My Lords, reducing the number of emergency re-admissions is an important priority for the NHS. NHS trusts are expected to target this area as part of their performance, improvement and clinical governance programme. The National Service Framework for Older People—with specific standards, targets and milestones to improve general hospital care, stroke services, and falls prevention and rehabilitation—will improve the quality of services and care that older people receive, including the tackling of emergency re-admissions.
My Lords, I thank the Minister for that reply. However, would it not be as well to try to establish the causes of the emergency re-admissions? Does the Minister agree that there are only two reasons: an over-zealous attempt to meet government waiting list targets on the one hand, or inadequate care in the community on the other, due to lack of government resources for social services?
My Lords, I certainly agree that we need to look at the main reasons for emergency re-admissions, but I have failed to detect any evidence to support the claims that the noble Lord subsequently made.
We know from research that an emergency re-admission to a hospital may be a consequence of the natural course of a patient's disease, or that he or she may not have received appropriate care after the first admission; or it may be entirely unconnected with the original patient care. A literature search by the National Centre for Health Outcomes Development, examining evidence throughout the world based on studies of older patients, suggests that between 15 and 60 per cent of re-admissions are unavoidable; but in two studies of medical patients, between 9 per cent and 18 per cent of re-admissions were considered preventable. That is why every NHS trust should be looking through its clinical governance programmes at the specific reasons for re-admissions—and that is what we expect the trusts to do.
My Lords, does the Minister agree that, as suggested by the noble Lord, Lord Clement-Jones, one of the major factors responsible for this situation is—I do not like the unfortunate term—bed-blocking in acute hospitals by elderly patients who have nowhere to go? Is it not the case that, progressively across the country, more and more care homes in the community have closed down within the last two years? Is it not also the case that certain misguided health authorities, such as that in Oxford, have closed down valuable community hospitals such as those in Burford and Watlington?
My Lords, I agree with the noble Lord that community hospitals have an important role to play in ensuring that rehabilitation and intermediate care facilities are available. He will know that, as a result of the Government's policy, we are seeing a great deal of investment in additional places for intermediate care.
So far as concerns care home capacity, the noble Lord is right to point out that there has been a reduction in the number of care home places throughout the country. The position is patchy, with some parts of the country still having an excess of places over the number of people wishing to go there. We have put in extra resources to local authorities to enable them to buy additional care home places. As regards bed-blocking, I am glad to report that we have seen a reduction in the number of beds blocked between the third quarter of the current financial year as opposed to the third quarter of the last financial year.
My Lords, can my noble friend say how seriously the present shortcomings in providing community care are impacting on the incidence of hospital re-admissions? What figures are available? Moreover, ought the pejorative term "bed-blockers" to be applied, not to vulnerable people for whom only hospital care is available, but to those failing in their legal duty to provide adequate and appropriate community care for them?
My Lords, my noble friend is right to suggest that, if appropriate community care and community facilities are not available, that can have an impact, particularly on older people who have been discharged from hospital and who may have cause to be re-admitted. That is why, in dealing with the issue of beds that are being blocked, we have made additional resources available to local authorities which can be used to purchase extra care places. More importantly, those resources can also be used to provide additional packages of community care.
Part of the work of an NHS trust in reviewing re-admission rates is to ensure that discharge procedures are as effective as possible, and that there is a strong partnership between the health service and local government, to make sure that there is a seamless transition of care.
My Lords, does the Minister agree that there is a flaw in the collection of data as regards waiting lists and re-admissions? It was brought to my notice that a patient on the point of going into theatre for an operation was in fact sent home pending further tests and the operation taking place at a later time. She is now not deemed to be on the waiting list, although, by anyone's understanding, she is still waiting for her operation.
My Lords, I am always happy to examine individual cases to see whether the trust has recorded a patient properly. It is very important to the Government to ensure that data collection is treated with all due seriousness by the NHS. It is why we commissioned the Audit Commission to examine the quality of NHS data, and why we have agreed with it that it will undertake spot-check reviews of NHS trusts to make sure that they are recording data properly.