‘Prejudiced’ hospital admissions guidance for the elderly dropped by NHSE

NHSE published a reference guide during the Easter weekend on patient management during the coronavirus pandemic.

The section of the guidelines dealing with the conveyancing of patients, stated: ”The following patients should not ordinarily be conveyed to hospital unless authorised by a senior colleague”.

It then stipulated four groups of patients

• ”Any patient who could be cared for in a community setting, e.g. replacement of urinary catheter, minor illness and injury/urgent care need;
• Any patient with dementia whether or not on anticoagulation who following a head injury or fall is functionally unchanged.
• Any patient whose advance wishes state they do not wish to receive intravenous therapy or resuscitation; and
• Any patient aged over 70 who following a first syncopal (fainting or passing out) episode has fully recovered and exhibits normal vital signs.”

In addition the original conveyancing guidelines said care home residents or community hospital patients should not be taken to hospital accident and emergency departments until their case had been discussed with “a clinical adviser”.

HSJ has heard concerns that NHSE’s advice raised the bar for hospital admission for head injuries higher than guidance from the National Institute for Health and Care Excellence.

NICE guidelines tell telephone advice lines and community health services to refer head injury patients to emergency departments if they are currently on anticoagulants, if there was any loss of consciousness or persistent headaches as a result of the injury or if the patient has a history of bleeding or clotting disorders.

The first version of NHSE’s guidance has been withdrawn. A newer version of the reference guide, without much of the previous conveyancing guidelines, was published by NHS England on 14 April. 

One senior NHS leader, who asked not to be named, told HSJ the guidance published over the weekend “[seemed] prejudiced against older people, those with dementia and those in care homes,” risked placing “obstacles between vulnerable older people and ED,” and would put “significant burdens on systems not equipped to provide pre-ED 24/7 expert clinical advice”.

They added: “This raises serious questions about the origins of the guidance, its clinical rationale and the level of scrutiny and consultation it underwent prior to publication.”

An NHSE spokesman said: ”Decisions about the right care must be made between an individual patient and their clinician.

“Decisions about when a patient would benefit from hospitalisation are judgements for clinicians to take in consultation with patients and their families in the usual way.”

NICE declined to comment.

Updated on 15 April 2020 at 6:03pm to include comment from NHS England.