Call for action to meet acute sector needs

A report published by the Royal College of Physicians (RCP) says that the demand on clinical services has now increased to the point where acute care is unable to keep pace in its current form. It has identified that there are now one-third fewer general and acute beds than were available 25 years ago, despite a 37% rise in emergency admissions in the last decade alone.1 Patient needs have also changed. Nearly two-thirds (65%) of people admitted to hospital are now over 65 years old and an increasing number are frail or have a diagnosis of dementia. However, many hospital buildings, services and staff are not equipped to deal with patients exhibiting these multiple, complex needs. The report – Hospitals on the edge? The time for action – says that this is having a detrimental effect on patient care. RCP members have reported a lack of continuity of care as their biggest concern about the current health service.2 ‘It is not uncommon,’ say members who contributed to the report, ‘for patients, particularly older patients, to be moved four or five times during a hospital stay, often with incomplete notes and no formal handover.’ Every ward move puts at least one day on a length of stay and has a detrimental impact on patient experience. This could also put even further strain on the acute sector as a lack of clinical continuity also detracts from the overall quality of care experienced in hospital, particularly in patients aged 70 and over with multiple health problems. A report from The King’s Fund shows that older patients are more likely than others to be readmitted to hospital within a short time of discharge and are often moved around in hospital.3 The RCP report gives an overview of the myriad challenges facing acute hospitals today. These include:

• Increasing clinical demand – Hospitals have, until recently, coped with the reduction in general and acute beds, coupled with the increase in demand by reducing the average length of stay for patients. However, this fall in length of stay has now flattened and in the past three years has started to rise for patients over 85 years of age.

• Changing patients, changing needs – Many hospital buildings, services and staff are not equipped to deal with the increasing amounts of elderly patients with multiple, complex needs including dementia.