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Last nail in the coffin of cradle-to-grave NHS
- Author:
- CRESWELL Jackie
- Journal article citation:
- Community Care, 25.8.94, 1994, p.9.
- Publisher:
- Reed Business Information
Reports on critical response to draft Department of Health guidance on the continuing care of older people, which appears to open the way for the NHS to discharge older people into means-tested social services.
Caring for older patients with complex needs: how does England compare with 11 OECD countries?
- Authors:
- KNIGHT Hannah, et al
- Publisher:
- Health Foundation
- Publication year:
- 2021
- Pagination:
- 19
- Place of publication:
- London
This long read sets out to examine the results for England of the first piece of research by the International Collaborative on Costs, Outcomes and Needs in Care (ICCONIC), which aims to advance international comparisons research by using patient-level data. The research focused on patients aged 65 and older admitted to hospital for hip fracture surgery and patients aged 65–90 hospitalised with heart failure and with a comorbidity of diabetes. Based on pre-pandemic data, the analysis is further evidence that the NHS in England remains a relatively low-cost health care system. The findings support previously stated concerns that the mortality rate in England among older patients with high needs is higher than average among comparable countries. England is performing relatively well in acute care according to the measures available (time to surgery and readmission rates), which suggests further scrutiny and investment may be needed to improve the availability and quality of post-acute care. The results also highlight potential opportunities to improve productivity – and free up additional capacity for tackling the backlog from the pandemic – by reducing length of stay in acute care for hip fractures. Hip fracture patients in England spend on average 21.7 days in hospital after their surgery, the highest of all 11 countries. It was not possible to adjust statistically for differences in comorbidities between countries, but we compared the number of comorbidities. England was towards the middle, so while case-mix adjustment may have reduced some of the differences we saw, it is unlikely to have eliminated them. With integrated care systems (ICSs) to be established as statutory bodies from April 2022, there is a clear opportunity to make a step change in terms of linking up patient data and using the insights generated to reduce delays in discharge and improve quality of care and patient experience. (Edited publisher abstract)
A delicate balance? Health and social care spending in Wales
- Authors:
- LUCHINSKAYA Daria, OGLE Joseph, TRICKEY Michael
- Publisher:
- Wales Public Services 2025
- Publication year:
- 2017
- Pagination:
- 24
- Place of publication:
- Cardiff
This briefing note looks at trends in public spending on health and local authority funded adult social care in Wales since 2009-10, with some comparisons with the other UK nations. It reports that the total health and social service spend per head in Wales was higher than that of England in 2015-16. Over the period 2009-10 to 2015-16, day-to-day spending on local authority-organised adult social services in Wales remained broadly flat in real terms, but the increasing over-65 population means that spending per older person has fallen by over 12% in real terms. The briefing concludes that spending may need to increase by at least £129 million (23%) between 2015-16 and 2020-21 to get back to the equivalent spend per-head in 2009-10, which amounts to a 2.5% year-on-year increase. (Edited publisher abstract)
The social value of sheltered housing: briefing paper
- Author:
- WOOD Claudia
- Publisher:
- DEMOS
- Publication year:
- 2017
- Pagination:
- 16
- Place of publication:
- London
Drawing on the findings from a review of evidence on the impact of sheltered housing for older people, this briefing paper provides estimates of the cost savings sheltered housing can achieve for health and social care. The paper gives a conservative estimate of a social value saving made by sheltered housing of nearly half a billion pounds. This figure takes into account costs saved through a reduction in the number of falls by older people, the time spent in hospital, combating loneliness, as well as fewer unnecessary call-outs to emergency services. The paper was commissioned to help Anchor, Hanover and Housing & Care 21 consider the future of sheltered housing. (Edited publisher abstract)
Survey five: the state of the NHS and social care ahead of the Comprehensive Spending Review
- Author:
- NUFFIELD TRUST
- Publisher:
- Nuffield Trust
- Publication year:
- 2015
- Place of publication:
- London
Summarises the views of health and care leaders on the pressures facing the NHS and social care ahead of the Comprehensive Spending Review. Although most respondents are involved in planning for reduced spending, many leaders do not see how the efficiency savings required to free up an additional £22 billion for the NHS can be achieved: two thirds of survey respondents are not confident that their area has a credible local plan to make the efficiency savings needed this year, with half of respondents saying their area’s savings plans are dependent on reducing agency staff spend. Asked to choose from a list which non-NHS public service most deserved to be ring-fenced, 53.3 per cent selected spending on older people's social care: many panellists expressed the view that NHS and social care budgets should be viewed as being interdependent. 96 per cent of respondents thought it should be a high or moderate priority to deliver improved urgent seven-day services in line with NHS England clinical standards: the quality benefits of seven-day urgent services were clear to respondents; the cost implications less so. However, only 37.8 per cent believed seven-day elective services should be a high or moderate priority. (Edited publisher abstract)
Older people's experiences of dignity and nutrition during hospital stays: secondary data analysis using the Adult Inpatient Survey
- Authors:
- VIZARD Polly, BURCHARDT Tania
- Publisher:
- London School of Economics. Centre for Analysis of Social Exclusion
- Publication year:
- 2015
- Pagination:
- 210
- Place of publication:
- London
The report uses the Adult Inpatient Survey 2012 to build up an in-depth quantitative evidence base on older people’s experiences of dignity and nutrition during hospital stays in England. It shows that just under one-quarter of inpatients reported that they were not treated with dignity and respect, or were only sometimes treated with dignity and respect during their hospital stay. The analysis estimates that this is equivalent to around 2.8 million people on an annual basis - of whom about 1 million are aged 65 or over. Inconsistent and poor standards of help with eating during hospital stays were also a key concern. In 2012, about a quarter of all survey respondents indicated that they needed support with eating during their hospital stay. This is a substantial proportion and points towards the issue of support with eating being a major issue for significant numbers of inpatients – just under three and a half million each year - rather than being a marginal or specialist issue. Of those who needed help with eating, more than 1 in 3 reported that they only sometimes received enough help with eating from staff, or did not receive enough help from staff. Logistic regression analysis suggests that, after other factors are controlled for, the risk of not being helped with eating is significantly higher for women rather than men and for individuals who experience a longstanding limiting illness or disability such as deafness or blindness, a physical condition, a mental health condition or a learning difficulty, or a longstanding illness such as heart disease, stroke or cancer. Perceptions of inadequate nursing quantity and quality, and lack of choice of food, stand out as having consistent, large associations with lack of support with eating during hospital stays. The report concludes that there was a widespread and systematic pattern of inconsistent or poor standards of dignity and respect, and help with eating, in hospitals in England in 2012, and these were a significant general problem affecting inpatients in the vast majority of NHS acute hospital trusts (Edited publisher abstract)
Commission on hospital care for frail older people: main report
- Author:
- HSJ/SERCO COMMISSION ON HOSPITAL CARE FOR FRAIL OLDER PEOPLE
- Publisher:
- Health Service Journal
- Publication year:
- 2014
- Pagination:
- 16
- Place of publication:
- London
A report from the HSJ/Serco Commission, addressing the problem of how the NHS should care for the country's increasing number of frail older people. The commission's central conclusion is that hospital providers and commissioners should not rely on government plans for greater integration between health and social care as a solution - they must and can take action now themselves to tackle the problem. The report sets out five key findings: there is a myth that providing more and better care for frail older people in the community, increasing integration between health and social care services and pooling health and social care budgets will lead to significant, cashable financial savings in the acute hospital sector and across health economies; the commonly made assertion that better community and social care will lead to less need for acute hospital beds is probably wrong as improving community care may postpone the need for hospital care, but it will make frail older people neither invincible nor immortal; more realism is needed in the debate about the quality and quantity of care that can be provided in an environment of funding that is declining relative to demand; hospitals should not be used to provide care that should more appropriately be provided elsewhere; while acute hospital admission is often the right thing to do for frail older people, being in hospital also creates risks for older people and hospitals need to gear up to provide the very best care for frail older people, who are now their most frequent users, involving geriatricians from the start of the admission together with the other appropriate specialists. Alongside the report HSJ has published a series of case studies showing good practice from around the NHS. Further evidence that led to the commissioners' conclusions and a full bibliography is also available. (Edited publisher abstract)
The mandate: a mandate from the Government to NHS England: April 2014 to March 2015; presented to Parliament pursuant to Section 13A(1) of the National Health Service Act 2006
- Author:
- GREAT BRITAIN. Department of Health
- Publisher:
- Great Britain. Department of Health
- Publication year:
- 2013
- Pagination:
- 31
- Place of publication:
- London
This Mandate reaffirms the government’s commitment to an NHS that remains available to all, based on clinical need and not ability to pay; and that is able to meet patients’ needs and expectations now and in the future. Specifically, it reflects the priority to transform NHS care provision for older people and those with complex needs. It is structured around five main areas where the government expects NHS England to make improvements: preventing people from dying prematurely; enhancing quality of life for people with long-term conditions; helping people to recover from episodes of ill health or following injury; ensuring that people have a positive experience of care; and treating and caring for people in a safe environment and protecting them from avoidable harm. Further sections of the Mandate cover: freeing the NHS to innovate; the broader role of the NHS in society; finance; and assessing progress and providing stability. (Edited publisher abstract)
Integrated care in action
- Author:
- O'HANLON Shaun
- Journal article citation:
- Health Service Journal, 123(6372), 25 October 2013, pp.20-21.
- Publisher:
- Emap Healthcare
The Caldicott review's 'duty to share' data is an imperative for the NHS, but the author asks whether the systems are in place, and identifies the rewards and pitfalls. (Edited publisher abstract)
Exploring the system-wide costs of falls in older people in Torbay
- Authors:
- TIAN Yang, et al
- Publisher:
- King's Fund
- Publication year:
- 2013
- Pagination:
- 12
- Place of publication:
- London
One in three people aged over 65, and half of those aged over 80, fall at least once a year. Falls cost the NHS more than £2 billion per year. With the number of people aged 65 and over predicted to increase by 2 million by 2021, the costs incurred of treating patients across health, community and social care services are set to rise further. This paper uses Torbay’s unique patient-level linked data set to explore the NHS and social care costs of the care pathway for older people in the 12 months before and after being admitted to hospital as a result of a fall. On average, these costs for each patient who fell were almost four times as much in the 12 months after admission for a fall as the costs of the admission itself. Over the 12 months that followed admission for falls, costs were 70% higher than in the 12 months before the fall. Comparing the 12 months before and after a fall, the most dramatic increase was in community care costs (160%), compared to a 37% increase in social care costs and a 35% increase in acute hospital care costs. While falls patients in this study accounted for slightly more than 1% of Torbay’s over-65 population, in the 12 months that followed a fall, spending on their care accounted for 4% of the whole annual inpatient acute hospital spending, and 4% of the whole local adult social care budget. The authors discuss how linked health and social care data can be used to inform policy and practice. The findings strengthen the case for an integrated response for frail older people at risk of falls. However, to allow comparison of different models of care, other localities need to emulate Torbay’s recording and analysis of whole-system data at the patient level - which, to the authors' knowledge, is the first time that such detailed analysis of the costs in the health and social care system has been carried out in relation to falls patients in England. (Edited publisher abstract)