The British Geriatrics Society welcomes this new report from the National Audit Office about patient flow through hospitals. This is the latest in a growing list of reports showing that waiting times in Emergency Departments (EDs) are causing harm to patients and that this is an issue that affects the whole system, not just emergency care. Older people living with frailty, dementia and other long-term conditions are the group most likely to face long waits in accident and emergency and are also most likely to experience harm from long waits. Once admitted to hospital, older people are often subject to unnecessarily long stays and delays when they are medically fit for discharge, which has knock-on effects on patient flow.
Long waits and their impact on older people are not inevitable – they can be addressed but a whole system approach is needed to tackle this challenge. Strengthening community services ensures that older people are supported to live independently and reduces their need to attend ED in the first place. Front door frailty services can identify older people with frailty as soon as they arrive in accident and emergency and, where appropriate, divert them to community-based services or treat them and discharge them on the same day. If hospital admission is considered necessary, older people should receive high-quality care, delivered efficiently and with dignity. Planning for discharge should begin at the point of admission with older people able to access rehabilitation both in hospital and in the community as well as receiving any social care that is necessary. This will all contribute to older people being able to leave hospital as soon as they are medically well enough.
Professor Jugdeep Dhesi, BGS President, said:
This new report adds to the evidence that flow through hospitals is not working properly and that older people living with long-term conditions like frailty and dementia are the ones most like to experience harm as a result. However, we know that this issue is not insurmountable and, if implemented at a system-level, there are interventions that can make a real difference to the quality of care older people receive. We welcome recent initiatives that aim to improve services for older people, including the shift from hospital to community, the national focus on frailty through the upcoming Modern Service Framework for Frailty and Dementia and the Frailty Improvement Collaborative, as well as the Prime Minister’s recent announcements on social care. Implementation now needs strong leadership and support for wider structural changes to deliver services that meet the needs of those who depend on health and social care services the most – older people.
