Analysis

Norfolk trust set to open UK's first emergency department dedicated to older patients

The emergency department for patients over 80 is expected to be up and running at the end of November and will treat an estimated 18,000 people a year

The emergency department for patients over 80 is expected to be up and running at the end of November and will treat an estimated 18,000 people a year

  • Norfolk's population has a much older age profile than England as a whole, with almost one quarter of its residents over 65
  • Attendees at the current ED will be sent to the new department if interventions such as stroke care are not required

‘We recognised that the earlier we can assess our patients, the sooner we can get them back to full health, regaining their independence and avoiding hospital admission,’ says Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH) divisional nursing director for medicine, Kate Keeling.


Picture: Alamy

Patients over 80 presenting at Norfolk and Norwich University Hospitals usual ED will be assessed to ensure they do not need a specialist intervention, such as stroke care, surgery or resuscitation, before being sent to the new department created especially for their needs.

18%

rise in emergency admissions of older people between 2010-11 and 2014-15 in England

(Source: National Audit Office)

‘There are a number of key objectives in the revised model,’ says Ms Keeling. These include reductions in admissions and length of stay, plus earlier access to a geriatrician. This will ensure all patients receive a comprehensive geriatric assessment (CGA) as quickly as possible, she believes.   

Known as the gold standard of care, CGAs identify an older person’s risk of frailty, looking at their physical and mental health; level of function in daily activities; social support networks; living environment; and any individual concerns. Those who have a CGA in hospital are more likely to go home, says the British Geriatrics Society.

Reacting to the ageing population

The trust’s initiative is also a response to the county’s ageing population. ‘Norfolk has one of the largest older populations in England, which continues to grow at a fast rate,’ says Ms Keeling. Based on figures collated by the Office for National Statistics, Norfolk County Council says its population has a much older age profile than England as a whole, with almost one quarter of its residents over 65, compared to 17.9% in the rest of England.

While Norfolk and Norwich University Hospitals NHS Foundation Trust was rated as ‘requiring improvement’ in the Care Quality Commission’s August report, its urgent care and emergency services were rated as good overall. Currently the hospital’s ED sees an average of 50 patients of 80 or over every day.

The trust expects to treat an estimated 18,000 patients each year in the older people’s ED, which will be staffed by a multidisciplinary team, including emergency and older people’s nurses, and emergency and geriatric consultants.

25%

of all ED attendances made up of people age 65 and above

(Source: Age UK)

So far, the reaction from staff has been positive, says Ms Keeling, with the new department presenting some exciting opportunities.

Our start point will be completely different from our ambition, but we will have a big push on training and recruitment, as the shape of the workforce model develops,’ she says. ‘We are also looking to develop or recruit new roles, such as older people’s medicine nurses with a special interest in emergency medicine, or vice versa.’  

Age UK head of health influencing Lesley Carter welcomes the concept. ‘This could be positive news,’ says Ms Carter.

‘Hopefully it prevents older people being admitted to hospital unnecessarily, and waiting so long for treatment. We know that for every hour someone of this age group is in hospital, they deteriorate, especially if they have dementia, when their functioning can decline quickly. Being in a quieter and less busy area will also help this group of patients feel less confused.’

80-plus

age group most likely to attend EDs

(Source: House of Commons Library briefing paper)

Specialist team an advantage

A specialist team that understands older people’s specific needs will be another advantage, she believes. ‘Those who are treating them will have an interest and some experience,’ says Ms Carter. ‘They will understand all those things that can be different in older people, including the co-morbidities.’

'To spend NHS resources to fast track older people is a good use of money’

Lesley Carter, Age UK

Among the benchmarks will be how quickly patients pass through the new department, whether to another ward or service, or back home. ‘What we don’t want to see is, in effect, a skeleton service, where people are waiting as long to be seen, but just in a different place,’ says Ms Carter. ‘We need to be careful that they’re getting the best and fastest treatment, and it’s not just paying lip service. We would say that to spend NHS resources to fast track older people is a good use of money.’  

She would also like to see the new department adopt the principles of John’s Campaign in the way it treats older patients who have dementia, and their loved ones. Set up in 2014, John’s Campaign promotes the rights of family carers to stay with those who have dementia when they are receiving treatment in healthcare settings. More than 1,000 organisations have pledged their support, including acute hospitals, mental health providers and community organisations. 

‘If they support John’s Campaign here, it would show that they are really looking at what makes a difference to the patient experience,’ says Ms Carter.   

An ageing population and emergency care

According to the Office for National Statistics, in 2016, 2.4% of the population was age 85 and above. But numbers are expected to more than double in the next 23 years – reaching more than 3.4 million by 2040, compared to the current figure of 1.6 million.

‘The numbers of older people attending EDs have increased significantly in the past five years alone,’ says Age UK’s 2017 Briefing on the health and care of older people in England. In 2009-2010, there were 39,110 attendances per 100,000 among those age 70 or above, but by 2014-2015 this had increased to 47,920 – equivalent to a 22.5% rise.

‘It is clear that rapid increases in ED attendance among older people is a significant contributing factor to growing pressure on emergency departments,’ says the report. 

While the overall majority of emergency attendances are among those under the age of 65, older people are more likely to have complex needs that take time to manage, says the report.

‘By the time we reach our early eighties, only one in seven of us will be free of any diagnosed long-term health conditions and, once we reach the age of 85, 80% of us will be living with at least two,’ says Age UK. 


Lynne Pearce is a freelance health writer

 

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