Older People in acute settings Benchmarking report April 2015

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Contents Section 1: Foreword Section 1: Executive summary Section 2: Background and process Section 3: Benchmarking comparisons - Overview - Older people in A&E - Assessment units - Inpatient care - Discharge process - Quality & outcomes Section 4: Overall workforce benchmarking Section 5: Conclusion and next steps

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Section 1: Foreword

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Foreword Professor John Gladman, British Geriatrics Society representative to the Older People project There is much to be proud of about the care of older people in the UK. I reflect that, as a doctor who qualified in 1983, there were parts of the country at that time where older people were denied access to district general hospitals, or could do so only through a separate “on-take” system. Some were good, some were not. Specialist care for older people was often in sub-acute sites, some of which provided exceptional rehabilitation and palliation but not acute care. Over the decades, the notion of the “integrated take” became the default model for hospital admission for acutely unwell patients, whereby all such patients regardless of age had access to the same system. Over the same time, geriatric wards in acute hospitals were increasingly established, delivering that evidence based jewel - comprehensive geriatric assessment. All this was very welcome. Over these same decades the numbers of patients rose and the number of beds fell. The model that emerged at the “front door” under such pressure was the medical assessment unit, short term (