Analysis: Elderly prioritised in spend of £250m A&E fund

Ten of the 23 trusts which responded to HSJ’s query about their use of the fund specifically mentioned allocated funding to care of the elderly whilst nearly a third of them plan to provide extra community beds to speed up discharges.

There is also increased investment in primary care to treat patients in the community. Eight trusts have increased out of hours GP care and several have installed GPs in accident and emergency departments.

The DH has given the funding to clinical commissioning groups which pass the money on to trusts to spend in accordance to their urgent care plans.

Five of the 23 trusts are yet to receive their allocation, despite the DH awarding the money in September to help trusts put measures in place at an earlier stage than in previous winters.

Ealing Hospital Trust has not yet received its £2.9m share and it is not expecting it to arrive until the new year. It plans to increase the number of psychiatric nurses supporting the A&E.

Oxford University Hospitals Trust is investing in geriatricians in its emergency department. Kettering General Hospital Foundation Trust has already been piloting a “frail in-reach” service and will use part of its money to make this a permanent service. The service gives clinicians a target of discharging five patients a day who have complex needs.

North Bristol Trust is using its share to fund two consultant geriatric posts.

Southern Derbyshire CCG will encourage GPs to respond to community calls in mornings to even out flow of patients to A&E throughout the day.

Several trusts are also using the funding opportunity to try new measures outside of hospitals to keep patients away from A&E.

Medway and Swale CCGs are using the cash to extend an existing psychiatric liaison service to offering 24-hour care.

There is also an increased focus on bringing GPs into A&Es to deal with lower acuity patients and to speed up discharge. Northern Lincolnshire and Goole Foundation Trust, Kettering General Hospital Foundation Trust and Derby Hospitals Foundation Trust are all bringing GPs into their A&Es.

In a discussion at last week’s Hospital Directions conference several chief executives argued increasing numbers of elderly patients with complex conditions was their biggest problem, not winter.

East Kent Hospitals University Foundation Trust chief executive Stuart Bain said his staff were “not well trained for mental health”, when 30 per cent of patients were confused or had dementia.  “We need to train our GPs to care for the elderly, rather than A&E departments,” he added.