New report sets out how hospital admissions can be avoided and how patient flow can be improved ahead of busy winter period

CCN Latest News, CCN News 2023 | 20 November 2023

A major new report released today sets out how the health and social care system can work better this winter – by avoiding unnecessary hospital admissions and improving patient flow.

Published ahead of what is expected to be another challenging winter period for the NHS and social care, the new study from the County Councils Network (CCN) and Newton explores how the system to admit and discharge older people from hospital and support their care needs could work better , potentially improving the lives of tens of thousands of over 65s and reducing costs to the NHS and local government over £2.5bn.

Download the report here.

Instead of buying up short-term residential care beds to discharge over 65s from hospital, which can inadvertently reduce independence, the report outlines that the government should this winter instead look to broader solutions, particularly greater investment and then use of home-based care, community and reablement services – as well as reforming NHS ways of working.

The report argues that if additional funding is to be made available to health and social care systems this year for community capacity, it should be directed towards councils to enable the expansion of home-based reablement and rehabilitation and specifically support development of the therapy workforce. This would allow more adults to return to their own home following a stay in hospital.

The report, Finding a Way Home: how health and social care can optimise hospital flow and discharge this winter, finds that:

  • Around 175,000 fewer older people each year could avoid being admitted to hospital through improved decision-making from frontline health professionals with patients instead supported in the community. This would involve building trust and awareness in such community services. For example, if an over 65 suffered a minor injury, they could instead be treated in the community rather than sent to an acute setting.
  • With the NHS facing 1.6m admissions from over 65s each year, this represents one in 10 admissions and could free up thousands of beds and reduce costs by £600m a year.
  • 6m bed days could be saved by reducing delayed discharges, including 500,000 from ‘simple’ discharges. This could be achieved by utilising more criteria-led discharges, and by improving capacity in intermediate care services (such as reablement and rehabilitation at home).
  • For those discharged from hospital, over 80,000 elderly people could live more independent lives each year – such as in their own home– if improved decisions are made by professionals and there is more investment into intermediate care and therapy within these settings. This could reduce local authority costs by £1bn a year.

Government efforts have previously focussed on the role of social care in slowing down the system – particularly at the point of discharge from hospital. However, the report illustrates that a more significant impact could be had by focussing on avoiding admissions and on simple discharges.

For those over 65s that do require social care support after discharge, the report finds that investment in short-term care beds to get those patients out of hospital quicker may not be the most effective solution for a large number of those individuals. Many that stay in short-term settings become more reliant on care, and are then often unable to return home as their ability to care for themselves – and their confidence to do so – has declined.

At a local level, the report says that a better understanding of community offers, focusing on delays caused during hospital treatment, and investing and optimising community and home-based care will help ease the discharge logjam, provide better outcomes for patients, and could reduce costs by billions each year.

By improving the flow and discharge of older adults, there is the opportunity to stop tens of thousands of unnecessary admissions in each year, reduce the amount of time spent in hospital, and ensure individuals are discharged to the best setting for their needs and promote the ability for older people to live in their homes for longer.

Cllr Martin Tett, Health and Social Care Spokesperson for the County Councils Network, said:

“We are facing into one of the most challenging winters ever for the health and social care system, with immense pressures that have built up over the last few years showing no signs of abating. Every bed in each hospital will be vital as acute and emergency admissions rise over the coming months, and we need to ensure we maximise the most effective use of social care services to speed up discharges and improve outcomes.

“Last year the government was proactive in responding to the severe challenges of winter. But despite the best will in the world, this did not dramatically improve discharge rates, and for those who were discharged, it was not always the best option them. Our report today sets out a different way: one where patient outcomes are improved and costs are reduced significantly for both the NHS and councils.

“By investing more in the right community and intermediate care, as well as enabling improved decision-making across the system, today’s report sets out a clear pathway to creating a more sustainable and effective system, helping to avoid tens of thousands of unnecessary admissions each year and speeding up discharge rates. For those that then leave hospital, it also outlines how they can get the best possible health outcomes.”