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Emergency Hospital Admissions

Volume 789: debated on Wednesday 7 March 2018


Asked by

To ask Her Majesty’s Government what steps they are taking to reduce and prevent avoidable emergency hospital admissions.

My Lords, NHS England and NHS Improvement are implementing a number of national programmes to transform NHS services so that, where clinically appropriate, a patient’s care is managed without the need for a stay in hospital. This is being achieved through services becoming better integrated across health and social care, as well as managing hospital care differently, so that more patients are treated as day patients in A&E or streamed to see a general practitioner.

I thank the Minister for that Answer. The recent report of the National Audit Office stated that nearly 25% of people who go into hospital do so in an avoidable situation, which could be sorted out in the community. This is a clear case of why we need more prevention. What extra thinking and resources will the Government bring into the community so that we do not have the ridiculous situation of such people going into hospital, where we have the problem of a shortage of nurses and all the other things that knock on?

The noble Lord makes an important point. It was good to study the report and the noble Lord is right about avoidable hospital admissions. Two changes are happening. One is GP extended access, which now has 95% coverage across the country—that is, evenings, weekends and so on—as primary care. We also have interesting results coming from the new models of care programme. I highlight one that is happening in mid-Nottinghamshire. It is called PRISM and it is a virtual ward for at-risk patients which enables multidisciplinary teams to look at vulnerable people before they come to hospital. It has reduced A&E attendance for those aged over 80 by 17%, which is significant. It is precisely this kind of thing that will make the difference that we need.

Is the Minister aware that in 2016-17, 30% of admissions to A&E of people aged 65 and over were alcohol-related? Is he further aware that, given the need for the services of psychiatrists to look after those people, training for psychiatrists has reduced dramatically in the past 10 years and we have no facilities available to look after them? Turning to a longer-term public health policy, when will the Government do something about the increasing number of people going into hospital due to alcohol problems?

It is now the case that thousands of GPs and hospital staff have been trained to screen for the signs of alcohol abuse and to provide intervention. So not only are there dedicated staff and dedicated public health programmes, but hospital and primary care staff have now been specifically trained to look for the signs and to signpost people to care when they need it.

Does the Minister agree that one of the causes of the recent pressure on acute hospital beds is that young people and children who are waiting for scarce specialist mental health beds are frequently put into inappropriate adult wards because there is no room for them anywhere else? Would the Minister look into that again?

I thank my noble friend for making that point. Unfortunately, we have a growing prevalence of the kind of mental illness he is describing. We are in the process of increasing the number of in-patient beds available for young people going through those kinds of episodes. That is the right thing to do. It means that they will not have to travel so far from their homes and has the benefit of relieving the impact on adult acute beds.

Is the Department of Health and Social Care, in conjunction with NHS England, monitoring the completeness of 24/7 nursing coverage in the community? Even though the pilots, which will have a virtual ward, will help determine the most vulnerable patients, those patients will still need hands-on nursing at the time they need it. If it is not available, they will inevitably end up being transported to hospital.

One of the issues the NAO reports is that we do not yet have good enough data on what is happening in the community. The creation of the community services dataset will enable us to track precisely what is available in the community in every area. Concerns have been raised in this House before about the number of district nurses, which unfortunately has fallen over recent years. It has now shown a small increase year on year and we hope we are starting to turn the corner on community nursing numbers, too.

My Lords, there are two stark facts from the NAO report. First, the real problem has been the reduction in social care funding. Surely the real answer to this problem, above all else, is to restore what has been cut. Secondly, I refer the Minister to the chart in that report which shows that, despite the increase in demand, bed capacity has been cut by 6,000 beds since 2010-11. I understand that in February the occupancy rate reached a dangerously high level of 95%. Does the Minister accept that, while we need to prevent avoidable admissions, it is very unwise to reduce acute care capacity at the moment?

I agree with the noble Lord about funding. The Government have now made £9.4 billion of extra funding available to local authorities over three years, including in the most recent local government funding settlement. The noble Lord makes a good point about bed capacity: it had shown a downward trend for a long time before stabilising in recent years. I point to two successes this winter. The first is the improvement in delayed transfers of care—we have really started to get some traction on that. The second is about £60 million, I believe, of funding that went into providing extra bed capacity over winter. Occupancy levels are too high. The NHS is getting better at managing it more efficiently, but we certainly need to do better.

My Lords, does the Minister accept that part of the problem with emergency hospital admissions is the difficulty people have in accessing their GPs? Some of this is perhaps because of the high levels of stress among GPs, but there is also recent evidence suggesting that it is because of the £1 million pension cap imposed on GPs, which means many more of them are retiring before the age of 60. Surely, in the interests of the NHS, this particular cap should be looked at again.

Although the number of early GP retirements has been rising, the number of total GP retirements has been falling, which is encouraging. It is also important to point out that, while the pension cap obviously applies to everybody, it has not had the impact that the noble Lord described on dentists or consultants, so there is something more to it. It is to do with how GP services are structured and providing support for that partnership model. That is what we are trying to do at the moment.