Rushed hospital discharge puts lives at risk to hit target - Burstow

Elderly people are the victims of a 'revolving door' of rushed hospital discharge and emergency readmission new figures obtained by Liberal Democrat MP Paul Burstow reveal.

The number of frail older people re-admitted to hospital as emergency cases within 28 days of being discharged from their hospital beds has risen by over one quarter in the last four years.

Research has also found that 1 in 5 people re-admitted to hospital as emergencies die within 6 months. That means as many as 31,500 of the 158,000 over 75s re-admitted as emergencies last year could have died within 6 months.

The figures, obtained by Paul Burstow MP in a Parliamentary Question, show that the number of emergency readmissions within 28 days of discharge from hospital for people aged 75 and older has rocketed from 116,062 in 2000 to 157,925 in 2004 - 36%.

The figures also reveal that the number of emergency readmissions amongst people aged 75 years and over has increased by 10% in the last year alone, over 14,000 extra readmissions.

Paul Burstow MP commented:

"These figures graphically demonstrate the consequences of the Government's policy of putting a price on the head of every elderly person in a hospital bed.

"Care home closures and a dramatic decline in home care have created a revolving door culture in the NHS. A premature and poorly planned hospital discharge simply fuels the pressure on A&E departments.

"Hurrying people out of their hospital beds and fining councils for delaying discharges creates a false economy when so many people are readmitted to hospital only days later because adequate care and support is not in place for them elsewhere.

"These figures should be a wake-up call to Ministers. Older people are suffering, even dieing as a result of Government targets and fines."

ENDS.

Notes to editors

1. Answer released to Paul Burstow on 17th October 2005, column 762W.

Mr. Burstow: To ask the Secretary of State for Health how many emergency re-admissions of people there have been in each quarter since 2001; and how many were of people aged (a) 0 to 10, (b) 10 to 18, (c) 18 to 65, (d) 65 to 75 and (e) 75 years and over. [10164]

Emergency readmissions of people aged 75 and over within 28 days of hospital discharge

Age

Calendar year quarters 0-9 10-17 18-64 65-74 75+ Total

2001

1 January-31 March 14,404 5,159 49,783 19,934 32,224 121,504

1 April-30 June 12,589 5,146 52,301 19,845 32,219 122,100

1 July-30 September 10,904 5,084 54,119 19,815 31,734 121,656

1 October-31 December 13,472 4,794 46,114 17,296 28,056 109,732

2001 total 51,369 20,183 202,317 76,890 124,233 474,992

2002

1 January-31 March 14,705 5,195 51,291 19,556 32,321 123,068

1 April-30 June 12,631 5,559 54,200 20,056 33,586 126,032

1 July-30 September 10,928 5,088 55,084 20,034 34,074 125,208

1 October-31 December 13,418 4,611 45,652 17,493 29,802 110,976

2002 total 51,682 20,453 206,227 77,139 129,783 485,284

% inc 2001 - 2002 1% 1% 2% 0% 4% 2%

2003

1 January-31 March 14,551 5,779 53,164 20,755 35,782 130,031

1 April-30 June 12,335 5,620 57,004 21,502 36,656 133,117

1 July-30 September 11,090 5,511 60,462 21,844 37,576 136,483

1 October-31 December 13,888 5,112 50,393 19,073 33,613 122,079

2003 Total 51,864 22,022 221,023 83,174 143,627 521,710

% inc 2002 - 2003 0% 8% 7% 8% 11% 8%

2004

1 January-31 March 15,142 6,141 59,757 22,703 40,583 144,326

1 April-30 June 13,181 6,165 63,495 23,219 41,423 147,483

1 July-30 September 11,598 5,625 66,212 23,382 41,149 147,966

1 October-31 December 14,266 5,093 55,386 19,407 34,770 128,922

2004 total 54,187 23,024 244,850 88,711 157,925 568,697

% inc 2003 - 2004 4% 5% 11% 7% 10% 9%

% change 2001-2004 5% 14% 21% 15% 27% 20%

1. Statistics obtained from House of Commons library deposited papers 01/781, 01/1464, 02/629 and 02/1417 show there were 116,062 emergency readmissions of people aged 75 and over in 2000.

Emergency readmissions of people aged 75 and over within 28 days of discharge

1999/00 2000/01

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

26,702 26,758 26,523 28,611 28,735 28,820 29,896 31,528

1. The delayed discharge fines were introduced under the Community Care (Delayed Discharges) Act which received royal assent in April 2003.

2. From 5th January 2004, social services were fined £100 a day (£120 in London and south east England) for failing to have a care package available within two days of notification from a hospital that a client is to be discharged.

3. The Healthcare Commission's report The State of Healthcare 2005 indicates that the number of delayed discharges from hospital of older people has decreased. In the last year for which figures are published, 2003/2004, 46 out of 100,000 discharges of people over 65 years were delayed because the right services were not available in the community, compared with 57 in the previous year.

4. Commission for Social Care Inspection (2004) Leaving hospital - The price of delays found that the number of older people admitted directly from hospital into care homes was greater in some areas (one in three) than in other areas (one in 25), with some people being admitted to care homes when they could have been supported in their own homes. The report also found wide variations (from 8% to 50%) in the number of patients being readmitted to hospital within three months of being sent home, possibly indicating that some patients are discharged before adequate support is in place.

5. "One fifth of readmitted older patients die within six months" - taken from Nursing Older People, Munshi, S, March 2002 Vol 14 No. 1, p14-16 Readmissions of Older People to Acute Medical Units. In this detailed study of emergency readmissions over a three year period published in Nursing Older People, researchers found that:-

about 40% of hospital readmissions were avoidable

one fifth of readmitted patients will die within 6 months

 multiple medications causes many of the readmissions

6. According to the NHS Executive, the definition of emergency readmission is:-

"The emergency admission rate is an important measure of the effectiveness of community care arrangements for elderly people. At the point where it occurs, no emergency admission is avoidable. However, some emergency admissions result from a breakdown of a particular element of primary or community or social care , or from a breakdown in the co-ordination between the agencies involved. There is much that can be done to prevent the patient's condition deteriorating to such an extent that an emergency admission is required, for example timely community care to prevent an older person's health deteriorating or post operative support to prevent readmission."

7. For more information about delayed discharges and emergency readmission see http://www.nao.org.uk/publications/nao_reports/02-03/0203392es.pdf. Comptroller and Auditor General. (2003). Ensuring the Effective Discharge of Older Patients from NHS Acute Hospitals. Department of Health.