Radical change needed to reduce hospital admissions

Midlothian Health & Social Care Partnership says looking at approaches adopted abroad may be required

Thursday 22nd August 2019

Scotland may have to look to other countries for a ‘more radical approach’ on how to reduce pressure on hospitals due to unplanned admissions, according to a health & social care partnership.

The call has been made in a report being presented to Midlothian Integration Joint Board (IJB) today, which outlines plans for reducing unscheduled hospital care over the next three years.

However it warns despite ‘considerable efforts to strengthen community services’ there has been ‘only limited progress’ in reducing hospital-based activity.

The report notes the challenge is to ‘design and implement more radical change at a faster pace’.

It points to approaches taken in other countries, such as a ‘transformation’ of services in Canterbury, New Zealand. This involved a major shift to primary care, with patients receiving urgent care in their homes or communities from GPs, rapid-response community nursing and rapid diagnostic tests.

The Midlothian Health & Social Care Partnership (HSCP) report says: ‘The approach promoted in this paper is based on the premise that there are no ‘silver bullets’ to achieving a substantial shift in the balance of care and thereby easing the pressures on acute hospitals.

‘Whether this approach of improving arrangements on an incremental basis, throughout the whole health and care system will bring about the required scale of change remains to be seen: a more radical approach may be needed learning from models elsewhere in the world.’

The report notes one of the key drivers for integration of health and social care in Scotland was the recognition a new system was required because of growing pressure on hospitals – with the provision of better community services key to reducing admissions and A&E attendances.

Currently there are around 21 unplanned admissions of patients from the Midlothian area to hospitals every day, the majority at the Royal Infirmary of Edinburgh.

Midlothian HSCP has outlined measures to try and tackle this over the next three years through fewer preventable admissions and earlier discharge of patients from hospital – including by preventing illnesses such as diabetes, improving identification of people at risk of falls and strengthening support for carers.

It also says strengthening community-based alternatives to hospital should be considered, including carrying out an appraisal looking at the feasibility of local care and treatment centres.

The report notes: ‘In Midlothian there is clear recognition that, despite considerable efforts to strengthen community services, including placing more emphasis upon prevention, performance data indicates that only limited progress has been made in reducing hospital-based activity, although this is against a backdrop of a growing and ageing population.

‘Our challenge is to design and implement more radical change at a faster pace to ensure that our hospital services are able to provide high quality, timeous treatment for patients from Midlothian when community-based alternatives are neither appropriate nor viable.’