Ambulatory Care

Part of the debate – in Westminster Hall at 11:00 am on 27th April 2016.

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Photo of John Howell John Howell Conservative, Henley 11:00 am, 27th April 2016

The hon. Gentleman makes a valid point. The costs need to be offset. This is a balancing exercise within the NHS. Costs that are saved by stopping people going into hospital can be spent on the treatments and services they require to get them better. That is a far better way of working.

Emergency hospital admissions are distressing. Better management that keeps people well and out of hospital should lead to a better patient experience. The King’s Fund estimates that emergency admissions for ambulatory care-sensitive conditions could be reduced by between 8% and 18% simply by tackling variations in care and spreading existing good practice. That would result in savings of between £96 million and £238 million, which, as part of the overall management of the NHS budget, could be allocated against the provision of the often quite expensive services that provide the necessary medical investigations on the spot.

A doctor in my constituency, Dr Andrew Burnett of the Sonning Common practice, said:

“Very few of my patients want to be admitted to hospital.”

Most people, if they need to be treated or, indeed, if they are nearing the end of their life, would like that experience to be located at home. I think that probably applies to us all.

There is a particular problem in relation to dementia. I spoke to the Alzheimer’s Society, which said that people are often admitted with an acute physical illness on top of their dementia, and the combination of the two can cause their confusion to become worse. They are then taken out of familiar surroundings and placed on a hospital ward with lots of strange people, noises and smells. That can be terrifying for them and they rapidly deteriorate. The advice from the Alzheimer’s Society is to try to keep people out of hospital for as long as possible. That is why we, and the Oxfordshire medical facilities, are striving hard to develop systems to enable people with physical illnesses to be managed out of hospital.

That is one of the rationales for the new Townlands hospital in Henley, where the clinical commissioning group, along with Oxford University Hospitals, Oxford Health and, indeed, the county council, are members of the ambulatory emergency care network, through which organisations can learn from one another to develop robust pathways. Some good case studies are involved in that, but time prevents me from going through them at the moment. I draw the Minister’s attention to those if he needs some examples of how ambulatory care actually works.

Another clinician, Pete McGrane of the CCG, has said:

“Patients who were recently hospitalized are not only recovering from their acute illness;
they also experience a period of generalized risk for a range of adverse health events.”

There have been cases in my constituency where the health of elderly people has deteriorated following discharge, or even in hospital, due to other conditions. The relatives have sought to blame the health service for poor care. After following up on those cases, the complaints investigation has shown that it is not poor care that has exacerbated the patients’ distress and symptoms; it is a direct consequence of hospitalisation.

I went to see a hospital in Welwyn Garden City, which has no beds inside. Instead, it has beds in an adjoining care home at the side of the hospital. The place was absolutely heaving with people. I met a gentleman there called Dave. I do not have his surname, nor have I asked his permission to use his name, so we will just keep it as Dave. He could not speak highly enough of the treatment he got. He called in every day for treatment and then got on with his life at home. It revolutionised the treatment he received, which, doctors had confirmed, would otherwise have required a debilitating 56 days of medication, staying in hospital. His experience of hospital stays had shown up their disadvantages, and he pointed out that people were so much more likely to improve, as he had, and to feel better, as he did, if they could stay at home. He was clearly a great enthusiast for this type of service.

In Henley, there is one issue, above all, which I have already touched on and want to emphasise. It was helped by some papers that were forwarded to me by the Health Foundation, which said that it is undertaking

“a joint research programme…monitoring how the quality of health and social care is changing over time.”

I have been very concerned by the way in which we move forward with the integration of social care and health in the county to ensure that it delivers the sort of services that are required in the full context of the patient.

I am pleased and proud that I have helped to deliver a 21st century medical facility for the people not just of Henley, but of the whole of southern Oxfordshire, and that that incorporates ambulatory care. It is clearly the way forward and it is a way forward that I am sure will work.