Older people and the relationship between hospital services and intermediate care: Results from a national evaluation

Glasby, Jon; Martin, Graham; Regen, Emma

doi:10.1080/13561820802309729

Cited by 32 publications

(59 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As of 2010, it costs £99 and £71, respectively, to provide 24 hours' care in a standard nursing and residential home. 16 Daily residential intermediate care costs £186 17 and daily acute medical care £255. 7 Two-thirds of trusts do not implement the reimbursement levy, 18 perhaps as cooperation is deemed to be more effective in a resource-poor system.…”

Section: Resultsmentioning

confidence: 99%

In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience

Hendy¹,

Patel²,

Kordbacheh

et al. 2012

Clinical Medicine

View full text Add to dashboard Cite

-Delayed patient discharge will likely exacerbate bed shortages. This study prospectively determined the frequency, causes and potential cost implications of delays for 83 consecutive patients, who were inpatients for a total of 888 days. 65% of patients experienced delay whilst awaiting a service. 48% of patients experienced delays that extended their discharge date. Discharge delays accounted for 21% of the cohort's inpatient stay, at an estimated cost of £565 per patient; 77% of these hold-ups resulted from delays in the provision of social and therapy requirements. Discharge delays are costly for hospitals and depressing for patients. Investment is required to enable health and social-care professionals to work more closely to improve the patient journey. KEY WORDS: delayed discharge, patient experience, patient journey, Quality, Innovation, Productivity and Prevention (QIPP) agenda IntroductionThe NHS is increasingly criticised for bed shortages, delayed elective admissions and long waiting lists. 1 The number of admissions to secondary care in the UK is growing year-on-year 2 because of limited out-of-hours services in primary care, a greater number of patients who expect proactive hospital care and, most significantly, an increasing population of older people. Older patients are often frail and have complex social and healthcare needs, resulting in a prolonged inpatient stay. 3 At the same time as hospital admissions have increased, there has been a decrease in the number of hospital inpatient beds. 4 This has been off-set by efficiency directives, with a reduction in the average inpatient stay from 11.7 days in 1980 to 6.8 days in 2000. 5 One hospital has recently reported a reduction in average inpatient stay to 5.3 days, coincident with the introduction of twice-daily consultant ward rounds. 6 Nevertheless, demand frequently outstrips supply. Hospitals are often 'full' , with deleterious effects that include delayed patient flow, failure of specialty ward-based hospital systems and delayed or cancelled elective admissions.Bed pressures are increased by 'delayed discharges' , which exacerbate patients' exposure to hospital-acquired infections, low mood and increasing loss of functional capacity. Remedying such delays would provide both cost savings and better quality of care, in line with the NHS Quality, Innovation, Productivity and Prevention (QIPP) agenda.The aims of this longitudinal prospective study were to determine the length of inappropriate delay experienced by patients in a general medical ward prior to discharge, to identify common causes of delay and to estimate the financial implications of discharge delays. MethodsThe Chelsea and Westminster Hospital, London, admits both medical and surgical patients to an acute admissions unit (AAU), from which 60% are discharged home within 48 hours. The remainder are transferred to base wards. The majority of these patients require specialist elderly care that cannot be provided by single organ specialists.For seven weeks beginning 12 October ...

show abstract

Section: Resultsmentioning

confidence: 99%

In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience

Hendy¹,

Patel²,

Kordbacheh

et al. 2012

Clinical Medicine

View full text Add to dashboard Cite

show abstract

“…20,21 A notable difference, though, between the genetics pilots and, for example, efforts to join up health and social care services to improve discharge arrangements for older people, 5,22 was the general lack of engagement from significant numbers of primary care practitioners. Whereas, for all their disputes over responsibility, discharge arrangements are regarded as a matter of mutual concern for the acute, primary and social care sectors, here the prevalent view seemed to be that genetics was not of particular relevance to primary care, despite acknowledgement of the potential implications of the knowledge arising from the ‗new genetics'.…”

Section: Discussionmentioning

confidence: 99%

Bringing genetics into primary care: Findings from a national evaluation of pilots in England

Martin

Currie

Finn

2009

J Health Serv Res Policy

Self Cite

View full text Add to dashboard Cite

Objectives: Developments in genetic knowledge and clinical applications are seen as rendering traditional modes of organising genetics provision increasingly inappropriate. In common with a number of developed world countries the United Kingdom has sought to increase the role of primary care in delivering such services. However, efforts to reconfigure service delivery face multiple challenges associated with divergent policy objectives, organisational boundaries, and professional cultures. This paper presents findings from an evaluation of an English initiative to integrate genetics into ‗mainstream' clinical provision in the National Health Service.Methods: Qualitative research in 11 case-study sites focusing on attempts by pilots funded by the initiative to embed knowledge and provision within primary care illustrating barriers faced and the ways in which these were surmounted.Results: Lack of intrinsic interest in clinical genetics among primary care staff was compounded by national targets that focused their attention elsewhere and by service structures that rendered genetics a peripheral concern demanding minimal engagement. Established divisions between the commissioning of mainstream and specialist services, along with the pressures of shorterterm targets, impeded ongoing funding.Conclusions: More wide-ranging policy and organisational support is required if the aim of entrenching genetics knowledge and practice across the Health Service is to be realised.

show abstract

“…The first review noted that the different agenda and interests of the NHS and their local authority partners, as well as the complexity of planning processes, made strategic agreement difficult to achieve (Costongs & Springett 1997. Similar concerns were apparent within the second review with Drennan et al (2005) and Regen et al (2008) noting the problems of establishing a shared vision as well as difficulties turning divergent strategic agendas into operational reality.…”

Section: Organisational Issuesmentioning

confidence: 87%

“…Studies in both reviews reported that constant reform of the sector undermined relationships (Hodgson 1997) and diverted attention away from operational issues (Taylor 2001, Gulliver et al, 2002. Not surprisingly the impact of financial uncertainty remained a consistent feature, for example anxieties about cost shunting between organisations was thought to lead to distrust between partners (Hudson and Willis 1995) while concerns about a lack of dedicated funding for integrated services was reported to undermine initiatives from the outset (Regen et al, 2008).…”

Section: Contextual Issuesmentioning

confidence: 99%

“…Such problems led to inappropriate referrals and delays in treatment (McCormack et al, 2008) as well as confusion and protectionism amongst staff (Dickinson 2006). Importantly the second review identified the importance of role flexibility in supporting the aims of intermediate care, ensuring that services were more responsive to the needs of service users (Regen et al, 2008, Rutter et al, 2004.…”

Section: Organisational Issuesmentioning

confidence: 99%

See 1 more Smart Citation

What have we learnt about joint working between health and social care?

Cameron¹

2015

Public Money & Management

View full text Add to dashboard Cite

General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. AbstractJoint working between local authorities and the NHS has been an integral part of health and social care policy in the United Kingdom for many years. Using evidence from two literature reviews this article argues that there is little indication that joint working delivers the outcomes envisaged in policy. While recent reforms may be beginning to influence improvements, they are undermined by constant reform and professional scepticism.

show abstract

Older people and the relationship between hospital services and intermediate care: Results from a national evaluation

Cited by 32 publications

References 2 publications

In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience

In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience

Bringing genetics into primary care: Findings from a national evaluation of pilots in England

What have we learnt about joint working between health and social care?

Contact Info

Product

Resources

About