Letters Preventing admission of older people

A proactive and integrated approach works in caring for older people

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3723 (Published 11 June 2013) Cite this as: BMJ 2013;346:f3723
  1. Phil Taylor, general practitioner1
  1. 1Axminster Medical Practice, Axminster EX13 7RA, UK
  1. philtaylor{at}nhs.net

D’Souza and Guptha rightly suggest that reducing beds for older people is not well evidenced policy.1 Their own use of evidence is somewhat selective—for example, quoting Purdy’s King’s Fund 2010 report in support of their case but ignoring her clear statement in favour of hospital at home schemes.2

Many attempts to case manage in the community have been “parachuted” in as “stand-alone” interventions, rather than evolving through integrated working between primary care, community social care, and secondary care staff.

In East Devon, our population structure is equivalent to predictions for England in 2035. Striking and consistent differences exist in standardised admission rates between areas that use a proactive approach (intervene within two hours when patients are at high risk of admission) and predictive modelling as a focus for multidisciplinary discussions and action to reduce risk compared with areas without such an approach.

When, as Purdy recommends, “avoidable” admissions such as those in the standardised ACSC (ambulatory care sensitive conditions) are the focus, sustained differences in admission rates are even more striking.

Teams working in this way can also “pull” patients out of hospital as soon as their diagnostic and treatment planning phase is complete. Working in these ways does not necessarily require extra resources, except for the cost of the predictive modelling tool.

I hope those who read this editorial will understand that it is an argument against bed reductions not against developing systems that allow frail older people to be in hospital only when and for as long as needed.

Babies and bathwater come to mind.


Cite this as: BMJ 2013;346:f3723


  • Competing interests: PT is eastern Devon locality commissioning lead for healthcare for older people.


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