NHS trusts predicting worse deficit than originally anticipated

Quarterly performance of the NHS provider sector | NHS Improvement

The quarterly performance of the NHS provider sector for the second quarter (July to September) of the 2017-18 financial year reveals that NHS trusts and foundation trusts are collectively predicting a full-year deficit of around £623 million – £127 million worse than planned.

The data from NHS Improvement also showed that despite the NHS treating more patients than even before, more people were seen within four hours in A&E and within 18 weeks for planned care.

Between July to September of this year, 90.2% of emergency patients were seen within four hours – meeting the national ambition of 90% by September while 3.43 million patients were seen within 18 weeks, compared with 3.36 million during the same period last year.

Cost improvement programmes had delivered £1.25 million of improvements in the first six months of the year and hospitals had delivered a £119 million reduction in temporary staffing for the first six months of the financial year, compared to the same period last year.

Full detail at NHS Improvement

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UK has 6th highest rate of obesity – OECD

Health at a Glance 2017: OECD Indicators | Organisation for Economic Cooperation and Development | OnMedica

A report from the Organisation for Economic Cooperation and Development (OECD) has found that the UK has the sixth highest rate of adult obesity. The report looks at health indicators across its 100 member countries.

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It shows that almost 27% of the adult population of the UK is obese, compared with the OECD average of 19.4%. The UK has a smoking prevalence of 16.1%, which is below the OECD average of 18.4%.

However average alcohol consumption per UK adult is higher than the OECD average, with consumption averaging at 9.5 litres per adult. Although this is down from 10.4 litres in 2000, it is still above the OECD average, added to which harmful drinking among teens remains problematic. Nearly a third (30.5%) of 15-year-olds have been drunk at least twice in their life, compared with the OECD average of 22%.

Many quality of care indicators are close to or just below the OECD average, but avoidable hospital admissions are high, says the report.

Full document: Health at a glance 2017 – OECD indicators.

Adult and older adult mental health services 2012-2016

Adult and older adult mental health services 2012-2016: An analysis of Mental Health NHS Benchmarking Network data for England and Wales | Centre for Mental Health

The number of acute inpatient beds for adults with mental health problems in England and Wales fell by 15% between 2012/13 and 2015/16 while specialist community mental health services also reduced by about 6%, according to a new briefing published today by Centre for Mental Health.

The briefing, Adult and older adult mental health services 2012-2016, analyses data collected by the NHS Benchmarking Network since 2012/13 up to the publication of the Five Year Forward View for Mental Health.

The briefing finds that while psychiatric acute inpatient beds for adults fell by 15% between 2012 and 2016, and staffing levels fell by 20%, the number of people admitted and the time they stayed in hospital did not change. This means that bed occupancy levels have risen to an average of 94%.

During the same time, community mental health service provision fell slightly: the number of people on community team caseloads reduced by 6%, staffing levels fell by 4% and contacts reduced by 7%. By contrast access to psychological therapies rose rapidly, reaching some 900,000 people a year by 2015/16.

Full report:  Adult and older adult mental health services 2012-2016 

 

Shifting the balance of care

Imison C, Curry N, Holder H, et al. Shifting the balance of care: great expectations.  March 2017 | Nuffield Trust.

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Moving care out of hospitals into the community can deliver holistic, patient-centred care closer to home.  In most cases however, it is unlikely to save money, according to a  report published today by The Nuffield Trust.

The report is based on a review of 27 schemes to reduce hospital activity, which included changes to urgent and emergency care pathways; speeding up discharge; managing ‘at risk’ groups; supported care at home; and cutting down on admissions.

Most of the initiatives demonstrated the potential to improve patient experience, and in some cases, outcomes. The evidence on cost savings was much less clear cut, partly because good economic evaluations have often not been carried out.

Several schemes did seem to be cost-effective in the right circumstances, but where schemes had been evaluated, most were cost neutral or were more expensive.

Download the full report here 

Report summary available here

 

Report highlights alarming level of readmission for COPD patients

COPD: Who cares when it matters most? | National Chronic Obstructive Pulmonary Disease Audit Programme

A new report from the Royal College of Physicians and the British Thoracic Society shows that 43% of patients admitted for hospital treatment of chronic obstructive pulmonary disease (COPD) were readmitted at least once in the 3 months following discharge, representing a considerable increase from 33% in 2008.

COPD: Who cares when it matters most?,  demonstrates that, although COPD was the single most common cause of readmission, over 50% of readmissions were in older people with multiple health conditions.

The report also highlights improvements in the safety and efficiency of COPD care. The report shows that inpatient mortality has decreased from 7.9% in 2003 to 4.3% in 2014.

Fewer patients are dying after discharge from hospital. There has been a marked decrease in the average length of stay in hospital for acute exacerbation of COPD, which fell from 6 days to 4 days in the same period.

Recommendations to improve treatment and care of patients with COPD include:

  • early identification of individuals at risk of deterioration
  • careful assessment of patients with multiple healthcare needs and conditions
  • improved discharge planning, particularly for vulnerable and frail patients
  • the development of integrated approaches to COPD care.

Download the full report here

Seeing the same GP associated with fewer admissions

Older patients who see the same general practitioner over time experience fewer avoidable admissions to hospital, new research shows. | BMJ | OnMedica

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The Health Foundation research, published in The BMJ, shows that if patients saw their most frequently seen GP two more times out of every 10, this was associated with 6% fewer admissions for ambulatory care sensitive conditions such as asthma, diabetes, influenza and pneumonia.

 

The researchers examined whether continuity of care with a general practitioner is associated with hospital admissions for ambulatory care sensitive conditions for older patients. Data was analysed from over 230,000 anonymised patient records for older people aged 62-82 years.

The research found there were fewer hospital admissions for certain conditions when patients saw the same GP more consistently. The authors stress this is an observational study so no firm conclusions can be drawn about cause and effect. However, they conclude, “strategies to improve the continuity of care in general practice may reduce secondary care costs, particularly for the heaviest users of healthcare.”

Full reference: Barker Isaac, Steventon Adam, Deeny Sarah R. Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data

NHS Indicators: England, January 2017

The House of Commons library has published NHS Indicators: England, January 2017.

The full briefing paper looks at trends in the following areas:

  • Accident & Emergency attendance and performance
  • Ambulance demand and response times
  • Waiting times and waiting lists for routine treatment
  • Waiting times for cancer diagnosis and treatment
  • Cancelled operations
  • Delayed discharges and transfers of care
  • Diagnostic waiting times and activity
  • Waiting times for mental health treatment
  • Workforce numbers for doctors, nurses and other staff
  • Hospital activity, referrals and admissions
  • Bed availability and occupancy

Access the full report here