Saving Money through Prevention of Hospital Admissions and Earlier Discharge

PCTs are under great pressure to reduce costs and one way of doing this is to look at the number of people admitted into hospital, including 'frequent flyers'. Improved management of this group and others for whom admission avoidance is a possibility is not only good practice but could save PCTs and PBCs a great deal of money.

Consultus Live-in Nursing Service (CLINS) believes believe that we can offer our 'live-in' nursing service for a range of conditions that would generate gross savings to a Primary Care Trust or Health Board (PCT/HB) of between £10,000 and £400,000 per annum by:

Working with family doctors, especially those providing Accident & Emergency triage, to identify patients who could be prevented from entering hospital (as per the EverCare Programme). This would save the PCT/HB either the whole cost of the admission or at least convert a full admission into a short term tariff admission.
Working with hospital and community staff to facilitate early discharge from hospital. This would save the PCT/HB either having to pay the excess day rate over the trim point or by reducing the length of stay after medical stabilisation (see the NHS 2007 Payments by Results guidance).
Working with community nurses to provide intensive nursing care to people with long term chronic conditions, e.g. frail older people with complex or multiple needs. This could save the PCT/HB the cost of hospital re-admissions.
Working with the Continuing Care team to avoid respite or palliative care being undertaken in hospital, or hospice where institutional care is inappropriate.

The following table is based on our assessment of an 'average' Primary Care Trust in England. The table looks at a range of conditions that we believe would both financially and clinically benefit from our 'live-in' nursing service. The table sets out the potential gross savings where we are able to provide 2% and 5% of the total suggested range of conditions.

Savings for 'Average' PCT	2% of applicable conditions		5% of applicable conditions
	Episodes	Savings (£K)	Episodes	Savings (£K)
Excess trim days saved	16	11.2	36	25.1
Excess trim days AND short term tariff	57	102.4	121	212.1
Post acute phase - rehabilitation	22	3.1	43	5.5
Continuing care – hospice	2	5.3	5	13.4

We can customise this table to reflect your activity levels (please contact the Registered Manager Kevin May for a form). We can then produce for you an analysis of the gross savings that may be generated by using Consultus.

In addition to 'live-in' Registered Nurses we can (from late autumn 2007) provide well qualified 'live-in' Health Care Assistants. So when a patient's needs change and they no longer need intensive nursing care, we can put in place a carer. We think that this would be of great interest to PCT/HBs and their local authority colleagues when implementing the new national framework for Continuing Care.

We are very happy to talk with trusts, practice based commissioners, local authorities or contracted primary care providers about integrated working and pilot schemes.

"I don't think you could have sent a better nurse than Sam for [Mrs A's] last weeks. Apart from a huge range of nursing skills, her dedication, calm and good nature won us all over immediately. The decision not to [admit Mrs A] to a nursing home was entirely right."
CW, Dorset

"My dear Kate, Dr W. and I have valued your time with us. I know that his recovery is very much down to you!"
SN, Surrey

"Thank you and all the team at Consultus for your rapid response."
PK, Norfolk

"PCTs are under great pressure to reduce costs… one way of doing this is to look at the number of people admitted into hospital time and time again (‘frequent flyers'). Improved management of this group is not only good practice but could save money for the PCT..."

"People with long-term conditions use over 60% of hospital beds and 60% of GP consultations."
Public Health Report, east London PCT

"Extra care and rehabilitation input in the home environment can help people to get home from hospital more quickly and recover from a hospital stay in a safe and familiar place..."

"People should be given a choice and be supported to stay in their own home for as long as possible"
Intermediate Care Strategy, central London PCT