1999, p.12.
- Publisher:
- British Association of Social Workers
Asks whether joint rapid assessment schemes to keep people out of hospital are enough to prevent the admissions crisis that hospitals face each winter.
Coping with winter bed crises
- Authors:
- HANRATTY Barbara, ROBINSON Mike
- Journal article citation:
- British Medical Journal, 11.12.99, 1999, pp.1511-1512.
- Publisher:
- British Medical Association
Sudden increases in hospital admissions have been a feature of the NHS for many years, but explicit plans for their management were not introduced until 1996, after a particularly severe crisis that January. This editorial suggests that new surveillance systems might help the NHS to better manage winter bed crises.
The health and social care cost-benefits of housing for older people: a report for Mears Group
- Author:
- HOUSING LEARNING AND IMPROVEMENT NETWORK
- Publisher:
- Housing Learning and Improvement Network
- Publication year:
- 2019
- Pagination:
- 24
- Place of publication:
- London
A review, commissioned by the Mears Group, which identifies the evidence for the health and social care benefits of housing for older people, particularly extra care housing. Specifically, it looks at the cost benefits this generates for NHS organisations and local authority social care. The review covers evidence that that the use of older people’s and extra care housing leads to: reductions in the use of NHS services, for example reductions in unplanned hospital admissions and reductions in delayed transfers of care; improved outcomes and cost savings compared to the use of residential care; reductions in, or reduced growth in, care needs occurring in older people’s housing compared to the use of domiciliary care in the community; and improved outcomes for residents in extra care housing and other older people’s designated housing compared to other settings. Overall the review found reasonably strong evidence to suggest that housing for older people, particularly extra care housing, provide significant cost-benefits to the NHS and local authority adult social care. This included evidence to suggest NHS cost benefits and savings, savings compared to residential care, reduced care needs and improved outcomes for individuals. The report estimates that one older person living in extra care housing generates health and social care cost-benefits of £2,441 per annum. (Edited publisher abstract)
How NHS Sutton Clinical Commissioning Group is working with care homes to improve the health and wellbeing of older residents
- Author:
- HARGER Christine
- Journal article citation:
- Working with Older People, 19(2), 2015, pp.60-68.
- Publisher:
- Emerald
Purpose: To describe how NHS Sutton Clinical Commissioning Group (Sutton CCG) is working with nursing homes, residential homes and other health and social care organisations in Sutton to improve the quality of provision for residents in nursing and residential homes “care homes”. Design/methodology/approach: The paper explains how Sutton CCG engaged with care homes initially to seek their views on whether they wanted support and what support they would value. It describes what arrangements Sutton CCG put in place for managers and staff in local care homes to provide support face-to-face. The paper outlines the key areas for improvement that Sutton CCG and the care homes are focusing on. It includes examples of work carried out jointly by the care homes and Sutton CCG to improve the quality of care for residents. It goes on to describe joint-working arrangements between the CCG, London Borough of Sutton and other health and social care organisations to ensure the overall quality of care homes in Sutton. Findings: The paper outlines feedback from care home managers and staff who were invited to share their views about what support they wanted from Sutton CCG. It includes early feedback from care homes about the support put in place and the areas where they have found it most useful. Practical implications: In the UK many older people live in care homes. Britain has an ageing population so the need for residential and nursing homes and the numbers of people living in care homes is only likely to increase. Our ageing population also places additional demands on the NHS, with residents in care homes often spending time in A&E and lengthy spells in hospital. This paper highlights how CCGs and other health and social care organisations can work with care homes to improve the health and wellbeing of older residents in care homes and reduce pressures on other health services. Originality/value: Sutton CCG has put in place new arrangements for working with care homes that aim to support carers to improve the lives of their older residents. The paper shares practical examples of support that the CCG has provided which has successfully improved care and decision making in care homes; early indications show this has reduced 999 calls and conveyances to hospital. Sutton CCG, London Borough of Sutton and other statutory organisations with responsibility for care homes in Sutton have also set up a joint intelligence group to gain an overall picture of the quality of the borough’s care homes. (Edited publisher abstract)