NHS Clinical Commissioners have published a paper setting out their vision for the future of clinical commissioning.
Informed by interviews with CCG leaders and other key players in the health and care sector, The future of Commissioning suggests that we will continue to see an evolution in the commissioning system but that it remains a vital part of the health system that is focused on delivering for patients and local populations.
Objectives: Nursing home residents (NHRs) are frequently suffering from multimorbidity, functional and cognitive impairment, often leading to hospital admissions. Studies have found that male NHRs are more often hospitalised. The influence of age is inconclusive. We aimed to investigate the epidemiology of hospitalisations in NHRs, particularly focusing on age-specific and sex-specific differences.
Design: A systematic review was performed in PubMed, CINAHL and Scopus. Quality of studies was assessed.
Setting: Studies conducted in nursing homes were included.
Participants: Nursing home residents.
Primary and secondary outcomes: Outcome measures were the prevalence, incidence or duration of all-cause hospitalisation by age or sex.
Results: We identified 21 studies, 13 were conducted in the USA. The proportion of residents being hospitalised ranged across studies from 6.8% to 45.7% for various time periods of follow-up. A total of 20 studies assessed the influence of sex and found that hospitalisations are more often in male NHRs. A total of 16 studies conducted multivariate analyses and the OR of hospitalisation for males was between 1.22 and 1.67. Overall, 18 studies assessed the influence of age. Some studies showed an increasing proportion of admissions with increasing age, but several studies also found decreasing hospitalisations above the age of about 80–85 years. 8 of 13 studies conducting multivariate analyses included age as a continuous variable. Only 1 study reported stratified analyses by age and sex. 2 studies investigating primary causes of hospitalisation stratified by sex found some differences in main diagnoses.
Discussion:Male NHRs are more often hospitalised than females, but reasons for that are not well investigated. The influence of age is less clear, but there seems to be no clear linear relationship between age and the proportion being hospitalised. Further studies should investigate age and sex differences in frequencies and reasons for hospitalisation in NHRs.
In 2015/16, the 152 local Healthwatch across England engaged over 380,000 people to find out their views about health and social care, and helped to signpost a further 220,000 people to the right place for their needs.
Collectively they also visited more than 3,500 local hospitals, GP surgeries and care homes to find out if they are working for people, and published over 1,450 reports about what people want and need from health and care.
This demonstrates a substantial public appetite for involvement in shaping health and social care services. Local Healthwatch help to bring people and professionals together to put these views at the heart of changes to the NHS, resulting in services beginning to respond to local people
With big changes ahead, Healthwatch is committed to helping people voice what they expect from future health and care services and supporting those in charge of NHS reforms to act on these views.
Drawing on the wealth of evidence collected by the network, we have been able to bring local views to national attention, helping to inform ongoing changes to primary, secondary and social care services across the country.
Karakusevic, S. Nuffield Trust. Published online: 11 October 2016
This briefing lays out how greater speed through a system often requires more space. Looking at trusts that meet the four hour target and those furthest from meeting it, it estimates that at least 5.5% of beds need to be free for the standard to be met. Yet many hospitals are unable to provide this much of the time, making target breaches inevitable.
The paper looks at ongoing changes driving this squeeze on bed space, including mortality, the squeeze on bed space during years of austerity, rising numbers of patients with multiple conditions, and delayed discharges.
An analysis examines how bed use and patient flow change through the course of the day, drawing on Hospital Episode Statistics which track admissions and discharges. It shows that bed occupancy does not peak at midnight, when the official census of patients is carried out, but in mid morning. Meanwhile, the highest need for patients to be moved through hospital peaks at an entirely different time of day, in the evening.