Winter is here. Or should I say, it never really left.
Speak to many of the CSP’s members and they’ll attest that the NHS lives in an almost constant state of ‘winter pressures’.
As I write, the system is braced for the already significant pressure to ratchet up a few more notches before Spring arrives. There’s the influx of winter flu, a rise in covid cases and not enough staff; it’s a heady mix and one that was only ever going to result in yet another winter crisis.
Recent stories in the media show ambulances stacking up outside hospital, emergency departments on their highest escalation levels and patient flow through hospital going at a speed that would make glaciers look fast. Last weekend the Observer revealed that in November 42,000 patients spent more than 12 hours in A&E waiting for a bed. A recent investigation by the Health Service Journal found that health trusts across the country are employing a management strategy to hold patients in the back of ambulances to cope with current pressures.
The latest sit-rep data, published weekly shows many thousands of people in hospital, fit to be discharged, but unable to do so. Much of this because the services, including rehab, that they need are just not in place. But what this data also highlights, is where investment is needed.
Take pulmonary rehabilitation. COPD accounts for a huge number of A&E admissions each year alongside other long-term conditions but these could be avoided with timely and effective community rehabilitation. It helps people manage their symptoms and greatly improves their quality of life and in the process £69 million could be saved by the NHS every year if access was increased.
Many A&E admissions will also be down to falls – particularly among people who are frail and elderly. In 2019, falls cost the NHS £2.3bn and, following a fall, 50% of older people experience serious mobility impairments. Worse yet, there is a 10% probability of dying within a year. By investing in rehabilitation and prevention services in the community, many thousands of falls could be prevented, again easing pressure on the front door of hospitals.
This is backed up by a report by the County Council’s Network, titled ‘Finding a way home’ which focused on addressing delayed discharge – often seen as the log jam at the back door of hospital – and how there is the potential for an additional 40,000 older adults to benefit from reablement and rehabilitation at home on discharge from hospital, if the capacity were available.
What this data shows is the ripple effect that rehab can have through the entire NHS. It allows for discharge home, which frees up space on a ward, which in turn means someone can move from A&E, which creates space for an ambulance to hand over a patient, which means that ambulance can respond to a 999 call.
We also know what good looks like. The recently-published Intermediate Care Framework and new model for community rehabilitation have tangible actions that Integrated Care Systems can take and in doing so have a knock-on impact on the parts of the system struggling even more during the winter months.
we need to switch our focus to and invest in the community rehabilitation services that enable people to recover and manage long term conditions. If we don’t many people will continue to find themselves in a cycle of discharge and readmission. This puts people at higher risk of harm. This is avoidable not inevitable. The services that support people to stay at home to manage their long-term conditions and remain independent have been undervalued and underfunded for years. The result is a health system at breaking point, facing yet another bleak mid-winter.
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