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Shifting the focus of patient care into the community is not a problem that can be solved by any single initiative. I am surprised that this meeting seemed to highlight ‘inability to discharge’ as the most important factor in hospital overcrowding- while I agree that very few patients on wards have been admitted ‘inappropriately’, I am sure that many admissions could have been avoided by careful monitoring of vulnerable individuals in the community.
Educating patients with chronic disease about their condition in order to promote self management is definitely part of the answer. However those that constitute the vast majority of avoidable admissions (patients suffering from dementia or frailty) are obviously incapable of managing their condition, or perhaps more importantly recognizing those situations where they do need to seek professional help. Improving the services to which vulnerable patients are discharged following acute care is only part of the answer. Focus must remain on those that seek to prevent their admission in the first place.
The ‘hospital hotels’ discussed by Baroness Greengross are an intriguing suggestion, and would seem to offer both a suitable environment for monitoring vulnerable patients as well as a ‘next step’ for such patients following discharge from acute incidents. However, I believe the healthcare system in those countries where they are currently established (e.g. Finland, Sweden and more recently Germany) differ markedly from the NHS in that none are free at the point of delivery (although they are heavily government-subsidised). In Finland, for example, hospital in-patients pay a per diem charge of around EUR 30.00. ‘Hospital hotels’, therefore, do not represent a significant increase in expense compared to inpatient treatment in these countries. In Germany the figures are similar, plus around 23% of the total expenditure on health is from private sources rather than government, compared to only 16% in the UK (1).
Would these ‘hospital hotels’ be sustainable without such financial contributions from patients? If not, will they be viable in the UK where patients expect care that is free at the point of delivery? Might patients resist discharge if it is to an establishment where they would be required to pay?
Re: Lack of community care is responsible for crisis in hospitals, meeting hears
Shifting the focus of patient care into the community is not a problem that can be solved by any single initiative. I am surprised that this meeting seemed to highlight ‘inability to discharge’ as the most important factor in hospital overcrowding- while I agree that very few patients on wards have been admitted ‘inappropriately’, I am sure that many admissions could have been avoided by careful monitoring of vulnerable individuals in the community.
Educating patients with chronic disease about their condition in order to promote self management is definitely part of the answer. However those that constitute the vast majority of avoidable admissions (patients suffering from dementia or frailty) are obviously incapable of managing their condition, or perhaps more importantly recognizing those situations where they do need to seek professional help. Improving the services to which vulnerable patients are discharged following acute care is only part of the answer. Focus must remain on those that seek to prevent their admission in the first place.
The ‘hospital hotels’ discussed by Baroness Greengross are an intriguing suggestion, and would seem to offer both a suitable environment for monitoring vulnerable patients as well as a ‘next step’ for such patients following discharge from acute incidents. However, I believe the healthcare system in those countries where they are currently established (e.g. Finland, Sweden and more recently Germany) differ markedly from the NHS in that none are free at the point of delivery (although they are heavily government-subsidised). In Finland, for example, hospital in-patients pay a per diem charge of around EUR 30.00. ‘Hospital hotels’, therefore, do not represent a significant increase in expense compared to inpatient treatment in these countries. In Germany the figures are similar, plus around 23% of the total expenditure on health is from private sources rather than government, compared to only 16% in the UK (1).
Would these ‘hospital hotels’ be sustainable without such financial contributions from patients? If not, will they be viable in the UK where patients expect care that is free at the point of delivery? Might patients resist discharge if it is to an establishment where they would be required to pay?
(1) WHO: Global Health Expenditure Database
Competing interests: No competing interests