Annual Report and Accounts 2012/13 - Royal Devon & Exeter Hospital

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2. Our Trust Royal Devon and Exeter NHS Foundation Trust
Annual Report and Accounts 2012/13
Frail and older
people
As people get older they can develop
complex physical and mental health
issues, with social care needs which
are often compounded by isolation
and discrimination. Hospitalisation
entails greater risks for elderly
people, who are more prone to
hospital-acquired infections, falls and
delirium, and can become rapidly
dependent and institutionalised. It
also means added pressure on
acute hospitals.
• Frail older patients have
longer admissions
• High occupancy of inpatient
beds has a knock-on impact on
the flow of patients through
the hospital from admission to
discharge and this can result
in the cancellation of elective
admissions
• Patients are more likely to
be transferred to the wrong
wards.
A recent King’s Fund report on elderly
care suggests that elderly patients
occupying between 42-55% of bed
days would be better treated at home.
The population served by the RD&E
has a significant proportion of
elderly frail people, above that of the
national average. In one part of East
Devon, for example, a demographical
analysis shows that over 80s make up
5.28% of the population, which is
the same as what England as a whole
will be like in 2042. Despite these
pressures, caring for elderly people
costs more than the funding received,
and this pressure is likely to get
worse within a constrained funding
environment. Added to this is the
fact that reduced social care spending
per capita in Devon is lower than
the national average and focused on
institutionalised care, and that the
system for managing the care of the
elderly is fragmented. The challenge
of managing the health needs and
expectations of this population are
significant now and will become
more so in the future.
Meeting this challenge is a key
element of the Trust's strategy and
over the last year we have been
working on what we can do to
turn this challenge into a strategic
opportunity. Over time, the Board’s
aspiration is to develop a new,
innovative model of care, working
with our partners to ensure that
frail elderly patients receive the best
possible care and the Trust becomes
renowned as a centre of excellence.
We have undertaken a detailed
analysis of the pathways that patients
follow and this has helped identify a
number of improvements that would
have the biggest impact on frail older
patients including:
• Providing comprehensive
needs assessment at the
point of presentation to acute
hospital
• Providing active treatment
by health and social care
professionals in the patient’s
home for a maximum period
of 21 days as an alternative
to hospital admission in pilot
areas
• Providing education and
training in dementia care
across the Trust
• Involving patients and carers
in our redesign work.
This project has three key strands:
• Changing the way we manage
the care of elderly patients
within the Trust including
new ward arrangements,
active rehabilitation, increased
ambulatory care, 7/7 working,
improving discharge processes
and dementia screening
• Working with key partners
including improved early
detection and intervention
for dementia, rapid patient
assessments and partnership
working with primary care
clinicians
• Potential commissioning
changes: understanding
and discussing with new
commissioners how potential
changes in commissioning
may impact on elderly care.
As a result of this ongoing work,
while admissions for this group of
patients continue to rise, the length
of stay has decreased.