Dr Graham Ellis is an Associate Medical Director and Older Peoples Services Consultant Geriatrician for NHS Lanarkshire. He is also one of the key speakers at the Hospital at Home UK Forum at the BGS Autumn Meeting on Wednesday 23rd November in Glasgow.
Older people are presenting to acute hospitals in greater numbers year on year. Predictions of the future demographic raise serious questions about the sustainability of hospital based services. The Future Hospitals Commission recommended the development of specialist hospital services in the community delivering new and innovative services closer to the point of need.
Older people’s services in particular are challenged to meet existing and predicted demand. Recent headlines have highlighted inadequate alternatives to admission for older people. Yet older people should receive high quality, safe and effective care best suited to their needs that includes Comprehensive Geriatric Assessment. Services need to be designed from a patient centred perspective, but they must also be high-quality, safe and affordable.
Evidence from meta-analysis of admission avoidance hospital at home suggests that there may be a benefit to treatment in the patient’s own home as an alternative to acute admission for some patients. Some elements of Hospital at home are plausibly suited to older people where displacement can lead to disorientation or delirium and increase the risk of institutional care. Advanced frailty and end of life care can potentially be delivered in the patients preferred place of care. Yet some will question whether care in the patient’s own home can really match hospital based management of acute conditions in truly ill patients.
The evidence base is small and fragile and further research is desperately needed. Services are now springing up around the country in response to rising unscheduled care demands and sometimes in response to political pressures. A key question for the future of acute care of older people may be whether Hospital at Home really could provide a safe and effective add on to existing models of care? Where is the evolving evidence base and is it adequate to justify service development or commission service roll out? Are these services mature enough to tackle unscheduled care in a sustainable fashion? What should the future workforce look like? Are such services too expensive to be viable alternatives to hospital admission?
This year will see the first UK wide Hospital at Home forum, hosted at the BGS Autumn Meeting in Glasgow. This will be a truly multidisciplinary meeting running in parallel with the first day of the autumn meeting on the 23rd November and hosted by the Community SIG. The Hospital at Home forum has been organised with the intention of addressing questions, providing an opportunity to network – seeking to build on the existing evidence base and share best practice. We hope delegates will learn from models of Hospital at Home across the country as well as contribute to our understanding of such services.
Speakers from across the UK will describe the current evidence base and ongoing Hospital at Home trials as well as evolving clinical services. This one day forum is open to allied health practitioners, nursing and medical staff. The day will be split between plenary sessions and workshops. The plenary sessions will seek to describe the evidence and clinical service around the country whilst the workshops will get to grips with service development, workforce planning, cost effectiveness and the role of health and social care integration. View details about BGS Autumn Meeting including booking arrangements and programme for the day.
Register for the BGS Autumn Meeting HERE.