Real terms growth in older people’s needs

Following the intense interest in the Comprehensive Spending Review, we can be forgiven for thinking that the only figures that matter are the ones with pound signs in front of them. However, the Hospital Episode Statistics (HES) released last week come as a timely reminder of how important the NHS is for many older people.

The headline figures showed that average hospital stays for people over 75 years have grown by 66% since 1999. For people between 60 and 74 years, this number has grown by 48%. By comparison, people between 15 and 59 years saw growth in hospital says of 28% in the same period.

Further detail reveals how much longer older people need to stay in hospital compared with other groups. Observing average length of stay, we can see that people over 75 years are in hospital for almost three times as long as people between 15 and 59. However, people over 75 years have also seen the biggest drop in average length of stay since 1999, a decrease of almost four and a half days.

So apart from reflecting the growing numbers of our older population, what do these figures tell us? The growth in NHS funding since 1999 could explain the extra numbers of people being treated – we are spending around three times as much today then we were in 1999. People are also living longer and therefore could return to hospital on more occasions later on in their lives.

What of the decrease in the days spent in hospital? Reducing bed days has been a significant focus of the NHS for the past ten years and this clearly shows it has paid off. Certainly, getting people home, in appropriate circumstances and with the right level of support, should always be a priority. Advances in medical practice and the opportunity to treat more people as day cases have also paid dividends.

However, the numbers presented in the statistics relate to episodes of care, not individuals. We also know that emergency readmissions have gone up significantly since 1999. It could be that as the number of bed days go down, people have become more likely to return to hospital, thus generating a new episode of care. The Nuffield Trust recently made an assessment of rises in emergency admissions and highlighted the need for better care outside of hospital and prevention services. Whatever the figures show, it is important to remember that achieving more episodes of care is only one part of the picture.

The figures need further analysis to draw any firm conclusions, though it is immediately welcome that more older people are receiving care (though obviously less welcome that they need it in the first place). As we concentrate on the figures in the CSR going down, we must not forget those critical figures that continue to go up.

Author: Tom Gentry

Policy adviser - health services @tomogentry

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