“These shocking figures expose the growing crisis in older people’s care on David Cameron’s watch.”
Andy Burnham, shadow health secretary, 30 January 2014
Figures released by Labour this week seem to suggest the very oldest are being rushed to hospital by ambulance in massively increased numbers, supposedly because of government cuts to adult social care.
It’s a neat idea, but health experts tend to find that these things are more complicated than they first appear – and this story is no exception.
Labour use figures from the Health and Social Care Information Centre (HSCIC) to say that 165,910 people over 90 were taken to A&E by ambulance in 2009/10. In 2012/13 the number was 300,370. That’s an apparent increase of 81 per cent, and obviously cause for concern.
But Ian Blunt, a senior research analyst at the Nuffield Trust, has written a blog today pointing out big holes in the evidence.
He says most of the rise in numbers is down to changes in the way the data is reported. The figures used to cover people aged over 90, but now include people aged 90 AND over.
Comparing like with like – looking at people aged over 90 in both years – reduces the rise to just 43 per cent.
There’s more: “The recording of person-level activity in A&E suffers from being a relatively new data set – the earlier years of this dataset (like 2009/10) did not record all of the A&E attendances that actually happened.
“That means whenever we compare raw numbers in 2012 to those from 2009 we are likely to see a large increase.”
Mr Blunt suggests we stick to comparing years where the data is more complete. Between 2011/12 and 2012/13 the number of over-90s being taken to hospital by ambulance went up by 11 per cent (compared to 3 per cent for other ages).
But then the population is ageing. We have more over-90s. Adjust for this and the actual increase is 5 per cent.
The HSCIC has now issued a clarification on the figures Labour used, although it doesn’t go into as much detail as the Nuffield Trust research.
The information centre says: “We have become aware that a reported rise in the number of patients age 90 and above arriving at A&E by ambulance between 2009/10 and 2012/13 is based on a baseline figure which is being revised due to unclear labelling.
“For clarity, when looking at A&E attendances (excluding planned attendances) in 2009/10 HES recorded 202,537 attendances with an arrival method by ambulance of patients aged 90 and over at A&E departments in England.
“In 2012/13 the HES figure for attendances of the same was 300,039. This represents a rise of 48.1 per cent.”
It agrees that the incompleteness of the dataset means “changes over time may be partly attributable to improvements in data coverage”.
Health analysts aren’t suggesting we stop worrying about the elderly or scrutinising how the NHS cares for them.
The Nuffield Trust/Health Foundation QualityWatch research programme has found that older people are disproportionately likely to fall victim to certain health problems that are preventable – and rates of hospital readmission for certain conditions have risen.
And there is evidence from many sources that pressure on accident and emergency care has been rising in recent years. But unlike politicians, experts say the causes of this are difficult to explain and there is no readymade solution.
Ian Blunt concludes: “Is there a growing problem in care for older people? Possibly – we certainly need to keep watching.
“And the various arguments put forward as to the cause are all worth investigating.
“However, when presented with data which seem to tell one story, it’s usually wise for all sides of the debate to dig deeper into that data before drawing firm conclusions.”