Reducing Emergency Admissions: a Person-focused, Preventative Approach to Community Health

There has been a long running ambition to make the health system less hospital-focused and more focused on primary and community care. This looks to a proactive, preventative approach to health, as opposed to a reactive, treatment-based approach, with care delivered closer to people’s homes. The King’s Fund believes this requires an integrated, holistic response, rather than a ‘body part’ or single condition response, with more focus on people and outcomes, than processes and outputs.

This has been embraced at the pioneering Jean Bishop Integrated Care Centre (JBICC). Hull had around 25,000 residents living with frailty, and 3,200 with severe frailty. As a result, the health system was overwhelmed with non-elective hospital admissions. In response, Humber and North Yorkshire ICS developed an anticipatory care model that created an out-of-hospital service to help people to stay at home.

The JBICC was designed to deliver this, bringing together a range of specialist services to provide a holistic approach. Unlike regular community health facilities, where patients receive treatment for a single health issue, at the JBICC patients receive a full physical and mental health check, as well as social support. They may spend an entire day there, but they leave treated and with a care plan. The facilities and non-institutional character of the design reflect this.

A Wolfson Palliative Care Research Centre study showed:

• Those living in their own home saw a 15-20% reduction in emergency department (ED) attends and a 10-25% reduction in emergency admissions for the twelve months after their assessment.

• The frail cohort who had over five ED attends in the twelve months preceding their assessment, saw over 50% reduction in ED attends and admissions.

This presentation will explore how long-term investment in the right community-focused facilities can reduce demand for acute services, creating NHS savings, and improving individual wellbeing.