A report jointly published in November 2015 by NHiS Commissioning Excellence and the Multiple Sclerosis Trust (Thomas et al. 2015) highlights for the first time the burden that unplanned hospital care for people with multiple sclerosis (MS) places on the NHS. It vital that we explore how services for people with MS can be improved, because anecdotally we know that people with MS may not be receiving the services they need, and this is now backed up by the report’s analysis of Hospital Episode Statistics. Current failures to adequately support patients leads to unnecessary emergency hospital admissions, which could be prevented if a more proactive approach to MS management were adopted.
Approximately 90,000 people in England live with MS, and the period between 2009 and 2014 saw a steady increase in admissions to hospital. Whilst a large proportion of the elective admissions in MS will be due to the administration of disease modifying drugs (DMDs), the non-elective admissions are mainly a result of a problem arising.
In the year 2013/14 there were 23,554 emergency admissions for people with MS which cost the NHS £43 million. Despite emergency care being the minority of the total admissions into hospital, these admissions consume a disproportionately large amount of the overall admissions costs. In 2013/14 only 27% of admissions for people with MS were non-elective, but these accounted for 46% of hospital care costs.
Of the 23,554 emergency admissions recorded these relate to only 14,960 unique individuals (17% of all the people with MS in England) and demonstrate that many of these emergency admissions were re-admissions. This means 37% (8,695) people are hitting the ‘revolving door’ of A&E.
Reasons for admission
Why were people with MS being admitted to hospital? Headline results from the report reveal that the most common reasons for emergency admissions were preventable problems like urinary tract and respiratory infections, constipation and MS itself (including MS relapse). Bladder and bowel problems alone cost the NHS £11million among MS patients in 2013/14, whilst respiratory infections totalled in excess of £5.5 million.
Supporting MS service development
It is information like this that supports the Neurology Academy to define what areas clinicians undertaking the MS MasterClass training should focus on for their inter-module projects.
An integral part of the MasterClass programme, which has been honed over the last 14 years, is the inter-module project. Neurologists utilise the skills and knowledge they have gained during the taught sessions by undertaking a project or in some cases a service audit within their own trust to examine local service performance. By doing this they establish how services are functioning and work on more proactive care management strategies for patients. Ultimately this leads to better services for patients, and by addressing the problems identified often reduces overall service costs.
Data intelligence from the report highlights potential areas for delegates to investigate, such as urinary tract infections (UTIs), which accounted for 14% of all emergency admissions of people with MS in England in 2013/14 and on average cost £2,556 per admission. Rates of UTIs in MS are worryingly high compared to the rate of emergency admissions for a UTI amongst the general population, which is under 3%. Infections are also known to aggravate the symptoms of MS and could potentially exacerbate an MS relapse so should be a real focus for action.
By MS MasterClass delegates turning their attention to UTI, and issues like it, which seriously affect the wellbeing of MS patients, the inter-module project will in many cases become the catalyst for implementing new strategies that support local service improvement. Our hope is that real change for people with MS will stem from the Academy’s innovative training programme. www.msacademy.co
Download a copy of the report “Measuring the burden of hospitalisation in multiple sclerosis: A cross-sectional analysis of the English Hospital Episode Statistics database 2009-2014” at: http://www.nhis.com/commissioning-excellence/ms-report