The results of the Alzheimer’s Society research into NHS emergency hospital admissions in the six years up to 2017/2018 have been widely reported this week.
The research finds that approximately 25% of patients had dementia of some form recorded on admission, a rise of almost a quarter since 2012/2013. Some of this increase may be due to rising awareness and better trained staff leading to better identification and reporting of dementia on admission, which is no bad thing. However, the findings suggest that many patients with dementia who are admitted to hospital in an emergency situation will then remain in hospital far longer than they need to because of a lack of, or delays in obtaining, suitable community care. Approximately 10% of admissions where dementia was recorded resulted in stays of more than 28 days; a significant period of time.
Patients with dementia may be (medically) ready for discharge from hospital long before they can be safely discharged in practice, resulting in unnecessarily long stays. Aside from the obvious practical and economic reasons why hospitals which are already struggling with bed availability and funding deficits do not want to keep patients in hospital for longer than they need to, this is particularly concerning from a patient perspective.
Hospital stays – even those which are not longer than necessary – can be very distressing. Hospitals can be a scary and confusing environment for many people and for patients with dementia this is likely to be more acute. In addition to concerns over emotional and psychological health, long hospital stays can have significant detrimental effects on physical and cognitive health. NHS Improvement, for example, states in its 2018 Guide to reducing long hospital stays:
“Unnecessarily prolonged stays in hospital are bad for patients. This is due to the risk of unnecessary waiting, sleep deprivation, increased risk of falls and fracture, prolonging episodes of acute confusion (delirium) and catching healthcare associated infections. All can cause an avoidable loss of muscle strength leading to greater physical dependency (commonly referred to as deconditioning).”
Alzheimer’s Society chief executive Jeremy Hughes is quoted by the BBC as saying:
“People with dementia are all too often being dumped in hospital and left there. Many are only admitted because there’s no social care support to keep them safe at home.”
Hospitals should never be a “dumping ground” for any patient group, never mind those patient groups which are particularly vulnerable. It will benefit us all if the whole health and social care system moves towards reducing unnecessary or unnecessarily long hospital stays. Better, and more efficient systems, channels of communication and care pathways need to be in place to enable patients with dementia to receive quality community care, that meets their needs, at the time they need it. This is likely to require a more coordinated approach from everyone involved in the sector.
We hope that the government’s promised reform of health and social care will facilitate progress in this area and will support those in the sector seeking to achieve long overdue improvements.
Please contact Ridouts Professional Services Ltd on 0207 317 0340 if you wish to discuss the contents of this article, or require legal advice in healthcare matters.