Shifting the balance of care

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


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


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

Pressure on NHS beds could risk patient safety

Pressure on beds in the NHS in England has become so acute that on any given day last winter, the equivalent of more than five extra hospitals’-worth of beds had to be brought into service to cope with surges in demand | Nuffield Trust

winter beds.png

Image source: Nuffield Trust

On the single busiest day last winter, an extra 4,390 beds had to be opened, equivalent to more than seven extra hospitals in one day.  And on average, over 95% of beds across English hospitals were occupied every day last winter, despite evidence that once bed occupancy rates exceed 85%-90%, there is an increasing risk of infection (see note 1). Given that pressures on the health service have not lessened over the last 12 months, Trusts will face similarly high bed occupancy rates this winter.

Read the full overview here

Read the full report here

Demand for hospital services outstripping NHS funding

The number of admissions to hospital are rising steeply and are outstripping increases in the NHS budget, according to new analysis published today by The King’s Fund.


Image source: The King’s Fund

The analysis finds that admissions to hospital have increased by 3.6 per cent a year since 2003/4. In contrast, real terms increases in NHS funding have shrunk to an average of just 1.2 per cent a year since 2010/11, compared to average increases of 4.8 per cent a year between 2003/4 and 2010/11 (1).

Detailed analysis of hospital activity data over the past 13 years shows that:

  • emergency admissions from major A&E departments have increased by an average of 4.3 per cent a year since 2003/4
  • attendances at outpatient clinics have risen by an average of 3.8 per cent a year since 2007/8
  • admissions for planned treatment have increased by an average of 4.3 per cent a year since 2003/4.

Read the full overview here

Read the full report here

Age and sex differences in hospitalisation of nursing home residents: a systematic review

Hoffmann, F. & Allers, K. BMJ Open6:e011912


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.

Read the full article here