Acute Services - Data
What you told us
Read the Consultation and Engagement report for the Strategic Plan 2022-25 - for Acute Services (PDF)
What the data tells us
Unscheduled hospital admissions are not planned, usually arising as a result of an emergency. This data includes unscheduled admissions for Midlothian residents to any hospital in Lothian. £18m of the £131m IJB budget is 'set aside' for the provision of unscheduled care. The Royal Infirmary of Edinburgh is considered Midlothian's District General Hospital and is therefore where the vast majority of unscheduled care is provided.
On average 8,500 people are admitted every year as unplanned admissions. This accounted for 10-11% of all unplanned admissions in Lothian between 2012/13 and 2016/17.
The number of nights people spend in hospital is reducing.
Admission rates are higher among patients who live in areas of higher deprivation.
The cost of unplanned admissions to hospitals is very high; nationally it accounts for a third of the total budget on health and social care for older people and this is consistent with Midlothian’s spend.
The local Rapid Response Service has responded to 1,397 emergency falls call outs (2017/18) and the Hospital at Home service has had 2,751 occupied ‘virtual ward’ bed days supporting people in the community, both reducing length of stay and preventing hospital admissions. Other areas of targeted community intervention include COPD, frailty (8,500 people of which half are under 75) and alcohol related admissions.
A&E
On average there were 20,640 attendances per year to A&E from Midlothian to Lothian hospitals. This accounted for 11 -11.5% of all A&E attendance across NHS Lothian (2012 – 2017)
A&E attendance rates have been increasing over a number of years and continue to do so. Overall crude rate per 100,000 residents A&E attendance by Midlothian residents has remained higher than for NHS Lothian as a whole. There is a consistent trend for higher A&E attendance rates from the east locality of Midlothian in comparison to the west; this is likely to reflect the higher levels of socioeconomic deprivation in the East Locality.
Utilisation of Midlothian Community Hospital
Midlothian Community Hospital opened in 2010. It has 6 inpatient wards with 20 beds per ward with the exception of the 2 mental health wards which have 24 beds each. The hospital provides care for people who are very ill or are in the advanced stages of dementia alongside inpatient assessment and continuing and complex care of older people with acute mental health needs. In 2016 it was remodelled to incorporate a rehab and assessment ward for older people. This replaced the previous service provided by Liberton hospital, Edinburgh. The hospital also has an X-ray and outpatient department.
Delayed Discharge
A delayed discharge is when a patient is clinically ready to leave hospital but cannot do so. More than 1,000 hospital bed days are lost each month nationally due to delayed discharge. A long delay can increases the risk of the patient falling ill again, lead to the loss of life skills, independence or mobility and could increase the requirement of a care home placement due to deteriorating health and mobility. People who are delayed more than 72 hours have worse outcomes than those who go home sooner. The Scottish Government set a target in 2015 that people shouldn’t be delayed for more than two weeks. We are investing resources to reduce the number of delayed discharges and the number of days patients spend delayed by earlier identification for supported discharge and a new discharge to assess team which is likely to be active in early 2019
The majority of people who go into hospital are discharged on their planned discharge day.
Most people who are delayed are delayed for more than 2 weeks. This is also true for Scotland as a whole.
Only 1 in 5 Midlothian residents who are delayed are discharged within the 3 day commitment.
More people over the age of 75 are admitted to hospital than any other age group. In recognition of this we converted a care home facility for older people into a discharge hub with 31 intermediate care beds (6 with a focus on rehabilitation), 6 respite beds, 3 permanent residents & 1 emergency bed. All of these generally run at full occupancy. A new facility will replace Highbank, with 40 beds and the plans are for it to open in 2020.