Postcode lottery for elderly on emergency treatment

The study on how well the NHS and social care providers work together on services for the over-65s shows that older people in Barnsley and Hull are significantly more likely to require emergency hospital treatment.

The findings place a question mark against the quality of community and social care that should be targeted at avoiding hospital admission. Potentially avoidable hospital treatment also places a greater burden on the public purse.

The Audit Commission report on the integration of health and care services shows progress on joint working remains patchy across the country.

It also says that primary care trusts (PCTs) nationally could have saved £132m in 2009-10 if they had reduced emergency admission rates for the over-65s to the average level expected, taking into account local population characteristics.

In Barnsley, emergency admissions were 18 per cent higher than the expected level, while Hull’s figures were 31 per cent higher. Other areas in Yorkshire were much closer to or even below expected admission levels.

NHS Barnsley declined to comment but a spokeswoman for NHS Hull said: “As commissioners of local health services, we are continually working with colleagues in primary care and the local authority to reduce the number of older people requiring emergency admission to hospital.

“Over half a million pounds has been invested this year in initiatives to support planned treatment and care at home. These include the employment of a community geriatrician who is able to visit and monitor patients at home and rehabilitation services to support patients’ recovery outside hospital.

“Risk profiling is undertaken to identify those patients who may be at higher risk of emergency admission, including those with long term conditions such as chronic obstructive pulmonary disease, following which they will be assigned a community matron or GP to monitor their care.

“The PCT also continues to look at alternatives to hospital admissions for urgent care. The co-location of primary care with emergency services on the Hull Royal Infirmary site will help to ensure that, where patients do have urgent care needs, they receive the relevant treatment from the most appropriate service, and this may not always result in hospital admission.”

Audit Commission managing director of health Andy McKeon said: “Most older people want to continue living independently in their own homes, if possible, avoid admission to hospital and, ultimately, die at home. Supporting them to do these things are key elements of health and social care policy.

“There are also savings to be made by reducing the use of expensive hospital or residential care. Our evidence shows there is considerable local variation in achieving these aims. Progress will only be made by better integrating care locally.

“There is a temptation when times are tough to withdraw into silos and limit your focus. This instinct is misplaced. Real savings, and a better, more independent, experience for local people, can only be achieved through partnership, and a view of what constitutes value for money across both health and social care.”

Jane Farquharson, chief executive of Age UK Knaresborough, said service providers had not always worked well together and called for more “joined-up thinking”.

She said: “There has certainly been a lot of passing the ball from one to another and many older people have lost out on services as a result.“