When you assess the value of a healthcare system you want to get the biggest bang for your buck. In general the UK does reasonably well, but has dropped recently, particularly in relation to efficiency (see Bloomberg Health Efficiency Index). When you are managing chronic diseases an important metric is keeping people out of hospital. Unplanned, or avoidable, hospital admissions cost the NHS money and are a crude index of how well, or not so well, we are managing MS in the community. Sadly we have seen a rise in avoidable hospital admissions for pwMS, which indicates that there has been a fall in standards in how we are managing pwMS in the community. Almost all unplanned admissions are avoidable and are linked to MS related problems. In our last survey the top causes of unplanned admissions were:
1. Urinary tract infections and urinary catheter associated problems
3. Falls and fractures
4. Faecal impaction
5. Aspiration pneumonia
By treating MS early and effectively all of the above are preventable. In other words preventing pwMS becoming disabled should reduce these admissions. Despite this being obvious the UK still has one of the lowest penetration of DMTs, and particularly second-line more effective DMTs, in the developed world. So despite having the tools at our disposal a large number of pwMS have no access to DMTs.
The report below from the MS Trust using hospital admission records of people in England over the past two years found that there were a staggering 26,679 emergency hospital admissions for people with MS in 2015/16, compared to 23,665 in 2013/14; an increase of 13%. They estimated that these admissions cost the NHS ~£46 million. Please note that 1 in 5 of all people living with MS in England were admitted to hospital as an emergency in 2015/16. If you ask me this is shameful. We are clearly not giving pwMS the necessary care they need to prevent complications and when they get complications we are not treating them properly.
Who is responsible for this crisis and what can we do to improve it?
Do you think it is a resource issue and that austerity Britain with its budget cuts is responsible? Or is it the fault of the HCPs; are we not doing our jobs properly? Are pwMS responsible; should they learn to self-manage their disease more effectively? Clearly this problem needs to be addressed and in my opinion is a crisis already.
I am involved with a small initiative to try and get several key centres in England to engage with reducing UTIs, and bladder-related hospital admissions, in pwMS. The idea is to start with one well defined, albeit a complicated, problem to learn the ropes of implementing systems change that could then be expanded to address the bigger issue. I will keep you posted as things develop.
Sue Thomas, Geraldine Mynors, Siobhan Simpson, Nathan Meade, Amy Bowen. Measuring the burden of hospitalisationin multiple sclerosis: A cross-sectionalanalysis of the English Hospital EpisodeStatistics database 2009-2014. MS Trust 2017.
This report has been jointly written by NHiS Commissioning Excellence and the Multiple
Sclerosis Trust to highlight how better, more cost-effective services can be delivered for
people with MS.
Care for people with MS, especially unplanned care, is currently a huge burden to the NHS.
In 2013/14 non-elective hospital admissions for people with MS in England cost the NHS
The most common reasons for these admissions are infections, urinary tract and
respiratory, pneumonia and MS itself (including MS relapse). With more focus on
anticipatory care, many of these costly admissions could be prevented and the quality of life
for people with MS vastly improved. Furthermore the money saved could be invested in the
provision of more proactive care.
An important factor is identifying at-risk patients and addressing the issues before the
onset of a crisis. MS nurse specialists are ideally placed to identify this group of patients
and provide proactive care, also involving GPs, neurologists, allied health professionals and
Better data is key if commissioners are to make these much needed improvements and
plan better services for people with MS. A better understanding of the prevalence of MS
both nationally and locally at CCG level, as well as improving the admissions data that
CCGs are using and more accurate and consistent coding are essential and present
opportunities to reduce cost simply through strategies that target the reduction of
As for people with MS themselves, well planned services that provide intervention through
sufficient provision of skilled clinicians are vital to their wellbeing. High quality, proactive
care is needed to prevent many of the secondary complications of MS and to ensure that
people with MS stay as well as they possibly can.