ACSCs: CCGs need to think MS

December 8th 2015 ...in category Commissioning Excellence

With emergency admissions for people with MS totalling a staggering £43 million in 2013-14, the burden this places on services is a problem CCGs simply cannot ignore. Amongst the reasons for admission, two are Ambulatory Care Sensitive Conditions (ACSC).

Last week I wrote about the huge scale of hospitalisation among people with MS and the burden this places on services, as revealed in our new report published in November.

With emergency admissions for people with MS totalling a staggering £43 million in 2013-14, this is a problem CCGs simply cannot ignore and interestingly a couple of the reasons people with MS are admitted are acute Ambulatory Care Sensitive Conditions (ACSC) so all the more reason for CCGs to meet targets and focus on this area.

We looked at the reasons that are sending these patients to hospital and an intriguing picture emerged. The data showed that the most common reasons for emergency admission were preventable ones - the top ones were infections (urinary tract and respiratory), constipation, and MS itself (including MS relapse).

If CCGs have the right proactive care in place, these ACSCs could be dealt with before they reach a crisis, reducing unnecessary admissions, patient distress, and improving patient care.

Emergency admissions costs in 2013/14 in relation to respiratory issues totalled in excess of £5.5 million for people with MS, and bladder and bowel issues came to £11 million. So this finding offers a very real and exciting opportunity as the NHS outcomes framework includes two indicators for emergency admissions: unplanned hospitalisation for chronic ACSCs (NHSOF2.3.1) and emergency admissions for acute conditions that should not usually require hospital admission (NHSOF3a). In light of this CCGs should think MS.

If CCGs have the right proactive care in place, these ACSCs could be dealt with before they reach a crisis, reducing unnecessary admissions, patient distress, and improving patient care. Savings can be reinvested into the type of anticipatory services that keep people with MS as well as they can be and, crucially, out of hospital.

Urinary tract infections (UTIs) are of particular interest because they were the single biggest reason for people with MS being admitted as an emergency and the top cause of the acute ACSCs responsible for 75% of admissions (2012/13) yet are highly amenable to prevention. We found that UTIs accounted for 14% of all emergency admissions of people with MS in 2013/14, costing £2,556 per admission and totalling £8.8 million altogether across England.

Comparing that with the rate of admission among the general population, which is under 3%, UTI emergencies in people with MS are worryingly high. This is especially concerning since infections are known to often aggravate MS symptoms and could exacerbate MS relapse. UTI alone therefore represents a fantastic opportunity to drastically improve patient wellbeing and make huge savings on non-elective care spend.

By having the right services in place, UTIs should be treatable in primary care if caught early enough. We know that often this isn’t happening (because so patients are being admitted) and part of the reason for this could be that the symptoms of a UTI can be very similar to the symptoms of MS. This similarity could lead both patients and clinicians to believe that the symptoms are due to MS, not a UTI, leading to a delay in diagnosis.

To tackle this problem improved education of both people with MS and their GPs is needed. But so too, and I strongly feel this is vital, is making MS specialist nurses and continence advisors accessible. These clinicians are well placed to advise people with MS on measures they can take to reduce their risk, and because of the essential support, information and care they provide, are critical if CCGs are looking to create the kind of anticipatory ‘good services’ that prevent unnecessary admissions.

Coming up I will look at what good services look like for people with MS and explore the vital role of MS specialist nurses.

Read the full report on MS here.

About the Author


Sue Thomas

Sue Thomas

Chief Executive for Commissioning Excellence

sue.thomas@nhis.com
View more posts by Sue Thomas

December 8th 2015
...in category Commissioning Excellence

Commissioning Excellence

As one of NHS England’s recognised niche specialist commissioning support providers, we offer a full range services to assist you in improving patient outcomes. Our experience covers all long term conditions, with a particular specialism in the field of neurology.

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