Emergency care for older patients under the microscope in new review

Richard Pengelly, the permanent secretary at the Department of Health
Richard Pengelly, the permanent secretary at the Department of Health

A review has been announced into the Province’s urgent and emergency health system, looking particularly at how it deals with older people.

The Department of Health unveiled the move on Monday afternoon, saying it was spurred on by “unacceptable” waiting lists, and by the increased pressure the growing elderly population is putting on Northern Ireland’s hospitals.

It follows a report by retired doctor Dr David Stewart (called a population health needs assessment), which painted a detailed picture of the extent to which people at the older end of the age spectrum use A&E services.

The department has not said when it expects the review to end, who specifically will lead it, or what specific solutions it is looking at – though among the things it will consider is “the most appropriate arrangements for the assessment and admission” of older people.

Dr Stewart has pointed out for example that in England, an emergency department specifically for older people recently opened.

The department’s permanent secretary Richard Pengelly said: “The current model for urgent and emergency care in Northern Ireland is unlikely to keep up with the changing needs of our population in the years ahead.”

He added: “Patients are experiencing unacceptable waits and staff are being increasingly stretched. We need to fundamentally change the way we do things.

“That’s why we have announced this review, which will be clinically led.”

He also said that, in terms of dealing with short-term pressures on the health service, that a series of “detailed winter resilience initiatives have been planned to mitigate pressures in the weeks and months ahead”.

These include ensuring patients can leave hospital quickly when they are clinically fit, and improving ambulance turnaround times at emergency departments.

“We have to be honest and accept that this will be difficult period once again for patients and staff. It is expected to be the same for hospitals right across these islands.

“Once again, we will be heavily indebted to the health and social care staff who will be looking after us all.

“We can also all help the health service to help us. That includes using services appropriately and taking the right steps to keep ourselves well.”

Dr Stewart’s research into the long-term trends within the health system showed that over-85s are overwhelmingly more likely than any other age group to end up in A&E.

The figures for 2016/17 showed over 900 such attendances per 1,000 people in that age group.

By contrast, the same figure for people aged 65-84 was about 500 per 1,000.

He also found there were around 174,500 emergency admissions at hospitals in the Province in 2016/17, and that this is projected to rise to over 187,000 by 2025/26 (an overall increase of more than 13,000).

However, breaking the figures down shows that older people are set to drive this predicted growth.

Whilst admissions from under 65s are actually expected to fall by about 13,000 over that period, the number of cases of people aged 65+ being admitted to emergency departments is expected to rise from about 78,500 to over 104,000 (a rise of about 25,500).

Last month, it was announced by the department that five regional day surgery hubs would be created, essentially centralising where some less-urgent surgeries are performed, taking them away from busier hospitals.