Drive To Reduce Needless Admissions

Scotland’s Health Minister Andy Kerr has given his backing to a drive which is aiming to cut the number of people admitted to hospital by a quarter in two years. Teams of doctors, health and council workers in north-east Scotland have been set a target of reducing use of hospital beds by 25% by 2008. The move follows a survey which found as many as 44% of patients staying overnight in the wards did not need to be there. Mr Kerr praised NHS Grampian for giving community health teams the goal and is encouraging other authorities to follow in their wake with similar target schemes.

The minister said he did not want to dictate what targets should be set for different parts of Scotland. He suggested some areas might adopt a different aim of slashing so many deaths from heart disease by a certain date.

GPs gave a mixed response to the idea of targets for Community Health Partnerships (CHPs or CHCPs) – the local panels who pull together the health and social care services outside of hospitals.

Concern has also been raised about vulnerable pensioners being kept at home or discharged early in order to meet targets.

Andrew Sim, policy and research officer for Age Concern Scotland, said: “Sometimes hospital is the best place for a thorough medical and social assessment of what someone needs.”

NHS Grampian conducted a survey of 1125 patients staying in their hospital wards overnight, excluding those in elderly long-stay beds, last year. Those in accident and emergency wards were also excluded. Senior nurses and doctors were asked whether each patients’ needs could have been met in a community setting instead.

Dr Roelf Dijkhuizen, medical director of NHS Grampian, said in 19% of cases both the nurses and the doctors agreed the patient did not need to be in hospital. Including cases where either the nurses or the doctors felt the person could have been treated outside hospital, the proportion was 44%.

Patients who were well enough to be at home but had been admitted because they had travelled a long way for a course of treatment were among the examples.

People with head injuries who were in hospital because they needed intensive nursing and could not be placed elsewhere, were also counted.

Dr Dijkhuizen said: “What we are trying to do in our health plan is look at the various categories and make facilities available in the community for those patients so that they can be discharged from hospital.” He added that many of the patients were elderly and had been admitted with a flare-up of a long-term health problem such as a respiratory disorder.

These people, he said, could be treated in their own homes if the appropriate professionals could be dispatched to see them. If the 25% target is achieved, it would mean there were 250-275 fewer patients in Grampian hospitals at any one time. Dr Dijkhuizen said this would mean fewer hospital beds.

Mr Kerr said he found NHS Grampian’s approach very interesting and he would be raising it at his monthly meetings with health board chairmen. Mr Kerr said: “I am not going to set targets for the CHPs but I do think boards should set targets for the CHPs. It is the principle I want to see adopted not the specific.”

Dr Dean Marshall, deputy chairman of BMA Scotland’s GP committee, said: “It is important that the NHS shares good practice so that patients across the country can benefit from developments and improvements in health care service delivery.

“However, for CHPs to be successful, they must be clinically driven rather than management driven, engaging fully with GPs and consultants so that services are relevant and will benefit patients. Unfortunately this is not yet the case for many CHPs in Scotland, although some are working better than others.”

Dr Paul Ryan, clinical director of North Glasgow CHCP, said the point of targets was to encourage the partnerships to re-think the way services were planned. He said if individual GPs were told to restrict the number of people they admitted to hospital to a specific number they would refuse.

CHPs came on line in April this year. Membership includes at least one GP, nurse, dentist, pharmacist, optician, allied health professional (such as a physiotherapist), council representative, health board official and member of the public.