Doctors' Warning: Misperception Over Hospital Admissions May Harm Health Policy

25 April 2012

The Royal College of Physicians of Edinburgh (RCPE) has today written to all MSPs regarding a damaging misperception which it believes is emerging in Scotland about the number of patients unnecessarily admitted to hospital.

The RCPE is concerned that political misunderstanding is emerging regarding the number of patients currently admitted to and treated in hospital “unnecessarily”. It is concerned that this could result in premature shifts in policy, as evidenced by the ongoing reduction in beds in acute units in Scottish hospitals, and potentially dangerous planning to transfer resources away from the hospital sector with no comparable services available elsewhere for patients to be treated.

In particular, the RCPE has challenged false assumptions, inconsistent data and the lack of evidence behind two unproven principles which it believes have become generally accepted – that care of patients outwith hospital settings will be at least as safe and effective as hospital care and that it will provide better value of money.

In its briefing, ‘Inappropriate admissions to hospital: myth versus reality”, the RCPE highlights a range of evidence from independent, highly respected organisations including –

• A Health Foundation review (2011) which concluded that “the research literature did not reveal any examples where establishing community-based services had led to a reduction in, or decommissioning of, the corresponding acute inpatient service” and “the evidence is still not sufficient for us to be certain that shifting care into the community will always reduce costs”;
• A King’s Fund review (2010) which concluded that many admissions labelled as “avoidable” are necessary as the only place that the services which are clinically required are available is in the hospital sector and are required to obtain a diagnosis, rule out more serious diagnostic alternatives or to treat a condition in the optimal way. The review also concluded that “most evidence on intermediate care shows no reduction in admissions”; and
• An Audit Scotland Review of Community Health Partnerships (CHP) (2011) which concluded that “despite initiatives aimed at supporting older people to stay at home longer, emergency admissions for older people increased in three-quarters of CHP areas between 2004/05 and 2009/10. Over the same period, there was also an increase in the number of older people admitted to hospital as an emergency on more than one occasion in-year in Scotland.”

Dr Neil Dewhurst, President of the Royal College of Physicians of Edinburgh (RCPE), said,

“The RCPE supports shifting care closer to home, but never at the expense of safety or quality. While we support the aspiration to reduce what may be perceived as the unnecessary hospitalisation of, in particular, older people, there is limited evidence regarding the effectiveness and safety of other alternatives at this time.

“Patient safety must not be compromised and large-scale widespread pilots are needed to examine the potential of any strategies to move acute services into the community prior to wider implementation. There must be clear established evidence that care of patients outwith hospitals will be as safe and effective as hospital care, as well as better value for money.”