Emergency admissions

This is a critical time for the NHS, with many key themes to discuss. But my start to the year is dominated by emergency care – a very practical challenge but one that raises important questions about culture too.

Across the NHS we are really struggling with emergency activity. Even allowing for Norovirus and prolonged cold weather we are experiencing unusual pressure.

The...

Our new series of interactive charts: The NHS in numbers pulls together some key data on health care spending, activity, resources and performance. These charts broadly cover the boom years for health care in the UK, from the late 1990s to the early 2010s, reflecting the latest data publicly available from official sources.

During this period, when Government spending on the NHS rose at the fastest rate experienced throughout its history, both public and private spending on health care increased year-...

The queasily thin amount of experienced medical cover in some hospitals at nights and weekends was the subject of BBC Radio 4's File on 4 last week. Juniors missing key symptoms and signs, not wanting to bother a consultant out of hours, with occasional tragic results or at best near misses.

Suggestions for remedy included making consultants work 24/7 rotas. I sympathised with the experienced paediatrician who predicted that would be the last straw for many who have given their all for the NHS over many years.

The...

It's not as if we are not trying to reduce our need for emergency care. The past decade has seen a host of initiatives, innovations, policies and practices that should be helping to avoid the sort of health crises that lead to an emergency admission to hospital.

But have these worked? A recently published paper by the Nuffield Trust used a standard measure of health service performance to see what changes had occurred over the past decade.

The analysis looked at emergency hospital admissions for conditions where...

The purpose of predictive risk modelling is to segment a given population on the basis of their risk of experiencing a particular outcome, for example an emergency hospital admission (Billings and others, 2006).

This is often used for case finding, where appropriate prevention techniques are matched to each risk stratum. High risk patients will be a small minority of the total population, and the form of the intervention will change depending on the level of risk.

The highest risk patients might receive a personal...

What role should social care play to support someone at the end of life to die in their own home? And how can health and social care services work together to make this choice a reality?

Macmillan Cancer Support’s own research shows that, with the right support, 73 per cent of people with cancer would prefer to die at home – but only 27 per cent actually do. If people’s end of life wishes are to be respected, it is vital that we answer these two questions.

Macmillan has been...

Telehealth is increasingly being advocated as a way to monitor patients remotely and better manage long-term health conditions. The Nuffield Trust was part of the largest randomised controlled trial in this area, “the Whole System Demonstrator” (WSD) – the initial results were published earlier in the summer.

We held a seminar with practitioners, researchers and funders to discuss the remaining research that needs to be done, post WSD. Priorities were identified as;...

In the Whole System Demonstrator (WSD) trial, a team of researchers studied the impact of installing telehealth technologies in patients’ homes to monitor their vital signs such as blood sugar levels. 

Debate continues over whether the findings justify the Government’s policy of encouraging the NHS to invest more in telehealth. At the same time, the trial has raised a potentially even more significant discussion. 

How useful are randomised controlled trials...

The first results of the largest randomised controlled trial on telehealth were published in the British Medical Journal last week. Of the five arms of the Department of Health-funded 'whole system demonstrator' (WSD) trial, the first (conducted by a team here at the Nuffield Trust) examined the impact on hospital admissions and costs.

The headline results so far: patients receiving telehealth care had just 0.14 fewer emergency admissions in the one year of follow up; and...

It was a privilege to present the progress we’ve made in Devon at the predictive risk 2012 conference. Both Todd Chenore and I appreciated the chance to outline our results of integrating predictive modelling into a whole system approach, which appear to be consistent and transferable to other areas.

Predictive modelling and virtual wards in Devon began with three practices in North Devon in 2008 and the service now covers three distinct localities across Devon.  They have implemented the service in three slightly different ways...

This week, the British Medical Journal published the first results from one of the world’s most complex randomised controlled trials. Researchers at the Nuffield Trust led this analysis, which relied on collecting over a billion records of administrative data from more than 250 health and social care organisations.

The trial’s aim was to evaluate “telehealth” – a way of using technology to support people with long-term health conditions such as diabetes, heart failure or chronic obstructive pulmonary disease....

Since the development of the original PARR and Combined Predictive Model tools, many PCTs have introduced these or similar case finding tools, to identify people at risk of unplanned hospital admissions.

Our one-day conference for people interested in using predictive risk tools in health care took place last week. People from across the UK and further afield spoke about the ways in which these tools are being used, as well as highlighting some issues and cautionary tales that have come from experience in trying to introduce and use...

With the showers has come a certain malaise tinged with queasy uncertainty.

This could be a post-Bill slump in the NHS, a response to the long grind of making cuts with no end in sight, and the sheer weight of detail to be worked through with respect to the mass reorganisation outlined in the now Health and Social Care Act.

The queasiness extends beyond health, look at local Government for example facing an average six per cent cuts rather than a ‘flat real’ settlement as in health.

...

With the multiple challenges of tightening NHS finances, an ageing population and the growing burden of chronic illnesses, integrated care is seen by some as a key tool for improving the efficiency and effectiveness of care.

Many people (including people at Nuffield Trust) argue that integration can lead to both better outcomes and experiences for those who use services. In 2008 the Department of Health sought applications from sites that were interested in developing new models of clinically-led integrated care.

16 sites were eventually selected as pilots for the integrated...

Within the research group of the Nuffield Trust we have a number of studies that use the anonymised linkage of health and social care records. The results of one study are due to be published in the Journal of Health Services Research and Policy (JHSRP) soon but they have left us with a puzzle.

We found that from a population of older people (aged 75+) in four local authority areas, 14 per cent used some form of local authority social care over a one year...

OK, so everyone is fed up with the Bill, just getting on with it, and focusing on having a break. But here are a few things from us to ponder at the end of this unusual year.

Ideological tussles will not go away next year. Alan Garber, now Provost at Harvard and our Rock Carling fellow this year, focuses his gimlet eye on one battle line: what place for competition, what dose, what unit of, and how could it encourage integrated care rather than get in the way.

Alan brings together his long experience of analysis in the US, and his...

Earlier this autumn, I had the opportunity to visit the Hospital2Home virtual ward project in New York. Like other virtual wards, this project aims to reduce the risk of unplanned hospital admission for people at high predicted risk of admission. 

I was particularly interested to visit this project because it has strong partnerships with health care, social care and charitable organisations, and it cares for some of the most vulnerable people in...

The joys of policy analysis mean the NHS Operating Framework is obligatory reading. 'Grip' is its message, no surprises there. But tucked in amongst the pages four things caught my eye.

Para 3.29 requires commissioners to link patient NHS numbers to contractual payments by March 2013. By then, it should be possible to identify routinely how much NHS expenditure goes on each individual – a crucial milestone to identify efficiencies. My bet is on information to give the NHS the biggest lift over the coming decade.

The second was para 4.24 – in response to...

Keen readers of this blog will already know about the importance of risk prediction in health. As my colleague, Dr Geraint Lewis, has pointed out: “neither doctors, nurses nor case managers [are] able to predict which patients [are] at highest risk of readmission to hospital.”

So, if the NHS is to target effectively the ever increasing rate of emergency admissions, it is clear that it needs some help from predictive risk tools.

When the...

I recently had the opportunity to visit the Toronto virtual ward as part of my Management Fellowship role working with researchers at the Nuffield Trust who are evaluating the costs and benefits of the virtual wards in Croydon, Devon and Wandsworth.

The virtual wards work just like hospital wards, using the same staffing, systems and daily routines, except that the people being cared for stay in their own homes throughout.

The purpose of...