Top five findings from the HSJ commission on hospital care for frail older people

policy digest

02 / 12 / 2014

Commission on hospital care for frail older people
Health Service Journal, November 2014

The HSJ has published the main report of its Commission on Hospital Care for Frail Older People. Chaired by Dame Julie Moore, and carried out in conjunction with Serco, the Commission considered how the NHS should care for the increasing number of frail older people in our population.

The commission was launched in October 2013, when it described ensuring care for this group of patients was “the kind of care NHS staff would wish for their own parents” as “the most pressing issue facing the NHS”. To establish the project, the magazine convened a group of experts in health service leadership and older people’s care, chaired by chief executive of University Hospitals Birmingham NHS Foundation Trust, Dame Julie Moore, and including King’s Fund chief economist John Appleby, geriatrician Professor David Oliver, and Serco director John Myatt.

The Commission reviewed a wide range of previously-published evidence on care for frail older people. It also invited contributions from HSJ readers on examples of “imitable and scalable good practice”, and “policies, techniques and approaches” which could improve care of frail older people in hospitals. Following publication of an initial ‘scoping report’ in May 2014, which included tips and checklists for trust boards, clinicians and executives on ways to achieve changes and improve the care they give frail older people, the Commission has now produced a final ‘main report’. This sets out the findings and conclusions of its evidence gathering and analysis.

The report challenges what it describes as “a mind-set among some hospital colleagues that frail elderly patients are ‘not our core business’”. It sets out the top five findings of the Commission, which – to a greater or lesser degree – are likely to resonate with NHS Confederation members. Some of the findings are particularly in line with calls from the 2015 Challenge Manifesto published earlier this year:
  • The Commission found no evidence to support the ‘myths and assumptions’ that integration of health and social care, and pooling of budgets, would lead to “significant cashable financial savings in the acute sector and across health economies.”
  • The “commonly made assertion” that improvements and investment in community-based health services and social care would reduce the number of acute hospital beds required “is probably wrong.” It speculates that “a short-term reduction in acute sector demand” might follow community-based “demand reduction initiatives”, but says that this remains unproven. The report makes the bold argument that “improving community care may postpone the need for hospital care, but it will make frail older people neither invincible nor immortal: mostly, they will simply need the care later.” 
  • There should be “more realism” about the amount of care and the standard at which it can be provided, given that health service funding “is declining relative to demand”. The Commission believes that “pursuit of the current NHS funding policies looks likely to lead to a funding gap”.
  • The Commission confirms that care should be provided in the most appropriate location, rather than defaulting to hospital-based services for frail older people. To facilitate this, it says NHS commissioners “must improve community care to meet future demand”, but stresses that investment in community-based services “must be based on evidence” of its beneficial impact.
  • The report acknowledges the Commission’s acceptance of the risks inherent in inpatient care for frail older people, even when admission to an acute setting is “the right thing to do”. It calls on acute providers to “gear up” the care they offer to frail older people by involving geriatricians and other appropriate specialists from the start of the admission.
It concludes that hospital providers of care for frail older people should “forget about [waiting for] government plans” that could potentially change and improve care for this vulnerable patient group, and that they “must and can get on with it now”. 

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