Preventing hospital admissions & unnecessary hospital attendances

One of our priorities must be to make best use of the money that we have. Well over half of all the CCG's money is spent on acute care. I believe that there is a lot we can do to reduce the use of accident and emergency services by patients with minor problems. Much more significantly, I feel that by changing our approach to the care of people in the last year or two of their lives would not only save a lot of money by reducing unnecessary admissions to hospital but also improve the quality of lives of our patients and their carers/loved ones. I would like the CCG to focus a lot more energy and effort into understanding the cultural basis for how clinicians and patients behaving in Lambeth. Once we understand this we will be in a position to change behaviour. I would appreciate other people's views.

It would be useful to know if there is any existing literature on this or whether we should commission a piece of work to this end as a CCG.

If there is to be such a shift towards care within the home as opposed to in hospital then we may need to invest a lot more in support community services. The Integrated care pilot may be an existing service to link into

There are two parts to Johns question, I think, and we the patients would like to work on both of these with you!

Tarek, yes I know of some relevant research, and it would be great if you commission us local people to work with you , rather than just see this as buying in another clinical service.

On end of life care,

I really like the Conversation project, and would very much like to start the dialogue, with PPGs and Healthwatch, about how we can bring discussions about end of life choices , to be kitchen table discussions.I visited the IHI and heard about this:

- annoying, wont let me post link- but it's theconversationproject.org/

I have personal experience of knowing the end of life choices of a dear friend, and chasing the ambulance to St Thomas , after she had a third stroke, but arriving too late and they had already done things and admitted her and put up drips and lots of machinery.
Her written directive was eventually implemented, with assistance from the Chaplain, but would be good to work together to make sure people know they can have peace at the end if they wish.

AND on the cultural issues, yes again there is research, and would be great if the CCG would coproduce some work with local communities to make those communities active in promoting health and avoiding illness and admissions.

1. there is more than enough research work done on this (cultural values), so dont waste your time.
2.people go to A&E because they believe it is the correct thing to do for them.
Education at the initial registration with the healthservice might help.
thoughout most of the rest of the world patients go directly to a specialist or A&E, how could a new arrival know to do otherwise?
3. the NHS culture of targets makes it too easy to admit a patient rather than taking time to address their problems.

I wonder if we are looking at the wrong 'culture'?