The demand on clinical services is increasing to the point where acute care cannot keep pace in its current form says Hospitals on the edge? The time for action, a new report from the RCP. The hard-hitting report highlights that there are a third fewer general and acute beds now than there were 25 years ago, [i] yet the last decade alone has seen a 37% increase in emergency admissions.[ii]
This is coupled with a change in patients’ needs. Nearly two thirds (65%) of people admitted to hospital are over 65 years old,[iii] and an increasing number are frail or have a diagnosis of dementia. However, all too often hospital buildings, services and staff are not equipped to deal with those with multiple, complex needs including dementia.
This is having detrimental effects on patient care. RCP members have reported a lack of continuity of care as their biggest concern about the current health service.[iv] It is not uncommon for patients, particularly older patients, to be moved four or five times during a hospital stay, often with incomplete notes and no formal handover.[v] Older people are at particular risk as they account for 70% of bed days.[vi],[vii] Research shows that medical and nursing staff often feel that older patients ‘shouldn’t be there’. Being perceived as the ‘wrong patient on the wrong ward’ has been shown to reduce the quality of care, building attitudes of resentment from both medical and nursing staff.[viii]
Therefore the RCP is calling for:
- All health professionals to promote patient-centred care and to treat all patients with dignity at all times.
- The redesign of services to better meet patients’ needs. This may involve consolidation of hospital services and hospital closure. The planning and implementation of new services must be clinically led.
- The reorganisation of hospital care so that patients can access expert services 7 days a week.
- Access to primary care to be improved so patients can see their GP out of hours, relieving pressure on A&E services.
Sir Richard Thompson, president of the RCP says:
One doctor told me that his trust does not function well at night or at the weekend and he is ‘relieved’ that nothing catastrophic has happened when he arrives at work on Monday morning. This is no way to run a health service. Excellent care must be available to patients at all times of the day and night. We call on government, the medical profession and the wider NHS to work together to address these problems. This is why the RCP has established the groundbreaking Future Hospital Commission, to bring stakeholders together to examine better processes and standards for treating medical inpatients.
Professor Tim Evans, lead fellow, future hospital says:
This evidence is very distressing. All hospital inpatients deserve to receive safe, high-quality, sustainable care centred around their needs and delivered in an appropriate setting by respectful, compassionate, expert health professionals. Yet it is increasingly clear that our hospitals are struggling to cope with the challenge of an ageing population who increasingly present to our hospitals with multiple, complex diseases. We must act now to make the drastic changes required to provide the care they deserve.
Suzie Hughes, chair of the Royal College of Physicians Patient and Carer Network says:
Hospitals are struggling to allocate beds that are appropriate for the patient’s condition when admitted to hospital because there are not enough beds. On top of this, diagnostic services are unavailable or in extremely short supply during out of hours, weekends and at bank holidays. All the while, hospitals are expected to run services with fewer and fewer trained staff. These issues have a detrimental effect on patient care and lead to longer stays in hospital. The RCP should be congratulated for producing this report.
[i] Imison C, Poteliakhoff E, Thompson J. Older people and emergency bed use.Exploring variation . London: King’s Fund, 2012
[ii] Hospital Episode Statistics. www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937 [Accessed 3 September 2012].
[iii] Cornwell J et al . Continuity of care for older hospital patients: a call for action. London: King’s Fund, 2012.
[iv] Royal College of Physicians. Results of RCP Health and Social Care Bill survey 2012 . www.rcplondon.ac.uk/press-releases/results-rcp-health-and-social-carebil... [Accessed 3 September 2012].
[v] Royal College of Physicians. Local conversations with fellows and members, 2011–2012. Unpublished.
[vi] Cornwell J et al . Continuity of care for older hospital patients: a call for action. London: King’s Fund, 2012
[vii] Imison C, Poteliakhoff E, Thompson J. Older people and emergency bed use. Exploring variation . London: King’s Fund, 2012
[viii] Tadd W et al. Dignity in Practice: An exploration of the care of older adults in acute NHS Trusts. NIHR Service Delivery and Organisation Programme;2011 . London: Panicoa, 2011. http://panicoa.org.uk/panicoa-studies/dignitypractice
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- The Royal College of Physicians (RCP) plays a leading role in the delivery of high-quality patient care by setting standards of medical practice and promoting clinical excellence. We provide physicians in the United Kingdom and overseas with education, training and support throughout their careers. As an independent body representing over 27,500 fellows and members worldwide, we advise and work with government, the public, patients and other professions to improve health and healthcare.
- The Future Hospital Commission (FHC) was established in February 2012 by the RCP to examine the organisation, processes and standards of care in hospital in order to identify the best way to treat medical inpatients in the future. The commission is chaired by Professor Sir Michael Rawlins, and will report in spring 2013. Interim findings are expected in autumn 2012. The Hospitals on the edge? report makes the case for the radical change that the RCP expects the FHC to recommend.