Avoiding hospital, staying well
Many of these issues often combine to leave people in need of avoidable hospital care. The numbers of people admitted to hospital in an emergency for a health problem that could have been managed in the community has steadily risen over the last ten years, peaking in 2016/17. Older people are the group most likely to experience these admissions, coming in for things such as urinary tract infections, unmanaged chronic obstructive pulmonary disease and pneumonia.
Effective primary care and support to manage health conditions can keep such problems at bay, avoiding a stay in hospital that puts people at risk of deconditioning, healthcare-acquired infections and delirium. Despite this, spending in primary care is dwarfed by spending in hospitals and has experienced much slower growth.
Between 2013/14 and 2018/19, spending on Foundations Trusts alone, representing one portion of the secondary care sector, grew from £37 to £46 billion. In contrast, primary care, estimated to account for 90% of public interactions with the NHS, went from £8.2 to £8.5 billion (all in 2018/19 prices). The NHS Long Term Plan (2019) committed to address some of this imbalance, but there is significant work to be done in making sure care shifts much closer to people’s homes.