It is recognised that older people are a major service user cohort for both health and social care services, both in hospital (the acute setting) and in the community. It is well described that the population is ageing, as people are living longer, and as a result, there are more older people as a proportion of the overall population. The increase in the older population is projected to accelerate over the next twenty years and whilst overall life expectancy is rising, there are also significant inequalities across the country in terms of life expectancy.
The Older People’s Care in Acute Setting project content has been developed in partnership with British Geriatric Society and explores the pathway that people take through the acute hospital, beginning in A&E and assessment units, and moving through to inpatient wards and supported discharge teams. In addition, the project includes a service user level audit that collects data on the patient episode.
A total of 47 acute hospital providers in England and Health Boards in Wales took part in the 2016 benchmarking project collecting 2015/16 data. Participating organisations have access to a comprehensive online benchmarking toolkit, allowing them to view their positions on hundreds of metrics covering service models, activity, workforce, finance and quality and outcomes across the acute pathway. The full findings from the service user audit have also been included. Participants have also been issued with bespoke dashboard reports, highlighting their position on key metrics against other participants. These have also been peer group profiled.
Three key messages have emerged from the 2016/17 project that impact on the quality of care delivered for older people;
- the use of CGA is increasing;
- readmission rates are rising;
- delayed transfers of care continue to grow.
Further findings from the Older People’s Care in Acute Settings 2016 project (2015/16) data include:
- 40% of organisations have a dedicated geriatric team located in the A&E department. The average number of hours that these teams are available during the week is 9 hours, at weekends this reduces to 6 hours.
- 77% of trusts delivered Comprehensive Geriatric Assessments on the elderly care wards, and 42% delivered these assessments on other specialty wards.
- The ratio of qualified to unqualified nursing staff on the care of the elderly wards was found to be 55% registered and 45% unregistered. The RCN recommends a ratio of 65:35 skill mix for “ideal, good quality care,” and 50:50 for “basically safe care” across the participants (Safe staffing on older people’s wards, RCN, 2012).
- 85% of trusts operate Early Supported Discharge schemes, and 77% of trusts have an Integrated Discharge team.
- The average time for a continuing healthcare assessment to be undertaken is 10 days.
- 74% of organisations set estimated discharge dates within 24 hrs of admission.
- 83% of delayed transfers of care were attributable to people age 65 and over in 2015/16.
- 56% of patients admitted to the care of older people wards had been admitted to hospital within the previous 12 months.
- 14% of pay costs spent on bank & agency across the pathway.
With delayed transfers being highlighted as an issue for the NHS and part of the ‘NHS Operational Planning and Contracting Guidance 2017-19’, next year’s benchmarking cycle for this project will focus on a deep dive of DToCs.
For more information on this work please contact:
Leigh Jenkins, Project Manager