Abstract
Rapidly rising numbers of emergency hospital admissions among older people have been the major source of pressure on the NHS in Scotland in recent decades. Conventional wisdom long held that this was mainly a reflection of an ageing population. This paper shows that factors such as demographic change, changing morbidity and pressure on informal care have played the lesser explanatory role. The bulk of the explanation lies in the how the system has delivered care. Rising emergency hospital admissions primarily are a reflection of a system which has tended to provide fragmented, ‘crisis-management’ care rather than the co-ordinated and preventive care more appropriate to the management of long-term conditions in an ageing population.
Résumé
La croissance continue du nombre d’admissions d’urgence de personnes âgées à l’hôpital constitue la principale source de pression sur les services de soins en Ecosse au cours des dernières décennies. La sagesse traditionnelle a longtemps considéré qu’il s’agissait là des retombées du vieillissement de la population. Cet article montre que des facteurs tels que les changements démographiques, les changements en matière de morbidité, et la pression sur les aides informelles n’ont joué qu’un rôle mineur. L’explication principale réside dans la manière dont le système a distribué les soins. Une hausse des admissions à l’hôpital reflète essentiellement le fonctionnement d’un système qui a fourni des soins fragmentés pour gérer les crises plutôt qu’une stratégie de soins coordonnée et orientée vers la prévention, plus appropriée pour la gestion des maladies au long cours dans une population vieillissante.
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References
Aldridge, S., Halpern, D., & Fitzpatrick, S. (2002). Social capital: A discussion paper. London: Performance and Innovation Unit, Cabinet Office. http://www.number-10.gov.uk/su/social%20capital/socialcapital.pdf.
Aliotta, S. (2001). Case management of ‘at-risk’ older people. In D. Cochrane (Ed.), Managed care and modernisation: A practitioner’s guide. Buckingham: Open University Press.
Ashton, C. M., Souchek, J. Petersen, N. J., Menke, T. J., Collins, T. C., Kizer, K. W., Wright, S. M., & Wray, N. P. (2004). Hospital use and survival among veterans affairs beneficiaries. New England Journal of Medicine, 349, 1637–1646.
Bebbington, A., & Comas-Herrera, A. (2000). Healthy life expectancy: Trends to 1998 and the implications for long-term care costs. Personal Social Services Research Unit Discussion Paper 1695. December 2000. http://www.pssru.ac.uk/list.php?type=unpublished.
Berwick, D. (2002). Commentary: same price, better care. Commentary on Feacham GA, Sekhri KN and White KL (2002) Getting more for their dollar: A comparison of the NHS with California’s Kaiser-Permanente. BMJ, 324, 135–143.
Chief Medical Officer. (2002) Adding life to years: Report of the expert group on healthcare. Edinburgh: The Stationery Office. http://www.scotland.gov.uk/library3/health/alty-00.asp.
Clark, D., McKeon, A., Sutton, M., & Wood, R. (2004). Healthy life expectancy in Scotland. HLE Measurement in Scotland Steering Group. ISD Scotland March 2004. Edinburgh: Information Services Division http://www.isdscotland.org/isd/files/HLE_report_2004.pdf.
Comas-Herrera, A., Pickard, L., Wittenberg, R., Davies, B., & Darton, R. (2003). Future demand for long-term care for older people in England. Personal Social Services Research Unit Discussion Paper 1980. July 2003. http://www.pssru.ac.uk/pdf/dp1980.pdf.
Department of Health. (2005). Supporting people with long term conditions: An NHS and social care model to support local innovation and integration. http://www.dh.gov.uk/assetRoot/04/12/25/74/04122574.pdf.
Donaghy, E., Parker, S., Cunningham-Burley, S., & Walker, D. (1998a). Emergency medical admissions in Scotland: An investigation into factors associated with admissions and attitudes to alternatives: Ayrshire and Arran data. Edinburgh: University of Edinburgh.
Donaghy, E., Parker, S., Cunningham-Burley, S., & Walker, D. (1998b). Emergency medical admissions in Scotland: An investigation into factors associated with admissions and attitudes to alternatives: Highlands data. Edinburgh: University of Edinburgh.
Edwards, N., & Werneke, U. (1994). In the fast lane. Health Service Journal, 8th December: 30–32.
Eversley, D. (1983). The demography of retirement – prospects to the year 2030. In M. Fogerty (Ed.), Retirement policy: The next fifty years. London: Heinemann.
Freedman, V. A., Martin, L. G., & Schoeni, R. F. (2002). Recent trends in disability and functioning among older adults in the United States: A systematic review. Journal of the American Medical Association, 288(24), 3137–3146.
Gordon, D. S., & Donald, S. C. (1991). Informal care and older people in Scotland. Age Concern Scotland: Occasional Paper on Development.
Gould, M. (2004). Trusts in unequal struggle to cut emergency days. Health Service Journal 24th June: 14–15.
Grundy, E. (1995). Demographic influences on the future of family care. In I. Allen, & E. Perkins (Eds.), The future of family care for older people. London: HMSO.
Grundy, E. (1996a). Elderly people in complex and non-private (institutional) households: Changes in England and Wales 1971–1991. In House of Commons Health Committee long-term care: Future provision and funding. Volume II, Minutes of Evidence and Appendices, HC 59-II 81–89.
Grundy, E. (1996b). Population review (5): The population aged 60 and over. Population Trends, 84, 14–20.
Ham, C., York, N., Sutch, S., & Shaw, R. (2003). Hospital bed utilisation in the NHS, Kaiser-Permanente and the US Medicare programme: Analysis of routine data. BMJ, 327, 1257.
Hanlon, P., Walsh, D., Whyte, B. W., Scott, S. N., Hole, D., Lightbody, P., & Gilhooly, M. L. (2000). Influence of biological, behavioural, health service and social risk factors on the trend towards more frequent hospital admissions in an elderly cohort. Health Bulletin, 58(4), 342–253.
Harrison, A. (2001). Making the right connections: The design and management of health care delivery. London: King’s Fund.
Hirst, M. (2001). Trends in informal care in Great Britain during the 1990s. Health and Social Care in the Community, 9(6), 348–357.
Joshi, H. E., & Wright, R. E. (2004). Population replacement and the reproduction of disadvantage. Starting life in Scotland in the new Millennium: The Allendar Series. Glasgow: Fraser of Allendar Institute. http://www.fraser.strath.ac.uk/Allander/Allander%20Papers/Joshi&Wright.pdf.
Kendrick, S. (1986). Women’s economic activity in post-war Scotland: A comparative account. Research Centre for Social Sciences, University of Edinburgh.
Kendrick, S. (1996). The pattern of increase in emergency medical admissions in Scotland. Health Bulletin, 54(2), 169–183.
Kendrick, S. (1997). The development of record linkage in Scotland: The responsive application of␣probability matching. Record Linkage Techniques 1997: Proceedings of an international workshop and exposition. Arlington, VA: Federal Committee on Statistical Methodology, Office of Management and the Budget. http://www.fcsm.gov/working-papers/skendrick.pdf.
Kendrick, S., & Conway, M. (2003). Increasing emergency admissions among older people in Scotland: A whole system account. Whole System Project Working Paper 1. Information Services Division, NHS in Scotland. www.isdscotland.org/wholesystem.
Light, D., & Dixon, M. (2004). Making the NHS more like Kaiser Permanente. British Medical Journal, 328, 763–765.
Mooney, A., Statham, J., & Simon, A. (2002). The pivot generation: Informal care and work after fifty. Joseph Rowntree Foundation and the Policy Press.
Morgan, K., Prothero, D., & Frankel, S. (1999). The rise in emergency admissions – crisis or artefact? Temporal analysis of health service data. British Medical Journal, 319, 158–159.
Murphy, M., & Grundy, E. (2003). Mothers with living children and children with living mothers: The role of fertility and mortality in the period 1911–2050. Population Trends Nr, 112, 36–44.
National Statistics. (2002). Living in Britain 2001. London: Palgrave.
NHS Scotland. (2005). Building a health service fit for the future: A national framework for service change in the NHS in Scotland, vol. 2. A Guide for the NHS. http://www.show.scot.nhs.uk/sehd/nationalframework/Reports.htm.
OPCS/GRO Scotland. (1994). 1991 Census. Economic Activity, Great Britain, vol. 1, Table 1.
Phillipson, C., Bernard, M., Phillips, J., & Ogg, J. (2000). The family and community life of older people: Social networks and social support in three urban areas. London: Routledge.
Pickard, L. (2002). The decline of intensive intergenerational care of older people in Great Britain 1985–1995. Population Trends Nr, 110, 31–41.
Putnam, R. D. (2000). Bowling alone: The collapse and revival of American community. New York: Touchstone.
Scottish Executive. (2005). Delivering for health. Edinburgh: Scottish Executive. http://www.scotland.gov.uk/Publications/2005/11/02102635/26356.
Scottish Executive Health Department. (1999). Fair shares for all: Report of the national review of resource allocation for the NHS in Scotland. Edinburgh: Scottish Executive. http://www.scotland.gov.uk/library2/doc01/fsag-00.htm.
Scottish Executive Health Department. (2000). Clinical outcome indicators 2000. Clinical Outcomes Working Group, Clinical Resource and Audit Group. December 2000. Edinburgh: Scottish Executive. http://www.show.scot.nhs.uk/indicators/.
Shelton, N., & Grundy, E. (2000). Proximity of adult children to their parents in Great Britain. International Journal of Population Geography, 6, 181–195.
Spillman, B. C., & Pezzin, L. E. (2000). Potential and active family caregivers: Changing networks and the “Sandwich Generation”. The Millbank Quarterly, 78, 347–374.
Stearns, S., & Butterworth, B. (2001). Demand for and utilisation of personal care services for the elderly. In D. Machin & D. McShane (Eds.), Providing free personal care for older people: Research commissioned to inform the work of the care development group. Scottish Executive Central Research Unit. Edinburgh: Scottish Executive. www.scotland.gov.uk/cru/kd01/red/pfpc-00.asp.
Summerton, N. (1995). Positive and negative factors in defensive medicine: A questionnaire study of general practitioners. British Medical Journal, 310, 27–29.
Summerton, N. (2000). Trends in negative defensive medicine within general practice. British Journal of General Practice, 50, 565–566.
Wanless, D. (2002). Securing our future health: Taking a long-term view. Final Report. HM Treasury April 2002. London: HM Treasury. http://www.hm-treasury.gov.uk/wanless.
Wood, R., & Bain, M. (2001). The health and well-being of older people in Scotland: Insights from national data. Edinburgh: Information and Statistics Division: NHSScotland.
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Kendrik, S., & Conway, M. (2006) Demographic and social change: implication for use of acute care services by older people in Scotland. European Journal of Population, 22(2), 153–176
Kendrick, S., & Conway, M. (2006) Changement démographiques et sociaux: implication pour l'utilisation des soins de santé en urgence par les personnes âgées en Ecosse. Revue Européenne De Démographie 22(2), 153–176
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Kendrick, S., Conway, M. Demographic and social change: implication for use of acute care services by older people in Scotland. Eur J Population 22, 281–307 (2006). https://doi.org/10.1007/s10680-006-9002-9
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DOI: https://doi.org/10.1007/s10680-006-9002-9