David Oliver: “Considerably transformed”—changing the narrative on admitting older patientsBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m652 (Published 26 February 2020) Cite this as: BMJ 2020;368:m652
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Utilise our community hospitals to relieve pressure on acute hospitals.
Following up David Oliver’s Acute Perspective (1), I agree that our hospitals are too full. Yet the NHS has a supply of unused beds in the shape of community hospitals that have had inpatient beds closed, frequently in the face of fierce opposition from the local population (2).
I am currently working for an Urgent Community Response team that aims to promote early discharge from acute hospital and to prevent avoidable admissions. I work with an excellent team of nurses, therapists and health care assistants and yet the team struggles at times to avoid admissions and accommodate the acute hospital discharge requests. The irony is that the team is based in a modern community hospital that had its medical beds closed two years ago-the beds lie empty a few metres from our office.
NHS community hospitals have been the subject of three research studies in the past five years which have demonstrated that community hospitals efficiency is comparable with NHS acute hospital sector (3) and that these hospitals enable the provision of local intermediate care services for patients ‘stepping up’ from the community or ‘stepping down’ from the acute sector (4). Community hospitals provide a diverse range of services and patient experience is frequently reported to be better than in an acute hospital. (5). Community hospitals provide care near to patients’ homes and are highly valued and invested in by the local community (4).
The shortage of acute hospital beds is about to get worse with the accelerating novel coronavirus outbreak. Discharging more patients safely to home could be hard. Surely it is time that the potential of community hospitals to provide safe, local, intermediate care is realised and that the closure of these cost effective beds is reversed?
(1) Oliver D. Fixing the older inpatient narrative BMJ 2020;368:m652
(3) Young J, Hulme C, Smith A, Buckell J, Godfrey M, Holditch C, et al. Measuring and optimising the efficiency of community hospital inpatient care for older people: the MoCHA mixed-methods study. Health Serv Deliv Res 2020;8(1) https://doi.org/10.3310/hsdr08010
(4) Davidson D, Paine AE, Glasby J, Williams I, Tucker H, Crilly T, et al. Analysis of the profile, characteristics, patient experience and community value of community hospitals: a multimethod study. Health Serv Deliv Res 2019;7(1) https://doi.org/10.3310/hsdr07010
(5) Pitchforth E, Nolte E, Corbett J, Miani C, Winpenny E, van Teijlingen E, et al. Community hospitals and their services in the NHS: identifying transferable learning from international developments - scoping review, systematic review, country reports and case studies. Health Serv Deliv Res 2017;5(19)
Competing interests: No competing interests